Effects of Structured Exercise Program on Hip Pain, Physical Function and Quality of Life in Patients with Total Hip Arthroplasty

구조화된 운동 프로그램이 인공고관절 전치환술 환자의 고관절 통증, 신체기능 및 삶의 질에 미치는 효과

  • Kwon, Eunhee (Orthopaedics, Yangsan Pusan National University Hospital) ;
  • Lee, Haejung (College of Nursing, Pusan National University) ;
  • Lee, Sunghwa (Department of Nursing, Gimhae College)
  • 권은희 (양산부산대학교병원 정형외과) ;
  • 이해정 (부산대학교 간호대학) ;
  • 이성화 (김해대학교 간호학과)
  • Received : 2018.04.05
  • Accepted : 2018.07.25
  • Published : 2018.08.31


Purpose: The purpose of this study was to develop a 12-week structured exercise program (12-week-SEP) and evaluate its effects on pain, physical function and quality of life in patients with total hip arthroplasty (THA). Methods: A nonequivalent control group non-synchronized design was utilized to examine the effects of the 12-week-SEP on patients' outcomes after THA. A total of 46 adult patients (experimental group=25, control group=21) who had THA were recruited for the study. The 12-week-SEP consisted of education, exercise (muscle strengthening and progressive walking), and feedback. Data were analyzed by SPSS/WIN 21.0 using the $x^2$ test and repeated measures ANOVA. Results: The mean age of the participants was 60.9 years and 25 men (54.5%) and 21 women (45.7%) were included in the study. There were significant intervention effects on pain reduction and increased physical function but no effects on quality of life. Conclusion: The 12-week-SEP provided pain relief and enhanced physical function in patients underwent THA. Clinical application of the 12-week-SEP can improve postoperative nursing practices for patients with THA. Future research with larger sample is of necessity to obtain greater generalizability of the empirical evidences of the 12-week-SEP.


