Influence of physical rehabilitation on functional aspects in individuals submitted to total hip arthroplasty: a systematic review

Budib, Mariana Bogoni; Hashiguchi, Mateus Masayuki; Oliveira-Junior, Silvio Assis de; Martinez, Paula Felippe

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Revista Brasileira de Geriatria e Gerontologia

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Brasil

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Review Articles • Rev. bras. geriatr. gerontol. 23 (2) • 2020 • https://doi.org/10.1590/1981-22562020023.190252 copy

Influence of physical rehabilitation on functional aspects in individuals submitted to total hip arthroplasty: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

by performing a systematic review, the present study aimed to evaluate the influence of physical rehabilitation on functionality, range of motion and musculoskeletal strength in patients submitted to total hip arthroplasty due to osteoarthritis.

Methods:

a systematic search for randomized and non-randomized controlled trials was conducted using the PubMed, Web of Science, PEDro, Cochrane, Clinical Trials and SciELO electronic databases, using the search strategies recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results:

in general, protocols supervised by physiotherapists associated with performing active exercises of the hip periarticular muscles and knee extensors have provided effective functional prognosis. High intensity resistance exercises (dynamic and isometric) are more effective in improving functionality. Dynamic exercises with three to five sets of eight to twelve low and high intensity repetitions promoted more pronounced increases in muscle strength and range of motion than other therapeutic modalities.

Conclusions:

the techniques and protocols used for physical therapy treatment after THA are wide-ranging and their clinical efficacy is demonstrated in literature.

