Preoperative physical therapeutic intervention for high-risk patients who are scheduled for elective total hip arthroplasty

Total hip arthroplasty (THA) as final treatment in end-stage osteoarthritis has
become more and more accepted and used over the last two decades. Though most
patients recover significantly after a THA, others experience fewer benefits.
Often, the persons that benefit the most from THA are in general preoperative
in a better functional status than those who benefit less. Numerous
preoperative factors, such as negative expectations, functional status and pain
can negatively affect the outcome of a THA.
It seems rational, that improving the preoperative functional status would also
improve the outcome of the THA. The underlying notion is: *the better patients
enter the hospital, the better they will leave*. Therefore, we hypothesize that
therapeutic training of the aerobic capacity, muscle strength and functional
capacity will lead to a faster hospital admission after the total hip
arthroplasty. To gain more insight on the effects of a therapeutic intervention
on the postoperative recovery in frail elderly patients who were scheduled for
elective THA, a full randomized controlled trial (RCT) has to be performed. But
before embarking on a proper RCT, we will first perform a pilot study to test
the feasibility of the approach and to help clarify decisions about operational
issues and procedures.

Primary Objective:
The primary objective is to investigate the feasibility of a short-term
preoperative physical therapeutic intervention for frail elderly patients, who
have a higher risk on postoperative complications or a delayed recovery, after
elective total hip arthroplasty.

Secondary Objective(s):
The secondary objectives are to investigate the effect of short-term
high-intensity physical training program for frail elderly patients who are
scheduled for elective total hip arthroplasty on (i) the preoperative aerobic
and functional capacity and muscle strength and (ii) on the postoperative
health status and the functional recovery.

Single blind randomized controlled pilot trial.

The intervention group receives a preoperative patient-tailored therapeutic
physical exercise program for 3-6 weeks, 2-3 times a week. The patients recieve
a home-based exerciseprogram for minimal 30 minutes on non-trainingdays. The
training is directed at improving the aerobic capacity, the muscle strength of
the lower limb muscles and the functional capacity.

Time investment for the patients
- screening at the onset of the study and 2 days before surgery, 90 minutes
each time (intervention and control group)
- training 2-3 times a week during 60 minutes for 3-6 weeks in the outpatient
department of the hospital
- training at home for minimal 30 minutes each day, on the days the patients do
not train at the hospital (intervention group)

Nature of burden
- high intensity physical exertion (intervention group).
- completing a questionnaire (intervention and control group).
- performance of a simple functional test in postoperative period (intervention
and control group).

Risks
Elderly patients can safely tolerate high-intensity resistance training
programs. The risk is comparable with the normal risk associated with physical
exertion.