Sixteen trials (n=2,060) were included: 12 studies classified as Level I and four studies classified as Level II. Duration of follow-up ranged from six weeks to six months (length of follow-up was not reported for all the included studies).
Surgical exposure/minimally invasive surgical approaches (n=691): Five studies compared outcomes after mini incisions versus conventional approaches. Beneficial outcomes reported included earlier returns to normal activity, earlier discontinuation of use of walking aids, earlier improvements in gait velocity and improved pain control with minimally invasive surgical approaches in four studies. One study found no differences in hip function scores, WOMAC osteoarthritis scores and health and well being as measured by the SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey).
Hip restrictions (n=764): Two studies examined hip dislocation rate after anterolateral total hip arthroplasty and compared groups with and without postoperative hip restrictions. One study reported a lower dislocation rate without use of restrictions. The other study reported a faster return to normal activities and higher levels of satisfaction for the group where patients had no hip movement restrictions after more than six weeks post surgery.
Multi-modal pain control (n=358): Five studies compared various post-surgical pain control methods. Patients treated with local infiltration analgesia, lumbar plexus block, continuous femoral nerve block and periarticular injections, and continuous psoas compartment block had lower visual analogue scale pain scores and less nausea and vomiting than those treated with epidural infusions and intravenous patient-controlled anaesthesia (four studies).
Preoperative physiotherapy (n=247): Four studies assessed post-surgical functional outcomes (such as gait, muscle strength and frequency of home discharge) after preoperative physiotherapy treatment. In two studies, improvements in walking distance, gait velocity muscle strength and range of motion were observed for patients in intervention groups. One study found no difference between groups in hip scores, pain scores and range of movement over two years of follow-up. A fourth study found that frequency of home discharges was higher for the intervention group, but observed no differences in WOMAC scores.