  1. American Academy of Orthopaedic Surgeons. (2009). Total hip replacement. Retrieved March 19, 2018, from
  2. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. (2002). ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166(1), 111-117.
  3. Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. (1988). Validation study of WOMAC (Western Ontario and McMaster University Osteoarthritis): A health status instrument for measuring clinically-important patient relevant outcomes following total hip or knee arthropathy in osteoarthritis. Journal of Rheumatology, 15(12), 1833-1840.
  4. Christensen, C. P., Althausen, P. L., Mittleman, M. A., Lee, J. A., & McCarthy, J. C. (2003). The nonarthritic hip score: Reliable and validated. Clinical Orthopaedics and Related Research, 406, 75-83.
  5. Chung, M. S., & Kwak, H. S. (2008). Effects of a muscle strengthening exercise program after total knee arthroplasty. Journal of Korean Academic Society of Nursing Education, 14(1), 20-29.
  6. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed). Hillsdale, NJ: L. Erlbaum Associates.
  7. de Blok, B. M., de Greef, M. H., ten Hacken, N. H., Sprenger, S. R., Postema, K., & Wempe, J. B. (2006). The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: A pilot study. Patient Counselling and Health Education, 61(1), 48-55.
  8. Eom, S. B. (2008). A study on the effect of exercise training program on the function of a total hip in a patient with a total hip replacement after a surgery. Unpublished master's thesis, Kwangwon National University, Chuncheon.
  9. Gogia, P. P., Christensen, C. M., & Schmidt, C. (1994). Total hip replacement in patients with osteoarthritis of the hip: Improvement in pain and functional status. Orthopedics, 17(2), 145-150.
  10. Harris, W. H. (1969). Clinical results using the Mueller-Charnley total hip prosthesis. Clinical Orthopedics and Related Research, 86, 95-101.
  11. Heiberg, K. E., Bruun-Olsen, V., Ekeland, A., & Mengshoel, A. M. (2012). Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Follow-up one year after surgery. Arthritis Care and Research, 64(3), 415-423.
  12. Herr, K., Bjoro, K., & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review. Journal of Pain Symptom Manage, 31(2), 170-192.
  13. Jan, M., Hung, J., Lin, J. C., Wang, S., Liu, T., & Tang, P. (2004). Effects of a home program on strength, walking speed, and function after total hip replacement. Physical Medicine and Rehabilitation, 85(12), 1943-1951.
  14. Jeldi, A. J., Deakin, A. H., Allen, D. J., Granat, M. H., Grant, M., & Stansfield, B. W. (2017). Total hip arthroplasty improves pain and function but not physical activity. Journal of Arthroplasty, 32(7), 2191-2198.
  15. Kili, S., Wright, I., & Jones, R. S. (2003). Change in Harris hip score in patients on the waiting list for total hip replacement. Annals of the Royal College of Surgeons of England, 85(4), 269-271.
  16. Kim, S. E. (2017). Effects of early bed exercise education on the knowledge and compliance of the elderly after total hip replacement surgery. Unpublished master's thesis, Chonbuk National University, Jeonju.
  17. Klapwijk, L. C., Mathijssen, N. M., van Egmond, J. C., Verbeek, B. M., & Vehmeijer, S. B. (2017). The first 6 weeks of recovery after primary total hip arthroplasty with fast track. Acta Orthopaedica Scandinavica, 88(2), 140-144.
  18. Knight, S. R., Aujla, R., & Biswas, S. P. (2011). Total hip arthroplasty: Over 100 years of operative history. Orthopaedic Reviews, 3(2), 72-74.
  19. Korean National Health Insurance Service. (2017, November). Main Surgery Statistical Yearbook for 2016. Retrieved February 15, 2018, from
  20. McDonald, S., Page, M. J., Beringer, K., Wasiak, J., & Sprowson, A. (2014). Preoperative education for hip or knee replacement (Review). Cochrane Database of Systematic Reviews, 5, Art No:CD003526.
  21. Nallegowda, M., Singh, U., Bhan, S., Wadhwa, S., Handa, G., & Dwivedi, S. N. (2003). Balance and gait in total hip replacement: A pilot study. American Physical Medicine Rehabilitation, 82(9), 669-677.
  22. National Association of Orthopaedic Nurses. (2013). NAON patient education series: Total hip replacement. Chicago: National Organization of Orthopaedic Nurses.
  23. Oldmeadow, L. B., Edwards, E. R., Kimmel, L. A., Kipen, E., Robertson, V. J., & Bailey, M. J. (2006). No rest for the wounded: Early ambulation after hip surgery accelerates recovery. Australian and New Zealand Journal of Surgery, 76(7), 607-611.
  24. Park, K. H. (2013). Effects of a rehabilitation education program on hip function, activities daily living and fear of falling in elderly patients having undergone total hip replacement. Unpublished master's thesis, Chonnam National University, Gwangju.
  25. Ryu, K. A. (2003). A study on hip arthroplasty patients' compliance of medical regimen. Unpublished master's thesis, Pusan National University, Busan.
  26. Toogood, P. A., Abdel, M. P., Spear, J. A., Cook, S. M., Cook, D. J., & Taunton, M. J. (2016). The monitoring of activity at home after total hip arthroplasty. Journal of Bone and Joint Surgery, 98-B(11), 1450-1454.
  27. Unver, B., Kahraman, T., Kalkan, S., Yuksel, E., & Karatosun, V. (2013). Reliability of the six-minute walk test after total hip arthroplasty. Hip International, 23(6), 541-545.
  28. van Gool, C. H., Penninx, B. W., Kempen, G. I., Rejeski, W. J., Miller, G. D., van Eijk, J. T., et al. (2005). Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Arthritis Care and Research, 53(1), 24-32.
  29. Vincent, K. R., & Vincent, H. K. (2012). Resistance exercise for knee osteoarthritis. Journal of Injury, Function, and Rehabilitation, 4(5), 45-52.
  30. Ware, J., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220-233.