Ask Doctor K: Home exercises work well for rehab after hip surgery

DEAR DOCTOR K: I’m having hip replacement surgery next month. I know I’ll need rehabilitation afterward, but does it matter where I do it?

DEAR READER: It’s been routine after hip replacement surgery to have extensive physical therapy. This rehabilitation therapy, or “rehab,” usually consists of a series of outpatient appointments with a physical therapist, as well as exercises to do at home. The goal of rehab is to improve the strength, stamina and balance of walking.

The visits to the physical therapist usually take place two or three times a week for a month or more. But a new study calls into question the need for all the visits to physical therapists.

The researchers presented their findings at a recent meeting of the American Academy of Orthopaedic Surgeons. They studied 77 people having hip replacement surgery. Of these, half were randomly assigned to the conventional rehab program, in which they met with a physical therapist two or three times a week for two months. The rest were taught specific exercises to perform on their own at home for two months.

Here’s what they found:

– One month after surgery, there were no major differences in the individuals’ ability to function. “Function” was based on their ability to sit, walk and use stairs, or other measures of daily activities.

– Six months after the surgery, there was still no difference in results.

Changing rehab from supervised appointments to exercising at home could significantly reduce the cost of care. And the convenience of not having to be driven to all those physical therapy visits is an extra bonus. (For the first month or two after hip replacement surgery, you can’t drive yourself.)

Of course, this may not work for everyone. Many people who have hip replacement surgery cannot return home right away. That’s especially true if they live alone and have to climb a number of stairs right away. For them, surgery may best be followed by a stay at a rehabilitation facility. There, they can receive supervised physical therapy on a daily basis. They would be sent home once they were strong and steady enough to get around safely.

This new research should be considered preliminary. First, it included only a small number of study subjects. Also, the results have not yet been published in a peer-reviewed medical journal. More research will likely be needed to confirm the findings. Other studies can help identify who is likely to do well with self-directed rehab.

If the findings of this new study are confirmed, it will be welcome news. Thousands of people having hip replacement surgery may no longer have to trudge back and forth to physical therapy appointments.

Based on my own experience undergoing a hip replacement, I’ll bet that this study is basically correct: All those visits to a physical therapist may not be necessary. On the other hand, not everyone is alike. Some people will need more therapy visits than others, to master the exercises they need to do at home.

Dr. Komaroff is a physician and professor at Harvard Medical School.