Early Rehabilitation After Total Hip Arthroplasty

This study aims to investigate the effects of an early postoperative rehabilitation program combined with neuromuscular electrical stimulation (NMES) and telerehabilitation on functional recovery in patients undergoing total hip arthroplasty (THA). In the early postoperative period, patients commonly experience muscle weakness, impaired gait, and functional limitations that may delay recovery. Early rehabilitation has been shown to improve functional outcomes, while NMES may enhance muscle activation, particularly in hip abductor muscles. Additionally, telerehabilitation may support continuity of care following discharge by enabling supervised home-based exercise. In this prospective study, participants will be assigned to either an intervention group receiving early physiotherapy combined with NMES and telerehabilitation, or a control group receiving standard postoperative care. Functional outcomes, gait parameters, quality of life, and muscle-related changes will be evaluated at predefined time points.

This study is designed as a prospective, randomized controlled clinical trial to evaluate the effectiveness of an early postoperative rehabilitation program combined with neuromuscular electrical stimulation (NMES) and telerehabilitation in patients undergoing total hip arthroplasty (THA). Following THA, patients frequently experience muscle weakness, gait asymmetries, and reduced functional capacity, which may prolong recovery. Although early mobilization and rehabilitation are widely recommended, the combined effects of NMES and telerehabilitation within a structured early-phase rehabilitation program have not been sufficiently investigated. Participants will be randomly allocated into intervention and control groups using a simple randomization method. The intervention group will receive a structured physiotherapy program initiated on the first postoperative day and continued daily during hospitalization. This program will be combined with NMES targeting the gluteus medius muscle, applied using surface electrodes placed over the motor point with stimulation parameters adjusted according to patient tolerance. After discharge, participants in the intervention group will continue a structured home-based exercise program supported by synchronous telerehabilitation sessions conducted three times per week. These sessions will enable real-time supervision, feedback on exercise performance, and progression based on standardized tolerance criteria. The control group will receive the standard postoperative care protocol routinely applied in the clinic, without additional NMES or telerehabilitation support. All participants will be evaluated at predefined time points: preoperatively (within 3 days before surgery), at discharge (postoperative day 6), and at postoperative week 4. Outcome assessments will be performed by an experienced physiotherapist blinded to group allocation, and intervention delivery and outcome assessment will be conducted by different physiotherapists. The primary objective of the study is to determine whether the addition of NMES and telerehabilitation to early rehabilitation improves functional recovery following THA. Secondary objectives include evaluating changes in muscle strength, joint mobility, pain levels, gait characteristics, and muscle morphology.

Inclusion Criteria: * Patients scheduled for unilateral total hip arthroplasty due to osteoarthritis or developmental dysplasia of the hip (DDH) * Aged between 50 and 75 years * Willing and able to participate in all follow-up assessments * Able to comply with assessment procedures * Able to meet the requirements of telerehabilitation * Undergoing surgery with a standardized surgical protocol Exclusion Criteria: * Previous history of total hip arthroplasty on either side * Planned revision total hip arthroplasty * Severe osteoarthritis in the contralateral hip * Presence of severe acute metabolic, neuromuscular, or cardiovascular disease * History of active malignancy * Presence of respiratory infection * Concomitant orthopedic conditions (e.g., lower extremity fractures, severe hip/knee deformities, lumbar or sacroiliac dysfunction) * Body mass index \>35 * Occurrence of postoperative complications (e.g., prosthetic infection, thromboembolic events, or conditions requiring reoperation)