Keywords:
Arthroplasty; Replacement; Hip; Osteoarthritis; Exercise; Aging

Author, year	Design and Subjects	Intervention Group (IG)	Control Group (CG)	Analyzed variables	Results
Gremeaux et al., 2008⁸8 Gremeaux V, Renault J, Pardon L, Deley G, Lepers R, Casillas JM. Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(12):2265-73.	Randomized Clinical Trial n=29	LFEMS Group (Low frequency electric muscle stimulation and Physical Therapy) (n=16)	Physical Therapy Only (n=13)	Maximum isometric muscular strength of knee extensors (isokinetic dynamometer) and functionality (FIM).	The IG showed better knee extensor strength (p<0.05) and functionality (p<0.05) results than the control group.
Liebs et al., 2012¹³13 Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Multicenter Arthroplasty Aftercare Project. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil. 2012;93(2):192-99.	Multicenter Randomized Clinical Trial n=271	THA early group (Early aquatic therapy starting on 6^th postoperative day) (n=129)	THA group (Aquatic therapy after healing) (n=142)	Functionality (WOMAC and Lequesne).	The IG achieved better results for functionality (p=0.01).
Hesse et al., 2003¹⁴14 Hesse S, Werner C, Seibel H, Von Frankenberg S, Kappel EM, Kirker S,et al. Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil 2003;84(12):1767-73.	Randomized Clinical Trial n=79	Treatment group (conventional physical therapy and treadmill training) (n=39)	Conventional physical therapy alone (n=40)	Functionality (HHS) and hip abductor strength (MRC).	The IG had better results for functionality (p<0.0001) and hip abductors strength (p<0.001) than the CG.
Husby et al., 2010⁴¹41 Husby VS, Helgerud J, Bjorgen S, Husby OS, Benum P, Hoff J. Early postoperative maximal strength training improves work efficiency 6–12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years. Am J Phys Med Rehabil. 2010;89(4):304-14.	Randomized Clinical Trial n=24	STG group (Maximal strength training and conventional rehabilitation program) (n=12)	CRG group conventional rehabilitation (n=12)	Knee extensors strength (1RM), hip abductors strength (1RM), and functionality (Merle d’Aubigné and Postel).	STG group showed a significant increase in quadricep (p<0.002) and hip abductor (p<0.002) strength than the CG.
Heiberg et al., 2012¹⁰10 Heiberg KE, Bruun-Olsen V, Ekeland A, Mengshoel AM. Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery. Arthritis Care Res. 2012:64(3):415-23.	Clinical Trial Randomized n=68	Walking skill training group (n=35)	CG(n=33)	Functionality (FIM and HHS), hip flexion, extension, and abduction ROM (Goniometer)	The IG achieved significant improvement in hip extension ROM (p=0.02) and functionality (p=0.001) when compared to the CG.
Jan et al., 2004¹⁷17 Jan M, Hung JY, Lin JC, Wang SF, Liu TK, Tang PF. Effects of a home program on strength, walking speed, and function after total hip replacement. Arch Phys Med Rehabil. 2004;85(12):1943-51.	Clinical Trial n=53	Exercise-high (Conventional exercises at home - group with high adherence) (n=13) Exercise-low (Conventional exercises at home - group with low adherence) (n=13)	CG(n=27)	Hip flexors and extensors strength (isokinetic dynamometer) and functionality (HHS).	The Exercise-high group showed improvement (p<0.05) of hip muscles strength bilaterally and functionality.
Trudelle-Jackson and Smith, 2004¹¹11 Trudelle-Jackson E, Smith SS. Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2004;85(7):1056-62.	Randomized Clinical trial n=34	Experimental group (strength and postural stability exercises). (n=18)	Isometric and active range of motion exercises (n=16)	Functionality (12-Item Hip Questionnaire) and muscular strength of knee extensors and flexors, and hip extensors, flexors and abductors (platform of strength with software BEP).	There was significant improvement in functionality (p<0.01), hip flexors, extensors and abductors muscles strength (p<0.05), and knee extensors for the IG . There were no significant differences for the control group.
Stockton and Mengersen, . 2009⁶6 Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(10):1652-57.	Clinical trial n=57	Treatment Group (twice a day conventional physiotherapy and functional exercises) (n=30)	Once a day of conventional physiotherapy (n=27)	Functionality (Iowa Level of Assistance hip score Oxford).	There was no difference between groups.
