OBJECTIVE: To evaluate the effect of inpatient aquatic physiotherapy in addition to usual ward physiotherapy on the recovery of strength, function, and gait speed after total hip or knee replacement surgery. DESIGN: Pragmatic randomized controlled trial with blinded 6-month follow-up. SETTING: Acute-care private hospital. PARTICIPANTS: People (n = 65) undergoing primary hip or knee arthroplasty (average age 69.6 +/- 8.2y; 30 men). INTERVENTIONS: Participants were randomly assigned to receive supplementary inpatient physiotherapy, beginning on day 4: aquatic physiotherapy, nonspecific water exercise, or additional ward physiotherapy. MAIN OUTCOME MEASURES: Strength, gait speed, and functional ability at day 14. RESULTS: At day 14, hip abductor strength was significantly greater after aquatic physiotherapy intervention than additional ward treatment (p = 0.001) or water exercise (p = 0.011). No other outcome measures were significantly different at any time point in the trial, but relative differences favored the aquatic physiotherapy intervention at day 14. No adverse events occurred with early aquatic intervention. CONCLUSIONS: A specific inpatient aquatic physiotherapy program has a positive effect on early recovery of hip strength after joint replacement surgery. Further studies are required to confirm these findings. Our research indicates that aquatic physiotherapy can be safely considered in this early postoperative phase.

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