Objective: To examine the effectiveness of a specific physiotherapy program before hip arthroplasty in patients with hip osteoarthritis.

Design: Multidimentional prospective randomised controlled study

Subjects: 25 patients meet the inclusion criteria and were randomised in a study and a control group

Intervention: All the patient underwent THA performed by the same surgeon and implanted with the same prosthesis. Study group performed educational and physiotherapy program one month before surgery. Study and control group performed inpatient rehabilitation program only post surgery.

Main outcome measures: patients were evaluated, 1 month before surgery(T0), the day before surgery (T1), 15 days (T2), at 4 weeks (T3) and at 3 months (T4) post surgery using measure of hip muscle strength, hip range of motion, Barthel Index, Short Form-36, WOMAC, Harris Hip Score (HHS), Visual Analogue Scale (VAS).

Results: The study group present significant improvement of hip extrarotation at each evaluation, significant high values of gluteus medius strength (p level 0,004) at T1, significant hip abduction (p level 0,02) at T3, significant lower score in VAS at T1 (p level −2,10), T3 (p level −2,10) and at T4 (p level 0,02), significant improvement in Womac scores (p level −2,32) at T4. In study group, SF 36 Physical composite score was significant high at T1(p level 0,048), Mental composite score at T2 (p level 0,006) and T3 (p level 0,02).

Conclusion: our pre surgery programme improves values of clinical status and social function, besides pain reduced before surgery until three months after surgery.

Bone Loss is the main problem in failed total hip arthroplasties. Revision surgery must be conformed to the degree of the bone loss. Since 1986, 330 cases of failed THA underwent to revision surgery. Different solutions were adopted according to Paprosky femoral defects classification. In type I, a primary cementless stem was implanted (23%). In type II and IIIa, were proximal fixation is still possible to achieve, Mid PCA-Howmedica (5%) and modular S-ROM-J& J revision stems (18%) were implanted. In all the other degree of bone loss (IIIb–IV) cementless distal fixation stems, Long PCA-Howmedica (17 %), Wagner-Sulzer (18 %) and modular (MP-Link, Profemur-Wright) (19 %), were used. Patients were clinically and radiographically evaluated by HHS and according to Engh’s criteria. Best results were observed in Type I group (HHS=90). Long and mid PCA stems presented poor clinical (HHS=60) and radiographical results and required re-revision in 15% of cases. Intermediate results were observed in Wagner prostheses. Modular revision stems showed best results although earlier F-U. (HHS=80). Of these, re-revision surgery was performed in two cases, one of which because of infection and the other one due to severe thigh pain.

Cementless modular stems seem to be the most suitable technique. Distal fixation associated with proximal fill permit to manage the majority of femoral bone defects minimizing bone grafts. The modular stems, allow to conform the design of the components to the bone defects permitting to achieve primary stability (press-fit), restoring the centre of rotation and muscles tension, reducing pain and restoring hip function.