PhysiotherApeutic Treat-To-Target intervention after total hip and knee arthroplasty does not improve outcomes compared to usual physical therapy: the PATIO study

Background: This nationwide superiority cluster randomized controlled trial evaluated the effectiveness of a personalized, treat-to-target postoperative physical therapy (PPT) strategy compared to usual care after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: There were 18 hospitals randomized to treat-to-target or usual PPT, with 624 patients undergoing primary THA or TKA being eligible for participation. Assessments were conducted preoperatively and at six, 12, 24, and 52 weeks after surgery. The primary outcome was change in physical functioning three months after surgery, assessed with the Hip/Knee injury Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS/KOOS-PS). Comparisons between groups were done using marginal models, including hospital as a fixed effect, with adjustment for sociodemographic and clinical characteristics. There were 312 THAs (53% women, aged 67 years (range, 40 to 88)) and 312 TKAs (55% women, aged 67 years (range, 41 to 88)) included. The THA patients received, on average, around 20 PPT sessions, and TKA patients around 30 sessions.

Results: All groups showed significant and clinically relevant improvements in function. There were no statistically significant between-group differences in change scores found for either HOOS-PS (19.9 (95% confidence interval (CI): 17.8 to 22.1) in the intervention group versus 18.2 (95% CI: 16.0 to 20.5) in the control group) or KOOS-PS (31.3 (95% CI: 29.3 to 33.4) versus 31.1 (95% CI: 29.0 to 33.2), respectively) at 3-months follow-up.

Conclusions: The use of a personalized treat-to-target PPT strategy had no additional benefits over usual PPT regarding physical functioning after THA or TKA. The COVID-19 pandemic is a potential study limitation; findings should therefore be interpreted with caution.