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Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty 


Journal: Archives of Physical Medicine & Rehabilitation. February 2012, Volume 93.


Authors: Liebs TR, Herzberg W, Ruther W, Haasters J, Russlies M, Hassenpflug J. 2012


The authors evaluated the timing of aquatic therapy after THR (n=210) and TKR (n=135) surgery in a multicenter trial. They followed 465 hip replacement clients and 185 knee replacement clients. In Europe pool exercise is commonly used for TKR and THR clients using the properties of buoyancy and thermal regulation. There were 2 groups for each surgery - . Aquatic therapy was initiated on the 14 post-op day for group 1 and the 6th post-op day for group 2, for 3x/wk. for 30 minutes. This was in a thermo-neutral pool (34°C), using equipment and focussing on proprioception, coordination and strengthening up to the 5th post-operative week.  Usual post-op care of land based interventions was continued for both groups. They measured self-reported physical function (WOMAC), SF36 SF, Lequesne-Hip/Knee-Score. Follow-up was at 6, 12, and 24 months.


Results indicated that early intervention after TKR was more beneficial (higher WOMAC scores) whereas the later intervention in the THR resulted in less adverse effects and better long-term outcomes.


Take Home Message: In Europe, early use of aquatic therapy for post-op TJA surgery is common. There are more advantages to early aquatic intervention (6 days post-op) after a knee replacement with less risks than for the total hip replacements which would be recommended to start aquatic therapy at 14 days post-op.

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