Hip strengthening exercise compared to standard rehabilitation after revision hip replacement: a multicenter randomized controlled trial - 19/12/25

Doi : 10.1016/j.rehab.2025.102076

Martin G. Stisen ^a,^b,^⁎ , Alma B. Pedersen ^a,^c, Troels Kjeldsen ^a,^b, Frederik N. Foldager ^a,^b, Martin Lamm ^b, Anders Assenholt ^d, Kirstine L. Hvidberg ^d, Morten K. Rasmussen ^d, Peter K. Aalund ^e, Christina F. Frandsen ^f, Anders Holsgaard-Larsen ^g,^h, Martin H. Haubro ^g, Theresa Bieler ⁱ, Søren Overgaard ^j,^k, Torben Beck ^l, Kim G. Ingwersen ^m,ⁿ, Erik T. Parner ^o, Inger Mechlenburg ^a,^b
^a Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
^b Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
^c Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43–45, 8200 Aarhus N, Denmark
^d Department of Orthopaedic Surgery, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark
^e Department of Physiotherapy and Occupational Therapy, Regional Hospital Gødstrup, Hospitalsparken 15, 7400 Herning, Denmark
^f Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Hospitalsparken 15, 7400 Herning, Denmark
^g Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
^h Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
ⁱ Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
^j Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
^k Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
^l Department of Orthopaedic Surgery, Gentofte Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
^m Department of Physiotherapy, Lillebaelt Hospital – University Hospital of Southern Denmark, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark
ⁿ Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
^o Department of Public Health, Section for Biostatistics, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark

^⁎Corresponding author. Martin Gade Stisen, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark and Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark, Palle Juul-Jensens Boulevard 99, Indgang J, J501-122, 8200 Aarhus N, Denmark, Telephone: +45 26 19 41 51Department of Clinical Medicine, Aarhus University, Aarhus, Denmark and Department of Orthopaedic SurgeryAarhus University Hospital, Aarhus N, DenmarkPalle Juul-Jensens Boulevard 99, Indgang J, J501-122Aarhus N8200Denmark

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Friday 19 December 2025

Highlights

•	Hip strengthening equals Usual care after revision total hip replacement (THR)
•	Hip strengthening does not boost leg power more than Usual care after revision THR
•	Hip strengthening yields no meaningful chair-stand benefit after revision THR
•	Hip strengthening yields no meaningful gait speed benefit after revision THR

Le texte complet de cet article est disponible en PDF.

Abstract

Background

People undergoing revision total hip replacement (THR) typically experience slower recovery and greater functional limitations than those undergoing primary procedures. Rehabilitation practices following revision THR are inconsistent and often adapted from protocols for primary THR, despite limited specific evidence supporting their effectiveness.

Objectives

To compare the effectiveness of an exercise intervention targeting hip strengthening (NEMEX-STR) on functional performance at 4 months with the standard community-based rehabilitation (Usual care) in participants undergoing revision THR.

Methods

This multicenter, randomized, controlled, parallel-group, assessor-blinded superiority trial included participants undergoing revision THR who were randomized to NEMEX-STR or Usual care. The NEMEX-STR group underwent a 16-week intervention targeting hip strengthening, while the Usual care group received standard rehabilitation. The primary outcome was the between-group difference in functional performance assessed by the 30s Chair Stand Test (30s-CST), from baseline (ie, prior to surgery) to 4 months after the start of the intervention. Secondary outcomes included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the 40-m Fast-Paced Walk Test (40m-FPWT), the 9-step Timed Stair Climb Test (9-step TSCT), and unilateral leg extensor muscle power.

Results

A total of 84 participants were recruited between November 2022 and June 2024 and were allocated to either NEMEX-STR (n = 43) or Usual care (n = 41). The mean changes from baseline to 4-month follow-up in the 30s-CST were 1.9 (95% CI 0.8 to 3.0) in NEMEX-STR and 1.2 (95% CI 0.6 to 2.3) chair stands in Usual care, with a between-group difference of 0.7 (95% CI -0.8 to 2.3). Secondary outcomes showed no clinically relevant between-group differences in change for HOOS subscales, 40m-FPWT, 9-step TSCT, or unilateral leg extensor muscle power.

Conclusion

An exercise intervention targeting hip strengthening was not superior to standard community-based rehabilitation for improving functional performance at 4 months in participants undergoing revision THR.

ClinicalTrials.gov

NCT05657054.

Le texte complet de cet article est disponible en PDF.

Keywords : Exercise, randomized controlled trial, rehabilitation, revision total hip replacement

Abbreviations : ADL, CONSORT, GPE, HOOS, IQR, MCII, MIC, MID, NEMEX, NEMEX-STR, OA, QoL, REDCap, SD, THR, Usual care, 30s-CST, 40m-FPWT, 9-step TSCT