A randomized replication trial of physical rehabilitation versus no physical rehabilitation (DRAW2)

Total hip (THA) and knee arthroplasty (TKA) are effective surgical treatments for end-stage osteoarthritis aimed at reducing pain and improving function. Although physical rehabilitation is widely recommended after THA and TKA, its added clinical benefit beyond natural recovery remains uncertain. In the DRAW1 trial, no superiority of physical rehabilitation over no physical rehabilitation was observed. We aimed to replicate the DRAW1 trial by comparing physical rehabilitation (home-based telerehabilitation, or home-based rehabilitation) to no physical rehabilitation following THA or TKA. This was a three-arm, parallel-group randomized controlled replication trial with blinded outcome assessment. The primary outcome was the Hip Disability and Osteoarthritis Outcome Score/Knee injury and Osteoarthritis Outcome Score ADL-subscale. 169 patients (76 THA/93 TKA) were randomized to home-based telerehabilitation (n = 52, 24 THA/28 TKA), home-based rehabilitation (n = 58, 27 THA/31 TKA), or no physical rehabilitation (n = 59, 25 THA/34 TKA) for six weeks. Mean group differences between physical rehabilitation and no physical rehabilitation were - 0.5 points (95% CI - 3.1 to 2.1; p = 0.70) at 6 weeks, 0.8 points (95% CI - 1.7 to 3.4; p = 0.52). These findings replicate the DRAW1 trial, with no superiority of physical rehabilitation observed following THA or TKA compared to no physical rehabilitation. Trial registration: https://clinicaltrials.gov/study/NCT04960241 (02/07/2021).