Sashika et al.,1996⁹9 Sashika H, Matsuba Y, Watanabe Y. Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. Arch Phys Med Rehabil. 1996;77(3):273-77.	Non-Randomized Clinical Trial n=23	Group A (ROM and isometric exercises) (n=8) Group B (ROM, isometric and eccentric exercises) (n=8)	CG(n=7)	Knee extensors and hip flexors strength (MMT), maximum isometric strength of hip abduction (isokinetic dynamometer) and ROM (JOA hip score).	The maximum isometric hip abduction torque increased in the three groups in the hip submitted to THA (Group A: p<0.01; Group B: p<0.01; and Control: p<0.05). However, there was no difference between the groups.
Giaquinto et al., 2010¹⁶16 Giaquinto S, Ciotola E, Dall’armi V, Margutti F. Hydrotherapy after total hip arthroplasty: a follow-up study. Arch Gerontol Geriatr. 2010;50(1)92-95.	Prospective Interventional Cohort Study n=64	HTG (hydrotherapy group) (n=31)	NHTG (no-hydrotherapy group = conventional exercise) (n=33)	Functionality (WOMAC).	HTG had better result for functionality (p<0.01) than the NHTG group.
Galea et al., 2008¹⁸18 Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, et al. A targeted home-and center-based exercise program for people after total hip replacement: a randomized clinical trial. Arch Phys Med Rehabil. 2008;89(8):1442-47.	Clinical Trial n=23	Unsupervised exercise (n=12) Supervised exercise (n=11)	-	Functionality (WOMAC).	There was no significant difference between the groups.
Tsukagoshi et al., 2014³⁰30 Tsukagoshi R, Tateuchi H, Fukumoto Y, Ibuki S, Akiyama H, So K, et al. Functional performance of female patients more than 6 months after total hip arthroplasty shows greater improvement with weight-bearing exercise than with non-weight-bearing exercise. Randomized controlled trial. Eur J Phys Rehabil Med. 2014;50(6):665-75.	Randomized controlled trial n=65	WB group (Weight-bearing) (n=22) NWB group (Non-weight-bearing) (n=21)	CG(n=22)	Functionality (HHS) and isometric muscular strength of knee extensors, and hip abductors, flexors and extensors (hand dynamometer)	There was significant improvement in functionality (p<0.01) for WB group compared to the CG. There were no significant differences between the WB and NWB groups.
Barker et al., 2013³¹31 Barker KL, Newman MA, Hughes T, Sackley C, Pandit H, Kiran A, et al. Recovery of function following hip resurfacing arthroplasty: a randomized controlled trial comparing an accelerated versus standard physiotherapy rehabilitation programme. Clin Rehabil 2013;27(9):771-84.	Randomized controlled trial n=80	Treatment group (Tailored Protocol) (n=40)	Traditional Protocol (n=40)	ROM of hip flexion, extension and abduction (Goniometer), muscle strength of hip flexors, extensors and abductors (hand dynamometer), and Functionality (UCLA, OHS, HOOS, EuroQol)	There was a significant improvement in functionality (p<0.011) for the treatment group than the CG. There was also a significant improvement in flexion, extension (p<0.0005) and abduction (p<0.004) hip ROM in the IG than the CG.
Rahmann et al., 2009³⁵35 Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(5):745-55.	Randomized controlled trial n=54	Aquatic exercise Physiotherapy Program (Aquatic exercise - (fast pacemetronome 80–88bpm) (n=18) Aquatic exercise Program (Aquatic exercise - slow pacemetronome 50–58bpm) (n=19)	Ward Exercise program (conventional exercise during hospitalization) (n=17)	Hip abductors and knee extensors strength (hand dynamometer), ROM of knee flexion (Goniometer), and functionality (WOMAC).	Hip abductor strength was significantly greater after aquatic physiotherapy intervention (fast pacemetronome 80–88bpm) than ward exercise program (p=0.001) or water exercise program (slow pacemetronome 50–58bpm) (p=0.011)
Unlu et al., 2007⁴²42 Unlu E, Eksioglu E, Aydog E, Aydoð ST, Atay G. The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study. Clin Rehabil. 2007;21(8):706-11.	Randomized controlled trial n=26	Home exercise program (Conventional exercise) (n=9) Exercised under physiotherapist supervision in hospital (Conventional exercise) (n=8)	CG (n=9)	Hip abduction strength (isokinetic dynamometer).	Maximal isometric hip abduction torque improved significantly in the supervised (p=0.012) and home therapy (p=0.018) groups. The supervised group showed the best improvement for abduction torque (p=0.006).
