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30 SECONDS OF THERAPY: PRT Prehabilitation for THR

Apr 16

6 min read

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START


1. (PRT) Hip Stability 

  1. Progressive Resistance Training (PRT): Begin with twice-weekly resistance sessions, targeting the hip abductors, extensors, and flexors. 

    1. Exercises:

      1. Leg Press 

      2. Standing hip Abduction w/ Resistance

      3. Glute Bridges & Mini Squats

Evidence: Chen et al. (2024) demonstrated improved strength, gait, and balance with pre-op moderate-intensity PRT.


2.Functional Movement Integration 

  1. Progressive resistance should mimic daily life tasks to translate into real-world function. 

    1. Exercises:

      1. Sit-to-stands

      2. Step-ups

      3. Controlled lunges

Enhancing muscle strength is one thing training it into functional tasks is another.


3. Start Early 6 Weeks Pre-Op

  1. 6 Weeks Pre-Op: Initiate PRT  to allow neuroplasticity, muscle hypertrophy, and confidence building. 

  2. Start with Low load isometrics for frail patients 2 weeks to minimize injury

  3. The longer the runway before surgery, the stronger the patient at takeoff.


STOP


1. Relying Modalities Alone

  1. Modalities such as heat, massage, or TENS don’t prepare a joint for surgical stress. These tools should supplement, not replace, strength-focused prehab.


2. Waiting Until  Pain Subsides

  1. Mild pain isn't a contraindication, it's a clinical cue to modulate intensity or movement, not stop entirely. Strengthening under controlled pain thresholds is safe and effective.


3. Using Generic Protocols

  1. Each patient has unique biomechanical deficits. A one-size-fits-all approach wastes time and reduces adherence. Tailor intensity, progression, and movement patterns to match the patient’s specific impairments and goals. 

  2. Start at 50–60% of the patient’s estimated 1 Repetition Max (1RM). Estimate 50–60% 1RM by selecting a weight that allows 12–15 reps with good form and moderate effort.


WHY: 


1. PRT Reduces Length of Stay and Improves Surgical Outcomes

  1. Isolated PRT decreased hospital length of stay by 0.93 days, and enhanced 6 Minute Walk Time distance by 43.43 meters (McIsaac et al., 2025).

  2. Stronger patients walk sooner, transfer easier, and rely less on gait aids—clinically and financially impactful.

2. PRT Enhances Patient Confidence and Reduces Fear-Avoidance

  1. Muscle strength is foundational, but patient confidence determines postoperative engagement. Patients who feel strong before surgery are more likely to engage post-op. Think beyond the joint and train the mindset too.



