Effetti di una mobilizzazione molto precoce rispetto che precoce sugli outcome funzionali e psicosociali in fase acuta dopo protesi d’anca

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Effects of very early versus early mobilization and walking on functional and psychosocial outcomes in acute phase after hip arthroplasty

Autori

De Leo Davide [Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy]

Temporiti Federico [Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy] [Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy]

Della Gatta Sofia [Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy]

Conti Davide [Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy]

Adamo Paola [Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy] [Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy]

Gatti Roberto [Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy] [Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy]

Background and aims

Early mobilization and walking after total hip arthroplasty (THA) facilitate an early achievement of discharge criteria1, but heterogeneity in terms of administration timing has been reported2. In fact, mobilization and walking may be delivered in the first postoperative hours (very early) or between 12 and 24 hours (early) after surgery. The study aimed to investigate the effects of very early versus early mobilization and walking on functional and psychosocial outcomes in the acute phase after THA.

Methods

In this observational study, 237 patients who underwent THA performed either very early (n=174) or early (n=63) mobilization and walking. Functional mobility (Timed Up and Go – TUG) and pain (Numeric Pain Rating Scale – NPRS) were assessed preoperatively (T0), on the first (T1), and third (T2) postoperative days. Fear of movement (Tampa Scale of Kinesiophobia – TSK) and anxiety (Visual Analogue Scale for anxiety – VAS-A) were also investigated at T0 and T2. Finally, percentage of participants who achieved independent walking with crutches at T1, length of stay (LOS), rate of adverse events, and satisfaction (Visual Analogue Patient Satisfaction Scale – VAPSS) were collected.

Results

TUG worsened after surgery and improved from T1 to T2. Pain levels decreased from T1 to T2, while TSK and VAS-A improved from baseline to T2 without significant differences between groups. Similarly, no between-group differences were found for the percentage of patients achieving independent walking at T1, LOS, adverse events rate, and VAPSS.

Conclusion

Very early mobilization and walking were not superior to early mobilization and walking on functional and psychosocial outcomes after THA. These results suggest that mobilization and walking may be administered either within the first postoperative hours or on the first postoperative day, increasing its applicability and facilitating the distribution of rehabilitative activities in acute phase after THA.

REFERENCES

  1. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop. 2020;91(1):3-19. doi:10.1080/17453674.2019.1683790
  2. Zhang Q, Chen Y, Li Y, et al. Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J. 2024;100(1181):159-173. doi:10.1093/postmj/qgad125

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