Compliance with Home-Based Prehabilitation and Length of Stay After Total Hip Arthroplasty: A Prospective Cohort Study

Background/Objectives: Patients awaiting total hip arthroplasty (THA) may have a preoperative period for home-based exercise. However, the benefit of prehabilitation may depend on programme completion. This study assessed the association between compliance with home-based prehabilitation and postoperative course after THA, particularly hospital stay and self-assessed health status at discharge, and explored associations between compliance and changes in clinical and functional outcomes. Methods: In this prospective single-centre observational cohort pilot study, 40 adults scheduled for elective THA were included in a planned 60-day home-based prehabilitation programme as standard preoperative care. Assessments were performed before prehabilitation, preoperatively, and at discharge. Compliance was recorded using a daily checklist and expressed as a compliance index. Associations were analysed using non-parametric tests and Spearman correlation. Results: Median compliance index was 32.41%. Higher compliance was observed in participants reporting improvement or marked improvement at discharge than in those reporting slight improvement or no improvement (p = 0.0076). Compliance was inversely correlated with postoperative length of stay, median 6 days (rho = −0.593, p < 0.001). Compliance was lower in participants who reported pain during exercise (p = 0.0127). No significant associations were found between compliance and postoperative symptoms or changes in hip muscle strength, mechanical muscle properties, pain intensity, or functional test performance between baseline and preoperative assessments. Conclusions: Greater compliance with home-based prehabilitation was associated with shorter postoperative hospitalization and more favorable self-assessed health status at discharge. These findings support strategies to improve programme completion and minimize exercise-related pain.