Functional Recovery After Elective Total Hip Arthroplasty Due to Osteoarthritis: The Role of Postural Stability

The main objective of this dissertation was to advance understanding of the role of postural stability in functional recovery among individuals 60 years and older after elective THA for OA, and to inform strategies to reduce fall risk and optimize functional outcomes. Study 1 systematically reviewed the literature to identify outcome measures and the components of postural stability evaluated in people post-THA for OA, using the Systems Framework for Postural Stability and summarized the effectiveness of exercise interventions delivered within the first three months after THA for OA on both short-term and long-term postural stability. Sixteen studies were included. The Timed Up and Go test was the most common measure. Adding balance-challenging exercises to standard rehabilitation improved short-term postural stability more than standard care, while long-term effects remain unclear. Study 2 prospectively compared direct anterior and direct lateral surgical approaches from pre-surgery to three months post-THA in 77 participants, assessing postural stability, balance confidence and other relevant health outcomes. The direct anterior approach yielded earlier gains in postural stability, but these differences dissipated by three months. Balance confidence, quality of life, hip function, stiffness and pain, physical activity, and overall health recovered similarly across approaches over the first three months after THA surgery. Study 3 surveyed Canadian physical therapists to characterize early postoperative rehabilitation, falls prevention practices, and implementation facilitators and barriers. Physical therapy care commonly emphasized individualized education and exercise-based therapy, but the use of validated assessments and evidence-based falls prevention practices was inconsistent. Reported variability in practice reflected workflow, staffing, and access constraints more than disagreement on clinical goals. Establishing minimum assessment standards, embedding brief validated fall screening with clear cut-points, and creating simple referral pathways are pragmatic steps to strengthen patient safety and reduce falls risk. Together, these studies identify assessment gaps, recommends early balance-challenging exercises to improve postural stability, highlights no durable surgical-approach advantage by three months after surgery, and outlines feasible implementation targets to improve post-THA functional recovery and reduce fall risk in adults 60 years and older undergoing elective THA for OA.

Name thesis:degree_name

Ph D

Discipline thesis:degree_discipline

Health and Rehabilitation Sciences

Grantor dc:publisher

The University of Western Ontario

Year dc:date.issued

2025

Author dc:creator

• Adebero, Tony Ifeoluwa

Advisors dc:contributor.advisor

• Lanting, Brent
• Bryant, Dianne

• Postural stability
• Total Hip Arthroplasty
• Exercise Intervention
• Osteoarthritis
• Rehabilitation
• Balance Confidence

Statement dc:rights

• Attribution-NonCommercial-NoDerivatives 4.0 International

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/20.500.14721/39276

OAI identifier oai:identifier

oai:uwo.scholaris.ca:20.500.14721/39276