Jogi et al., 2015³³33 Jogi P, Overend TJ, Spaulding SJ, Zecevic A, Kramer JF. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: a randomized clinical trial. SAGE Open Med. 2015;3:1-10.	Clinical Trial n=30	THA Exercise (Conventional exercise) + Balance (n=13)	THA Exercise alone (Conventional exercise) (n=17)	Functionality (WOMAC).	There was a significant improvement in functionality in both groups (p<0.01). There was no difference between groups for functionality.
Husby et al., 2009¹⁰10 Heiberg KE, Bruun-Olsen V, Ekeland A, Mengshoel AM. Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery. Arthritis Care Res. 2012:64(3):415-23.	Randomized controlled trial n=24	Maximum strength + conventional treatment (STG) (n=12)	Conventional rehabilitation group (CRG) (n=12)	1RM leg press; Hip abductors strength (1RM) and functionality (Merle d’Aubigné and Postel)	No significant difference was observed for functionality in the STG than the CRG. 1RM Leg press for the healthy leg was significantly improved in the STG (p=0.044) than the CRG. From 6 to 12 months, hip abduction in the healthy limb improved in the CRG (p=0.031).
Temfemo et al., 2008²²22 Temfemo A, Doutrellot PL, Ahmaidi S. Early muscular strengthening after total hip arthroplasty: association of two models of rehabilitation. Ann Readapt Med Phys. 2008;38-45.	Clinical Trial n=81	Standard rehabilitation and isometric exercises with electromyographic feedback (n=40)	CG (Standard rehabilitation alone) (n=41)	Maximum voluntary isometric hip strength (isokinetic dynamometer).	The addition of exercises with electromyographic feedback provides increased strength of the operated gluteus medius seven days after surgery (p<0.001).
Umpierres et al., 2014⁷7 Umpierres CS, Ribeiro TA, Marchisio AE, Galvão L, Borges INK, Macedo C, et al. Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial. J Phys Med Rehabil. 2014;51(10):1567-78.	Randomized controlled trial n=106	Exercise and instructions (THAPCP) (n=54)	Only instructions (THAP) (n=52)	Functionality (Merle d’Aubigné and Postel), hip flexion, extension, adduction, abduction, and internal and external rotation ROM (Goniometer), muscle strength of knee flexion and extension, and hip flexion, extension, adduction, abduction, and internal and external rotation (Kendall test).	The THAPCP group obtained better results for flexion, extension (p<0.001), adduction (p=0.003), abduction (p=0.002), internal rotation and external rotation strength and functionality (p<0.001)
Wójcik et al., 2012²¹21 Wójcik B, Jabłoński M, Gębala E, Drelich MA. Comparison of effectiveness of fascial relaxation and classic model of patients rehabilitation after hip joint endoprosthetics. Ortop Traumatol Rehabil. 2011;14(2):161-78.	Clinical Trial n=35	Experimental group (conventional therapeutic exercises, and fascial relaxation) (n=25)	CG (conventional therapeutic exercises) (n=10)	ROM of hip flexion, extension, abduction, adduction, internal and external rotation (Goniometer).	The IG had a significant increase in abduction (p=0.04), adduction (p=0.01) and internal rotation (p=0.03) hip ROM than the CG.
Liebs et al., 2010²⁵25 Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Ergometer cycling after hip or knee replacement surgery. J Bone Jt Surg. 2010;92(4):814-22.	Randomized controlled trial n=203	Ergometer Cycling and conventional treatment (n=99)	CG (conventional treatment) THA (n=104)	Functionality (WOMAC).	The IG had a significant improvement in functionality (p=0.046) than the CG.
Suetta et al., 2004²⁰20 Suetta C, Magnusson SP, Rosted A, Aagaard P, Jakobsen AK, Larsen LH, et al. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients: a controlled, randomized study. J Am Geriatr Soc. 2004;52(12)2016-22.	Randomized controlled trial n=36	Electrical stimulation (n=11) Resistance training (n=13)	Home Exercise (n=12)	Knee extensor isokinetic strength (isokinetic dynamometer)	The resistance training group obtained better results for knee extensor strength (p<0.05).
Suetta et al., 2008³⁸38 Suetta C, Andersen JL, Dalgas U, Berget J, Koskinen SS, Aagaard P, et al. Resistance training induces qualitative changes in muscle morphology, muscle architecture, and muscle function in elderly postoperative patients. J Appl Physiol. 2008;105(1):180-86.	Randomized controlled trial n=36	Resistance training (n=13) Electrical stimulation (n=12)	Standard rehabilitationn (n=11)	Knee extensor muscle isokinetic strength (isokinetic dynamometer)	The resistance training group obtained better results for dynamic extensor muscle strength (p<0.05).
