THE IMPORTANCE OF PREOPERATIVE PHYSIOTHER APY BEFORE TOTAL HIP-REPLACEMENT IN OSTEOARTHRITIS OF THE HIP-JOINT

Osteoarthritis of the hip joint finally results in contracture, muscul ar atrophy, and immobility, after years of pain and reduced load capac ity. Preoperative physiotherapy ranks highly in respect of preventing contracture and alleviating pain. To verify the significance of preope rative physiotherapy, we measured the isometric and isokinetic power o f the musculature involving the hip, directly before surgery and six m onths postoperatively after individual total cement-free hip replaceme nt. Before doing so, we had studied the previous history of the patien t and the present clinical findings. Patients were subdivided into thr ee groups according to the intensity of preoperative physiotherapy. Fo r ethical reasons, postoperative physiotherapeutic management was equa l in all the three groups. Ail the three groups showed, after six mont hs, a clear increase in power in isometry and isokinetics of flexion, both at the operated hip and to a slight extent also at the non-operat ed hip. it became evident that those patients on whom preoperative phy siotherapy had been practised most intensively, suffered a distinctly slighter loss of power of the hip, compared to the other hip. However, those patients with the greatest loss of power who had been preoperat ively subjected to slight or no physiotherapy, succeeded in drawing al most equal with the other patients in respect of deficient power of th e hip, after a period of six months. Differences in preoperative physi otherapy did not result in any differences in respect of walking dista nce, use of walking aids, or consumption of analgesics. Nevertheless, preoperative physiotherapy did exercise a positive influence on mobili ty and pain management. Hence, intensive physiotherapy succeeded in po stponing total hip replacement by about four years, compared with pati ents who had not or only irregularly undergone physiotherapy, without exercising any negative influence on the mobility of the hip joint.