Open Access Research article

What does standard rehabilitation practice after total hip replacement in the UK entail? results of a mixed methods study

Tosan Okoro123*, Ashok Ramavath3, Jan Howarth4, Jane Jenkinson4, Peter Maddison12, John G Andrew3 and Andrew Lemmey2

Author Affiliations

1 School of Medical Sciences, Bangor University, Bangor, UK

2 School of Sports Health and Exercise Science, Bangor University, Bangor, UK

3 Department of Orthopaedics, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK

4 Department of Physiotherapy, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK

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BMC Musculoskeletal Disorders 2013, 14:91  doi:10.1186/1471-2474-14-91

Published: 12 March 2013



There is evidence of prolonged poor function in patients following total hip replacement (THR). Studies of progressive resistance training (PRT) interventions to improve function are often compared to ‘standard’ practice which is not well defined. This study aimed to investigate ‘standard’ rehabilitation care in the UK after total hip replacement (THR) as well as determine whether PRT was part of ‘standard’ care.


After ethical approval, questionnaire item development about rehabilitation practice was guided by a focus group interview (after informed consent) with physiotherapists (n = 4; >5 years post-qualification) who regularly treated THR patients. An online questionnaire investigating the exercises prescribed and rehabilitation practice following THR was developed and sent to physiotherapists working in hospitals in the UK. The survey was performed from January to May 2011. The survey results were analysed (frequency (%) of responses) focusing on the exercises the physiotherapists considered important, as well as their use of PRT in prescribed regimes.


106 responses were obtained from physiotherapists in the UK. The survey respondents considered that the most important muscles to target in all phases of rehabilitation were the hip abductors (62.2%), followed by the quadriceps (16.9%), and other muscles (21%). Exercise type prescribed revealed no consensus, with weight bearing (42%), functional (45%) and Bed-based/Bridging/Postural exercises (13%) favoured. 83.7% were able to define the basis of progressive resistance training (PRT), but only 33% prescribed it.


Standard physiotherapy rehabilitation in the UK after THR is variable, and appears to rarely include PRT. This may be a factor in prolonged poor function in some patients after this common operation.

Physiotherapy; Orthopaedics; Osteoarthritis; Training