JOA - 2026-07-01 - Journal Article; Randomized Controlled Trial; Equivalence Trial; Multicenter Study; Comparative Study; Research Support, Non-U.S. Gov't
PhysiotherApeutic Treat-To-Target Intervention After Total Hip and Knee Arthroplasty Does Not Improve Outcomes Compared to Usual Physical Therapy: The PATIO Study.
Groot L, Gademan MGJ, van Loon D, Peter WF, Vliet Vlieland TPM, Reijman M, PATIO study group
Topics
Key Takeaway
A personalized treat-to-target postoperative physical therapy protocol produced no significant improvement in HOOS-PS or KOOS-PS at 3 months compared to usual care after THA/TKA (between-group difference <2 points for both).
Summary Depth
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Summary
This multicenter cluster RCT asked whether a personalized treat-to-target postoperative physical therapy strategy outperforms usual care after primary THA and TKA, randomizing 18 hospitals and 624 patients with assessments at 6, 12, 24, and 52 weeks. The primary outcome, HOOS-PS/KOOS-PS change at 3 months, showed no statistically significant between-group difference: HOOS-PS improved 19.9 vs 18.2 points and KOOS-PS improved 31.3 vs 31.1 points in intervention vs control groups, respectively. Both groups achieved clinically relevant functional gains, indicating usual care is not inferior to the structured treat-to-target approach.
Key Limitation
COVID-19 pandemic disruptions to therapy delivery and patient attendance were uncontrolled and unquantified, making it impossible to determine whether the null result reflects true equivalence or protocol fidelity failure in the intervention arm.
Original Abstract
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.