Functional Problems and Treatment Solutions After Total Hip Arthroplasty

The success of total hip arthroplasties (THA) in terms of patient satisfaction, improved function, and reduced pain has been well documented. Cases of patient dissatisfaction are often linked to complications due to comorbitities, radiographic loosening, and poor prosthesis alignment; however, a small number of patients are still reporting functional problems without any obvious causes. The purpose of this study was to elucidate some of the abnormalities that may lead to biomechanical dysfunction after THA and to assess the efficacy of physical therapeutic modalities that have been specifically customized for this patient population. Seventy-eight THA patients complained of poor functional capabilities after THA. Physical examination, videotape analysis, 3-dimensional gait studies, and isokinetic strength assessment indicated gait abnormalities associated with muscle weakness (57), muscle tightness (32), limb-length differences (11), and/or 2-dimensional biomechanical malalignment of the leg (10). All patients were placed on individualized treatment protocols that included physical therapy, electrical stimulation, shoe lifts, orthoses, intramuscular botulinum toxin A, and intra-articular corticosteroid injections. At final follow-up of 63 months (range, 24-200 months), 73 (94%) patients had good to excellent clinical outcomes. Five patients were recalcitrant to both invasive and noninvasive conservative measures and were considered clinical failures. Overall, the mean Harris hip score improved to 94 points (range, 65-100 points) and patient satisfaction averaged 8.7 out of 10 possible points (range, 2-10 points). The excellent clinical results from this study suggest that thorough clinical assessment and 3-dimensional gait studies are valuable tools in identifying biomechanical abnormalities in patients with functional problems after THA. A standardized diagnostic algorithm to understand these underlying dysfunctions in patients who demonstrate no radiographic abnormalities facilitates the development of customized rehabilitation modalities and improves clinical outcome.