Die Bedeutung der praoperativen Physiotherapie vor einer Hufttotalendoprothesenversorgung bei Coxarthrose

Osteoarthritis of the hip joint finally results in contracture, muscular atrophy, and immobility, after years of pain and reduced load capacity. Preoperative physiotherapy ranks highly in respect of preventing contracture and alleviating pain. To verify the significance of preoperative physiotherapy, we measured the isometric and isokinetic power of the musculature involving the hip, directly before surgery and six months postoperatively after individual total cement-free hip replacement. Before doing so, we had studied the previous history of the patient and the present clinical findings. Patients were subdivided into three groups according to the intensity of preoperative physiotherapy. For ethical reasons, postoperative physiotherapeutic management was equal in all the three groups. All the three groups showed, after six months, a clear increase in power in isometry and isokinetics of flexion, both at the operated hip and to a slight extent also at the non-operated hip. It became evident that those patients on whom preoperative physiotherapy had been practised most intensively, suffered a distinctly slighter loss of power of the hip, compared to the other hip. However, those patients with the greatest loss of power who had been preoperatively subjected to slight or no physiotherapy, succeeded in drawing almost equal with the other patients in respect of deficient power of the hip, after a period of six months. Differences in preoperative physiotherapy did not result in any differences in respect of walking distance, use of walking aids, or consumption of analgesics. Nevertheless, preoperative physiotherapy did exercise a positive influence on mobility and pain management. Hence, intensive physiotherapy succeeded in postponing total hip replacement by about four years, compared with patients who had not or only irregularly undergone physiotherapy, without exercising any negative influence on the mobility of the hip joint.