Suetta et al., 2004³⁷37 Suetta C, Aagaard P, Rosted A, Jakobsen AK, Duus B, Kjaer M, et al. Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse. J Appl Physiol. 2004;97(5):1954-61.	Clinical Trial n=30	Standard rehabilitation and strength training (n=11) Standard rehabilitation and neuromuscular electrical stimulation (n=10)	Standard rehabilitation (n=9)	Knee extensor muscle maximum isometric strength (isokinetic dynamometer).	The resistance training group obtained better results for knee extensor muscle isometric strength (p<0.01).
Mikkelsen et al., 2014⁴⁴44 Mikkelsen LR, Mechlenburg I, Soballe K, Jorgensen LB, Mikkelsen S, Bandholm T, et al. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations: a single-blinded randomised controlled trial. Osteoarthr Cartil. 2014;22(12):2051-8.	Randomized controlled trial n=62	Intervention group (home-based exercise and progressive resistance training) (n=32)	CG (home-based exercise) (n=30)	Hip abductor and flexor strength (hand dynamometer) and functionality (HOOS).	There was no difference between groups for all outcome measures.
Nankaku et al., 2016⁴³43 Nankaku M, Ikeguchi R, Goto K, So K, Kuroda Y, Matsuda S. Hip external rotator exercise contributes to improving physical functions in the early stage after total hip arthroplasty using an anterolateral approach: a randomized controlled trial. Disabil Rehabil. 2016;38(22):2178-83.	Clinical Trial n=28	Exercise group (Conventional rehabilitation and exercise external rotator) (n = 14)	GC (Conventional rehabilitation) (n = 14)	Hip flexion and abduction ROM (Goniometer), knee extensor and hip external rotator and abductor strength (hand dynamometer).	Hip abductor strength (p<0.05) improved significantly in the IG after the intervention.
Monticone et al., 2014²⁴24 Monticone M, Ambrosini E, Rocca B, Lorenzon C, Ferrante S, Zatti G. Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial. Clin Rehabil. 2014;28(7):658-68.	Randomized controlled trial n=100	Experimental group (task-oriented exercises and abandoning of any support for walking) (n=50)	CG (open chain kinetic exercises, partial weight-bearing and support walking after surgery) (n = 50)	Functionality (WOMAC)	There was a significant improvement in functionality (p<0.001) in the IG.
Pohl et al., 2015³²32 Pohl T, Brauner T, Wearing S, Stamer K, Horstmann T. Effects of sensorimotor training volume on recovery of sensorimotor function in patients following lower limb arthroplasty. BMC Musculoskelet Disorders. 2015;16(1):1-10.	Clinical Trial n=58	Sensorimotor training 6 times a week (n=23) Sensorimotor training 4 times a week (n=15) Sensorimotor training twice a week (n=20)	-	Functionality (Lequesne).	There was significant improvement in functionality over the time (p< 0.001), but this did not differ between groups.
Smith et al., 2008²⁹29 Smith TO, Mann CJ, Clark A, Donell ST. Bed exercises following total hip replacement: a randomised controlled trial. Physiotherapy. 2008;94(4):286-91.	Randomized Clinical Trial n=60	Gait re-education and Bed Exercise (n=30)	Only gait re-education (n=30)	Functionality (ILOA).	There was no difference between groups for all outcome measures.
Matheis and Stöggl, 2018⁵⁰50 Matheis C, Stöggl T. Strength and mobilization training within the first week following total hip arthroplasty. J Bodyw Mov Ther. 2018;22(2):519-27.	Controlled trial n=39	Intervention group (mobilization and strength training) (n=20)	CG (n=19)	Hip flexion, abduction, and extension ROM (Goniometer), functionality (Merle d'Aubigné, HHS and WOMAC).	The IG showed significant improvement in hip flexion (p<0.01), extension (p<0.001) and abduction (p<0.01) ROM.
Winther et al., 2018³⁹39 Winther SB, Foss OA, Husby OS, Wik TS, Klaksvik J, Husby VS. A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty: Implementing maximal strength training into clinical practice. Acta Orthop. 2018;89(3):295-01.	Randomized controlled trial n=60	Conventional physiotherapy (n=29)	Maximal strength training (n=31)	Functionality (HOOS and HHS) and abductor strength (pulling apparatus)	The IG showed significant improvement in abductor strength (p ≤ 0.002)
Monaghan et al., 2017²⁶26 Monaghan B, Cunningham P, Harrington P, Hing W, Blake C, O’Dohertya D, et al. Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy. 2017;103(3):283-88.	Randomized controlled trial n=63	Exercise and usual care group (n=32)	Control group (usual care only) (n=31)	Functionality (WOMAC) and hip abductors strength (dynamometer.	The IG had a significant improvement in functionality (p<0.01).

