A quarter of patients who have a hip replacement need a second, more complex revision surgery, yet there is no standard physiotherapy to help them recover afterwards. This matters because revision hip replacements are harder on patients than first-time surgeries—they carry higher risks of death, longer hospital stays, and worse long-term function. Despite this, physiotherapy provision across the UK is inconsistent and often inadequate, leaving patients without evidence-based rehabilitation tailored to their more complicated needs. If this feasibility trial succeeds, it will pave the way for a full-scale randomised controlled trial testing a targeted physiotherapy programme that includes progressive strengthening, gait retraining, and adherence strategies. That larger trial could eventually establish a standard of care for thousands of revision hip replacement patients each year, improving their mobility, quality of life, and reducing the likelihood of needing yet another surgery. For now, this study will determine whether such a trial is practical—whether patients can be recruited and retained, and whether clinicians and patients find the intervention acceptable.
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Research question Is it feasible and acceptable to conduct a multicentre randomised controlled trial (RCT) of a tailored physiotherapy intervention after revision total hip arthroplasty? Background Total hip arthroplasty (THA) operations are highly successful, yet they have a finite lifespan and some fail early requiring revision surgery. People who have undergone revision total hip arthroplasty (rTHA) have a higher mortality rate, longer hospital length of stay, higher risk of re-revision surgery, and worse patient-reported outcome measures compared to primary THA. Considering the poorer functional status and complexity of rTHA, physiotherapy provision varies widely across the UK, possibly leading to inadequate provision. Aims and Objectives Aims: (1) To evaluate the feasibility of an RCT testing the clinical effectiveness of a tailored physiotherapy intervention after rTHA; and (2) To assess the acceptability of the intervention to patients and clinicians. Objectives: (a) Determine if we can recruit and retain participants; (b) Appraise adherence to the intervention; (c) Evaluate outcome measures to refine and review acceptability; (d) Confirm a definitive primary outcome for a full trial; (e) Explore the barriers and facilitators of the intervention for patients and clinicians. Methods The study will be a multicentre, parallel 2-arm feasibility RCT with an embedded qualitative study involving four secondary care NHS hospitals representing a range of sociodemographic backgrounds. Inclusion criteria are adults ≥ 18 years undergoing a single stage or final stage rTHA who are independently mobile. Main exclusion criteria are: planned lower limb surgery within 8 months; conditions that make participation in an exercise programme unsafe or prevent collection of physical outcome measures. The intervention will involve targeted progressive strengthening, gait re-training, and education, plus integrated exercise adherence strategies. It will comprise of a physiotherapy evaluation and 5-8 follow-up sessions over a 12-week period, and two follow-up calls (5- and 7-months post-operatively). Usual care will comprise of a physiotherapy assessment with home exercise programme and up to two follow-up sessions within 12 weeks. Main outcome measures: recruitment rate, retainment rate, intervention fidelity and adherence, adverse events, and acceptability. Secondary outcome measures: self-reported and performance-based measures capturing physical function and mobility, disability, quality of life, self-efficacy and health resource use (collected pre-operatively, 4-months and 8-months post-operatively). Data will be summarised, compared against progression criteria, and will inform a sample size calculation for a definitive RCT. A minimum of 30 participants in each arm will be recruited. We will interview participants and clinicians in the intervention arm from each site and analyse using reflexive thematic analysis. Timelines for Delivery The trial will be conducted over 24 months. We will recruit for 6 months, interventions delivered by Month 15, follow-ups by Month 19. Qualitative interviews and analysis will be completed during Months 12-20. During Months 21-24 we will analyse and report on our data and develop into a full trial. Anticipated Impact and Dissemination We will disseminate our findings through journal publications and conference presentations. We anticipate our findings will inform the development of a definitive RCT to advance the evidence base for rehabilitation after rTHA.
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