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vol. 52
Original paper

Assessment of the impact of the rehabilitation procedure on functional and clinical condition of patients with coxarthrosis

Dariusz Jankowski
Anna Kuryliszyn-Moskal

Reumatologia 2014; 52, 1: 57–61
Online publish date: 2014/03/23
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Osteoarthritis is one of the most frequent diseases of the musculoskeletal system. Its widespread occurrence makes it a life style disease. Osteoarthritis is a slowly progressive joint disorder which principally affects the hands and the large weight-bearing joints. The destabilisation of the homeostasis between the cartilage degradation and synthesis processes is the key factor in the pathogenesis of the disease [1, 2].

Aim of the study

The aim of this study was to assess the impact of the rehabilitation procedure on functional and clinical condition of patients with coxarthrosis, taking into consideration such factors as gender, disease duration and type of treatment applied.

Material and methods

The test was conducted in the Independent Public Health Care Centre, Rehabilitation Centre in Suwałki, after a positive opinion by the Bioethics Committee at the Medical University of Białystok (no. R-I-002/424/2011). Eighty-five patients, having given written consent, were tested: 50 patients were treated non-invasively, including 35 women and 15 men, and 35 – were treated surgically, including 21 women and 14 men. The characteristics of patients are presented in Table I.

All patients were provided with physiotherapeutic treatments for 10 days, excluding Saturdays and Sundays. For physiotherapy, a point diode (semiconductor) laser CTL-1106MX was used with the wavelength of 820 ±10 nm, with a total output power of 100 mW, doses = 8 J frequency 1000 Hz and 12-minute treatment time used for the hip joint areas. For kinesitherapy, the patients did non-weight-bearing exercises. They also performed isometric exercises for muscles of the hip. For therapeutic massage, patients were subjected to classical massage of the sacro-iliac joint areas and the hip joint for 25 minutes.

The assessment of functional and clinical condition of patients with coxarthrosis was conducted on the basis of the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) Questionnaire and the Lequesne Pain Index for the hip joint. The test were carried out on the first and the last day of treatment.

Statistical analysis

For comparison of dependent variables, the Wilcoxon paired rank test was applied for two variables. The findings were considered as statistically significant at p < 0.05. The statistica 10.0 package by StatSoft was used for calculations.


For both groups of patients, a significant decrease in the WOMAC Index values after applying the rehabilitation procedure in relation to the WOMAC Index value for patients before rehabilitation was demonstrated (Table II). Also, for both groups of patients, a significant decrease in the Lequesne Index values after applying the rehabilitation procedure in relation to the Lequesne Index value for patients before rehabilitation was observed (Table II).

The results of the study indicate that the rehabilitation procedure significantly affects functional and clinical condition of patients with coxarthrosis (Fig. 1).

Both for patients treated non-invasively and surgically, a significant decrease in the WOMAC and Lequesne Index value could be observed after applying the rehabilitation procedure. However, the group of patients treated surgically achieved greater differences within the WOMAC Index after rehabilitation as compared to the patients treated in a non-invasive manner (Figs. 2, 3).

With regard to disease duration, although the rehabilitation procedure had a favourable effect in both groups, the patients with shorter disease duration (less than 10 years) had a greater difference in the both indices (Figs. 2, 3).

The WOMAC and Lequesne Index values were significantly lower after rehabilitation, gender-independently, however, the group of male patients had a greater differences in both indices after rehabilitation as compared to the group of female patients (Figs. 4, 5).


Coxarthrosis is one of the main causes of deterioration of life quality resulting from pain and limited joints mobility. Recently, the development of a large number of health-related quality of life measurement instruments has been demonstrated. The WOMAC Index and the Lequesne Index provided valuable information about improvements in feelings of pain, stiffness and mobility of joints in patients with coxarthrosis [3–6].

The Lequesne Index is used in gonarthrosis, but its modification can also be applied when assessing the functional and clinical condition of patients with the coxarthrosis [5]. It assesses the degree of pain in the joint at rest and during motion. Interesting findings for both indices were presented in a publication by Basaran et al. [6] where the correlation between the WOMAC and the Lequesne Index was tested in relation to the hip and knee joint.

Both indices are good tools for measurement to the functional and clinical condition of patients with coxarthrosis. There are many wide-perspective case studies concerning the assessment of the functional and clinical condition of patients with the coxarthrosis, but the majority of them mainly refer to the problem of endoprosthetics [7–17]. Recently, an algorithm of physical therapy exercises in patients after total hip arthroplasty has been proposed [18].

Interesting results showing improvement of the functional and clinical condition of patients with coxarthrosis were presented in a publication by Iwaniszczuk and co-authors [19]. The assessment of the impact of physiotherapeutic procedures applied in patients with coxarthrosis, showed significant efficiency of physical therapy that improved functional and clinical condition. It was also observed that non-weight-bearing exercises were a relevant element of the therapy.

Tyborowicz’s [20] showed that all groups of patients, independently of the clinical feature and duration of the disease, achieved an improvement in joint’s mobility and decrease of pain after exercises. The author points out that a better effect in joint mobility can be achieved when starting exercises at the early stage of the disease.

A positive influence of rehabilitation was reported in a publication by Pop and co-authors [21]. The aim of that study was to assess the effects of sanatorium rehabilitation in patients with coxarthrosis. They found that 80% of patients defined the improvement in their health condition as considerable, 18% as slight and only 3% of patients reported no improvement at all. Improvement was interpreted as improvement in the range of hip joint mobility and decrease in oedema and pain [21].

Interesting results were presented in a publication by Demczyszak and co-authors [22]. The study involved 30 patients aged 61–80 years after total hip replacement. The physiotherapeutic procedure used in their study improved the range of motion of the operated joint.

A positive influence of rehabilitation was observed in a publication by Hawrylak and co-authors [23]. The study group comprised 30 patients, aged 60–75 years, following cementless hip replacement surgery. The physiotherapeutic treatment brought about an improvement of hip joint mobility and the process of maintenance of body balance in the standing position in patients who had undergone hip replacement surgery, thus improving the quality of their lives.

Hagner et al. [24] carried out a study aimed at assessing in the significance of early rehabilitation in the recovery process after hip joint’s endoprosthesis. The findings led to conclusion that rehabilitation procedure had positive influence on improvement of functional and clinical condition after hip joint endoprosthesis.

Similar conclusions were reached by Golec et al. [25]. The authors analyzed 37 literature items dealing with issues of patients’ health status improvement after hip joint total alloplastics. They are of the opinion that improvement of functional and clinical condition of patients after hip joint total alloplastics can be achieved not only by choosing invasive surgery, but also by implementation of the rehabilitation procedure.

The findings from the literature on the impact of rehabilitation in coxarthrosis patients were confirmed in our study. The satisfactory improvement of physiotherapy in the treatment strategy of patients suffering from coxarthrosis presented in this report requires further prospective long-term studies in a large group of patients.


The proposed rehabilitation procedure significantly improves the functional and clinical condition of patients with coxarthrosis.

Disease duration (more than 10 years), female gender and non-invasive treatment are factors influencing the efficiency of rehabilitation for patients with coxarthrosis.

The results suggest the necessity of using rehabilitation procedure’s in patients with coxarthrosis.

The authors declare no conflict of interest.


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Copyright: © 2014 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

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