Author, year	Randomized	Suitable randomization?	Double blind	Suitable double blind?	Sample losses	Punctuation	Quality
Gremeaux et al., 2008⁸8 Gremeaux V, Renault J, Pardon L, Deley G, Lepers R, Casillas JM. Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(12):2265-73.	Yes	Yes	No	-	Yes	3	High Quality
Liebs et al., 2012¹³13 Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Multicenter Arthroplasty Aftercare Project. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil. 2012;93(2):192-99.	Yes	Yes	No	-	Yes	3	High Quality
Hesse et al., 2003¹⁴14 Hesse S, Werner C, Seibel H, Von Frankenberg S, Kappel EM, Kirker S,et al. Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil 2003;84(12):1767-73.	Yes	Yes	No	-	Yes	3	High Quality
Husby et al., 2009⁴¹41 Husby VS, Helgerud J, Bjorgen S, Husby OS, Benum P, Hoff J. Early postoperative maximal strength training improves work efficiency 6–12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years. Am J Phys Med Rehabil. 2010;89(4):304-14.	Yes	Yes	No	-	Yes	3	High Quality
Heiberg et al., 2012¹⁰10 Heiberg KE, Bruun-Olsen V, Ekeland A, Mengshoel AM. Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery. Arthritis Care Res. 2012:64(3):415-23.	Yes	Yes	No	-	Yes	3	High Quality
Jan et al., 2004¹⁷17 Jan M, Hung JY, Lin JC, Wang SF, Liu TK, Tang PF. Effects of a home program on strength, walking speed, and function after total hip replacement. Arch Phys Med Rehabil. 2004;85(12):1943-51.	Yes	No	No	-	Yes	1	Low Quality
Trudelle Jackson and Smith, 2004¹¹11 Trudelle-Jackson E, Smith SS. Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2004;85(7):1056-62.	Yes	Yes	No	-	Yes	3	High Quality
Stockton and Mengersen al., 2009⁶6 Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(10):1652-57.	Yes	No	No	-	Yes	1	Low Quality
Sashika et al.,1996⁹9 Sashika H, Matsuba Y, Watanabe Y. Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. Arch Phys Med Rehabil. 1996;77(3):273-77.	No	-	No	-	Yes	1	Low Quality
Giaquinto et al., 2010¹⁶16 Giaquinto S, Ciotola E, Dall’armi V, Margutti F. Hydrotherapy after total hip arthroplasty: a follow-up study. Arch Gerontol Geriatr. 2010;50(1)92-95.	Yes	No	No	-	Yes	1	Low Quality
Galea et al., 2008¹⁸18 Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, et al. A targeted home-and center-based exercise program for people after total hip replacement: a randomized clinical trial. Arch Phys Med Rehabil. 2008;89(8):1442-47.	Yes	No	No	-	Yes	1	Low Quality
Tsukagoshi et al., 2014³⁰30 Tsukagoshi R, Tateuchi H, Fukumoto Y, Ibuki S, Akiyama H, So K, et al. Functional performance of female patients more than 6 months after total hip arthroplasty shows greater improvement with weight-bearing exercise than with non-weight-bearing exercise. Randomized controlled trial. Eur J Phys Rehabil Med. 2014;50(6):665-75.	Yes	Yes	No	-	Yes	3	High Quality
Barker et al., 2013³¹31 Barker KL, Newman MA, Hughes T, Sackley C, Pandit H, Kiran A, et al. Recovery of function following hip resurfacing arthroplasty: a randomized controlled trial comparing an accelerated versus standard physiotherapy rehabilitation programme. Clin Rehabil 2013;27(9):771-84.	Yes	Yes	No	-	Yes	3	High Quality
Rahmann et al.,2009³⁵35 Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(5):745-55.	Yes	Yes	No	-	Yes	3	High Quality
Unlu et al., 2007⁴²42 Unlu E, Eksioglu E, Aydog E, Aydoð ST, Atay G. The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study. Clin Rehabil. 2007;21(8):706-11.	Yes	Yes	No	-	Yes	3	High Quality
Jogi et al., 2015³³33 Jogi P, Overend TJ, Spaulding SJ, Zecevic A, Kramer JF. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: a randomized clinical trial. SAGE Open Med. 2015;3:1-10.	Yes	No	No	-	Yes	1	Low Quality
Husby et al., 2010¹⁰10 Heiberg KE, Bruun-Olsen V, Ekeland A, Mengshoel AM. Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery. Arthritis Care Res. 2012:64(3):415-23.	Yes	Yes	No	-	Yes	3	High Quality
