Robotic Total Hip Replacement (THR) Protocol

Rehabilitation: Robotic Total Hip Replacement (THR)

Rehabilitation: Robotic Total Hip Replacement (THR)

Rehabilitation Philosophy

This is a criteria-based, function-driven, and biologically informed protocol designed to optimise recovery following robotic-assisted total hip replacement.

Progression is guided by strength, movement quality, pain response, pelvic control, and functional independence, not time or walking distance alone.

Robotic-assisted THR enables:

  • Accurate implant positioning

  • Restoration of leg length and offset

  • Improved soft-tissue balance

This facilitates early confident loading, but does not replace the need for progressive strength and neuromuscular rehabilitation.

Surgical Approach Considerations

Rehabilitation must account for the surgical approach (anterior or posterior), as this may influence early precautions and loading strategies.

  • Anterior approach:
    Typically allows early functional progression, with attention to soft-tissue irritation and hip flexor loading.

  • Posterior approach:
    Requires early awareness of posterior soft-tissue healing and avoidance of combined flexion/adduction/internal rotation in the early phase.

Beyond the early post-operative period, rehabilitation principles converge, with strength, control, and gait symmetry remaining the primary determinants of outcome.

Core Rehabilitation Priorities

  • Restoration of hip extension and abductor function

  • Pelvic control and gait symmetry

  • Progressive resistance training as the primary driver of recovery

  • Walking as an adjunct, not a substitute for strengthening

Clinical Governance & Escalation

The following should prompt reassessment and possible surgical review:

  • Persistent or worsening lateral hip pain

  • Trendelenburg gait or progressive limp

  • Failure to progress despite appropriate loading

  • Increasing pain or functional decline

Key Principles

Rehabilitation must be individualised based on:

  • Surgical approach and implant

  • Pre-operative strength and gait pattern

  • Abductor integrity

  • Patient-specific functional goals

Early priorities:

  • Hip extension restoration

  • Abductor and extensor activation

  • Pelvic and trunk control

Movement quality and load tolerance, not time, govern progression.

Preoperative Phase (Prehabilitation)

Goals

  • Optimise hip ROM (particularly extension), if tolerated

  • Improve gluteal and trunk activation

  • Maintain strength and balance

  • Prepare for accelerated recovery

Clinical Notes

  • Minimum one physiotherapy session recommended

  • Address:

    • Trendelenburg gait

    • Abductor weakness

    • Gait aid familiarity

Education focus

  • Strength-led recovery model

  • Expected pain and fatigue trajectory

  • Early mobilisation principles

Phase 1 – Early Mobility & Activation (0–2 Weeks)

Goals

  • Protect healing soft tissues

  • Restore functional movement

  • Activate abductors and extensors

  • Achieve independent mobility

Rehabilitation Focus

  • Active ROM within comfort

  • Sit-to-stand retraining

  • Gluteal activation and hip abduction

  • Straight leg raise (as tolerated)

  • Gait retraining:

    • Pelvic stability

    • Step-length symmetry

  • Weight-bearing as tolerated with gait aid

  • Cryotherapy and swelling management

Clinical Emphasis

  • Short, frequent movement bouts

  • Avoid prolonged inactivity

  • Prioritise control over walking distance

Phase 2 – Early Strength & Gait Normalisation (2–6 Weeks)

Goals

  • Improve abductor and extensor strength

  • Normalise gait

  • Build functional confidence

Rehabilitation Focus

  • Closed-chain strengthening:

    • Sit-to-stand

    • Mini-squats

    • Step-ups

  • Hip abduction and extension work

  • Balance and proprioception training

  • Cycling or treadmill walking (adjunct only)

Monitor

  • Lateral hip pain

  • Trendelenburg pattern

  • Fatigue-related gait deterioration

Phase 3 – Strength & Capacity (6–12 Weeks)

Goals

  • Restore strength symmetry

  • Improve pelvic and trunk control

  • Increase load tolerance

Rehabilitation Focus

  • Progressive resistance training:

    • Squats

    • Split squats

    • Step-down control

  • Hip abductor and external rotator strengthening

  • Core stability

  • Dynamic balance and directional control

Phase 4 – Advanced Function (3–6 Months)

Goals

  • Maximise independence

  • Restore endurance and confidence

  • Return to lifestyle and recreational activities

Rehabilitation Focus

  • Higher-load strengthening

  • Uneven surface balance

  • Endurance conditioning

  • Activity-specific progression (low impact)

Return To Activities (Criteria-Based)

Driving

  • Safe emergency braking

  • No opioid/sedating medication

Guide:

  • Right THR: ~4–6 weeks

  • Left THR (automatic): ~2–3 weeks

Minimum Criteria for Return to Recreation

  • Minimal or no pain

  • Functional ROM

  • Independent, non-antalgic gait

  • No Trendelenburg sign

  • Adequate abductor strength for:

    • Single-leg stance

    • Stair negotiation

Encouraged

  • Walking

  • Cycling

  • Swimming

  • Golf

  • Gym-based strengthening

Discouraged

  • Running

  • High-impact activity

  • Contact or pivoting sport

Surgeon Notes

  • Abductor strength and pelvic control are key determinants of outcome

  • Persistent Trendelenburg gait requires targeted intervention

  • Robotic-assisted THR supports:

    • Earlier confidence in loading

    • Accelerated progression when criteria are met

Modify rehabilitation for:

  • Revision THR

  • Significant deformity

  • Abductor deficiency or trochanteric pathology

Key Clinical Message

Rehabilitation following THR is strength-led, not step-count driven.

Walking supports recovery, but durable outcomes depend on restoring strength, control, and movement quality.

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