Rehabilitation after primary total hip replacement. Comparison between Italian and international protocols

In intensive rehabilitation departments (Code 56) there is a high case-load of patients with recent total hip replacement (THR). Whereas there has been a progressive standardisation and perfecting of prosthetic materials and surgical techniques, time-frames and modalities of rehabilitation programmes are still very variable. Following the Ministerial Guidelines, issued in 1998 by the Italian National Health System, and the introduction of Accreditation Requirements, methods must become more uniform and there must be increased scientific rigour in treatment so as to reduce variability and the subjective nature of the service provided. Ana-lysis of the working methods of large Rehabilitation Centres may help to focus on the problems more clearly and stimulate any improvements that may be required. The study analyses and compares rehabilitation protocols for hip replacement patients adopted in Italian and international rehabilitation centres.

Thirty-four post-THR rehabilitation protocols were analysed; 14 Italian plus 20 international.

The analysis revealed that some factors are unanimously considered important and are therefore codified: 1) posture and positioning; 2) prevention of deep vein thrombosis; 3) rapid return to mobility; 4) education of patients to joint care.

Weight-bearing on the operated limb is not yet a standardised aspect and thus the physiatrist's attention should be focused on this for a return to walking that is safe (for patients and for implanted prosthesis) correct (from the biomechanical and kinematic standpoints) and that plays a normal role in performing activities of daily living.