Temfemo et al., 2008²²22 Temfemo A, Doutrellot PL, Ahmaidi S. Early muscular strengthening after total hip arthroplasty: association of two models of rehabilitation. Ann Readapt Med Phys. 2008;38-45.	No	-	No	-	No	0	Low Quality
Umpierres et al., 2014⁷7 Umpierres CS, Ribeiro TA, Marchisio AE, Galvão L, Borges INK, Macedo C, et al. Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial. J Phys Med Rehabil. 2014;51(10):1567-78.	Yes	Yes	Yes	Yes	No	4	High Quality
Wójcik et al., 2012²¹21 Wójcik B, Jabłoński M, Gębala E, Drelich MA. Comparison of effectiveness of fascial relaxation and classic model of patients rehabilitation after hip joint endoprosthetics. Ortop Traumatol Rehabil. 2011;14(2):161-78.	No	-	No	-	No	0	Low Quality
Liebs et al., 2010²⁵25 Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Ergometer cycling after hip or knee replacement surgery. J Bone Jt Surg. 2010;92(4):814-22.	Yes	Yes	No	-	Yes	3	High Quality
Suetta et al., 2004²⁰20 Suetta C, Magnusson SP, Rosted A, Aagaard P, Jakobsen AK, Larsen LH, et al. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients: a controlled, randomized study. J Am Geriatr Soc. 2004;52(12)2016-22.	Yes	Yes	Yes	Yes	Yes	5	High Quality
Suetta et al., 2008³⁸38 Suetta C, Andersen JL, Dalgas U, Berget J, Koskinen SS, Aagaard P, et al. Resistance training induces qualitative changes in muscle morphology, muscle architecture, and muscle function in elderly postoperative patients. J Appl Physiol. 2008;105(1):180-86.	Yes	Yes	No	-	Yes	3	High Quality
Suetta et al., 2004³⁷37 Suetta C, Aagaard P, Rosted A, Jakobsen AK, Duus B, Kjaer M, et al. Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse. J Appl Physiol. 2004;97(5):1954-61.	Yes	No	No	-	Yes	1	Low Quality
Mikkelsen et al., 2014⁴⁴44 Mikkelsen LR, Mechlenburg I, Soballe K, Jorgensen LB, Mikkelsen S, Bandholm T, et al. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations: a single-blinded randomised controlled trial. Osteoarthr Cartil. 2014;22(12):2051-8.	Yes	Yes	No	-	Yes	3	High Quality
Nankaku et al., 2016⁴³43 Nankaku M, Ikeguchi R, Goto K, So K, Kuroda Y, Matsuda S. Hip external rotator exercise contributes to improving physical functions in the early stage after total hip arthroplasty using an anterolateral approach: a randomized controlled trial. Disabil Rehabil. 2016;38(22):2178-83.	Yes	No	No	-	Yes	1	Low Quality
Monticone et al., 2014²⁴24 Monticone M, Ambrosini E, Rocca B, Lorenzon C, Ferrante S, Zatti G. Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial. Clin Rehabil. 2014;28(7):658-68.	Yes	Yes	No	-	Yes	3	High Quality
Pohl et al., 2015³²32 Pohl T, Brauner T, Wearing S, Stamer K, Horstmann T. Effects of sensorimotor training volume on recovery of sensorimotor function in patients following lower limb arthroplasty. BMC Musculoskelet Disorders. 2015;16(1):1-10.	Yes	No	No	-	Yes	1	Low Quality
Smith et al., 2008²⁹29 Smith TO, Mann CJ, Clark A, Donell ST. Bed exercises following total hip replacement: a randomised controlled trial. Physiotherapy. 2008;94(4):286-91.	Yes	Yes	No	-	Yes	3	High Quality
Matheis and Stöggl, 2018⁵⁰50 Matheis C, Stöggl T. Strength and mobilization training within the first week following total hip arthroplasty. J Bodyw Mov Ther. 2018;22(2):519-27.	Yes	No	No	-	Yes	1	Low Quality
Winther et al., 2018³⁹39 Winther SB, Foss OA, Husby OS, Wik TS, Klaksvik J, Husby VS. A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty: Implementing maximal strength training into clinical practice. Acta Orthop. 2018;89(3):295-01.	Yes	yes	No	-	Yes	3	High Quality
Monaghan et al., 2017²⁶26 Monaghan B, Cunningham P, Harrington P, Hing W, Blake C, O’Dohertya D, et al. Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy. 2017;103(3):283-88.	Yes	yes	No	-	Yes	3	High Quality

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[1] Correspondence Mariana Bogoni Budib Hashiguchi marianabudib@hotmail.com