# A Case of Successful Perioperative Rehabilitation in Two-Stage Revision Total Hip Arthroplasty for an Intraoperative Acetabular Fracture: Insights Into Interim-Period Rehabilitation Strategies

## TL;DR

This case study shows how targeted muscle training during a two-stage hip surgery helped a patient recover walking ability effectively.

## Contribution

The study highlights effective interim rehabilitation strategies for two-stage hip revision surgery.

## Key findings

- Progressive muscle training improved strength in both upper and lower limbs during the interim period.
- The patient achieved a walking speed of 0.90 m/s after four weeks of post-reimplantation rehabilitation.
- Interim muscle training supported early gait recovery without hindering bone fusion.

## Abstract

Two-stage revision arthroplasty often results in poor functional outcomes. Rehabilitation strategies to maximize functional recovery after two-stage revision arthroplasty have not yet been established. This report presents a case of successful rehabilitation in two-stage revision total hip arthroplasty (THA). A 75-year-old Japanese woman underwent primary THA and experienced an intraoperative acetabular fracture. Staged revision THA was performed because of a large bone defect. After the first-stage implant removal, progressive muscle strength training, such as quadriceps and isometric exercises for the hip muscles, was performed with consideration of bone fusion, in addition to strengthening the unaffected limbs. During the interim period, an improvement in muscle strength was observed in both the upper and lower limbs. After the second-stage reimplantation, weight-bearing was gradually allowed. Three weeks after full weight-bearing was allowed, the patient was able to walk at 0.67 m/s with a cane. Further recovery of walking speed was achieved after a further four weeks of inpatient rehabilitation, reaching 0.90 m/s. In this case, interim-period muscle strength training was assumed to have contributed to early gait acquisition after reimplantation, without interfering with bony fusion. Well-worked muscle strength training to maintain or even improve muscle strength during the prosthesis-free interval may be important for functional recovery after two-stage revision arthroplasty.