Reference: Prehabilitation for THR: Evidence Based Tips and Tricks for the PT and OT Provider Andrea Salzman, MS, PT. 1. McIsaac DI, Kidd G, Gillis C, et al. Relative Efficacy of Prehabilitation Interventions and Their Components: Systematic Review With Network and Component Network Meta-Analyses of Randomised Controlled Trials. BMJ (Clinical Research Ed.). 2025;388:e081164. 2. McIsaac DI, Kidd G, Gillis C, et al. Relative Efficacy of Prehabilitation Interventions and Their Components: Systematic Review With Network and Component Network Meta-Analyses of Randomised Controlled Trials. BMJ (Clinical Research Ed.). 2025;388:e081164. 3. Punnoose A, Claydon-Mueller LS, Weiss O, et al.Prehabilitation for Patients Undergoing Orthopedic Surgery: A Systematic Review and Meta-Analysis. JAMA Network Open. 2023;6(4):e238050. 4. McIsaac DI, Kidd G, Gillis C, et al. Relative Efficacy of Prehabilitation Interventions and Their Components: Systematic Review With Network and Component Network Meta-Analyses of Randomised Controlled Trials. BMJ (Clinical Research Ed.). 2025;388:e081164. 5. Wu L, Li X, Hua L, Sun Q. Effects of Technology-Assisted Rehabilitation for Patients With Hip Arthroplasty: A MetaAnalysis. Medicine. 2023;102(45):e35921 6. Guida S, Vitale JA, Swinnen E, et al. Effects of Prehabilitation With Advanced Technologies in Patients With Musculoskeletal Diseases Waiting for Surgery: Systematic Review and MetaAnalysis. Journal of Medical Internet Research. 2024;26:e52943. 7. Adebero T, Omana H, Somerville L, Lanting B, Hunter SW. Effectiveness of Prehabilitation on Outcomes Following Total Knee and Hip Arthroplasty for Osteoarthritis: A Systematic Review and MetaAnalysis of Randomized Controlled Trials. Disability and Rehabilitation. 2024;46(24):5771-5790. 8. Chen G, Yu D, Wang Y, et al. A Prospective Randomized Controlled Trial Assessing the Impact of Preoperative Combined With Postoperative Progressive Resistance Training on Muscle Strength, Gait, Balance and Function in Patients Undergoing Total Hip Arthroplasty. Clinical Interventions in Aging. 2024;19:745-760. 9. Du D, Li H, Xu Y, et al. Study on the Effect of Pain Programmed Care Based on the Concept of Prehabilitation on the Recovery of Joint Function and WHOQOL-BREF Score in Elderly Patients After Total Hip Arthroplasty. Alternative Therapies in Health and Medicine. 2023;29(8):618- 623. 10. Szilágyiné Lakatos T, Lukács B, Veres-Balajti I. Cost-Effective Healthcare in Rehabilitation: Physiotherapy for Total Endoprosthesis Surgeries From Prehabilitation to Function Restoration. International Journal of Environmental Research and Public Health. 2022;19(22):15067. 11. Sabo GC, Stern BZ, Balachandran U, et al. Associations Between Prehabilitation and Postoperative Healthcare Utilization for Total Hip or Total Knee Arthroplasty in Medicare Beneficiaries. The Journal of Arthroplasty. 2024;:S0883- 5403(24)00950-1. 12. Masaracchio M, Hanney WJ, Liu X, Kolber M, Kirker K. Timing of Rehabilitation on Length of Stay and Cost in Patients With Hip or Knee Joint Arthroplasty: A Systematic Review With Meta-Analysis. PloS One.2017; 12(6):e0178295. 13. Rombey T, Eckhardt H, Kiselev J, et al. CostEffectiveness of Prehabilitation Prior to Elective Surgery: A Systematic Review of Economic Evaluations. BMC Medicine. 2023;21(1):265. doi:10.1186/s12916-023- 02977-6. 14. Chen G, Yu D, Wang Y, et al. A Prospective Randomized Controlled Trial Assessing the Impact of Preoperative Combined With Postoperative Progressive Resistance Training on Muscle Strength, Gait, Balance and Function in Patients Undergoing Total Hip Arthroplasty. Clinical Interventions in Aging. 2024;19:745-760. 15. Frydendal T, Christensen R, Mechlenburg I, et al. Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. The New England Journal of Medicine. 2024;391(17):1610-1620 16. Hermann A, Holsgaard-Larsen A, Zerahn B, Mejdahl S, Overgaard S. Preoperative Progressive Explosive-Type Resistance Training Is Feasible and Effective in Patients With Hip Osteoarthritis Scheduled for Total Hip Arthroplasty--a Randomized Controlled Trial. Osteoarthritis and Cartilage. 2016;24(1):91-8. 17. Hayashi K, Tsunoda T, Tobo Y, Ichikawa F, Shimose T. Effects of Pericapsular Soft Tissue and Realignment Exercises for Patients With Osteoarthritis of the Hip and Harris Hip Score Below 60 Points. Current Medical Research and Opinion. 2022;38(9):1567-1578. 18. Uysal İ, Özden F, Yalçın M, Işık Eİ, Sarı Z. Th. The Effect of Dual-Task Training in Older Adults With Total Hip Arthroplasty: A Randomized Controlled Trial. BMC Musculoskeletal Disorders. 2025;26(1):29. 19. Roxburgh BH, Campbell HA, Cotter JD, et al. Upper-Limb High-Intensity Interval Training or Passive Heat Therapy to Optimize Cardiorespiratory Fitness Prior to Total Hip or Knee Arthroplasty: A Randomized Controlled Trial.. Arthritis Care & Research. 2024;76(3):393-402 20.Tian Y, Liu Z, Liu S, et al. Efficacy of Bed Exercise in Elderly Patients After Total Hip Arthroplasty: A Retrospective Study of 539 Patients. Medicine. 2022;101(47):e31779. 21. Hayashi K, Tsunoda T, Tobo Y, Ichikawa F, Shimose T. Effects of Pericapsular Soft Tissue and Realignment Exercises for Patients With Osteoarthritis of the Hip and Harris Hip Score Below 60 Points. Current Medical Research and Opinion. 2022;38(9):1567-1578. doi:10.1080/03007995.2022.208 8716. 22. Łyp M, Kaczor R, Cabak A, et al. A Water Rehabilitation Program in Patients With Hip Osteoarthritis Before and After Total Hip Replacement. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2016;22:2635-42. 23. Gill SD, McBurney H, Schulz DL. Land-Based Versus PoolBased Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2009;90(3):388-94 24. Frydendal T, Christensen R, Mechlenburg I, et al. Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. The New England Journal of Medicine. 2024;391(17):1610-1620 25. Kim DH, Rockwood K. Frailty in Older Adults. The New England Journal of Medicine. 2024;391(6):538-548. 26. Frydendal T, Christensen R, Mechlenburg I, et al. Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. The New England Journal of Medicine. 2024;391(17):1610-1620. 27. Hermann A, Holsgaard-Larsen A, Zerahn B, Mejdahl S, Overgaard S. Preoperative Progressive ExplosiveType Resistance Training Is Feasible and Effective in Patients With Hip Osteoarthritis Scheduled for Total Hip Arthroplasty--a Randomized Controlled Trial. Osteoarthritis and Cartilage. 2016;24(1):91-8. 28. Hoogeboom TJ, Dronkers JJ, van den Ende CH, Oosting E, van Meeteren NL. Preoperative Therapeutic Exercise in Frail Elderly Scheduled for Total Hip Replacement: A Randomized Pilot Trial. Clinical Rehabilitation. 2010;24(10):901-10. doi:10.1177/0269215510371427. 29. Ginnetti JG, O'Connor MI, Chen AF, Myers TG. Total Joint Arthroplasty Training (Prehabilitation and Rehabilitation) in Lower Extremity Arthroplasty. The Journal of the American Academy of Orthopaedic Surgeons. 2022;30(11):e799-e807. 30. Weber M, Zeman F, Craiovan B, et al. Predicting Outcome After Total Hip Arthroplasty: The Role of Preoperative PatientReported Measures. BioMed Research International. 2019;2019:4909561. 31. Sniderman J, Stark RB, Schwartz CE, et al. Patient Factors That Matter in Predicting Hip Arthroplasty Outcomes: A Machine-Learning Approach. The Journal of Arthroplasty. 2021;36(6):2024- 2032. 32. Fell, D. W. (2004). Progressing therapeutic intervention in patients with neuromuscular disorders: a framework to assist clinical decision making. Journal of Neurologic Physical Therapy, 28(1), 35. 33. American College of Sports Medicine (ACSM) Guidelines for Exercise Testing and Prescription

  • ACSM recommends 50–60% of 1RM for older adults or clinical populations starting resistance training.

  • ACSM’s Guidelines for Exercise Testing and Prescription, 11th ed.


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