Hip replacement: What is it?
The total hip replacement is a surgical procedure in which both damaged surfaces of the hip joint are replaced with prosthetic substitutes. During a hip replacement, the head of the femur is replaced with a prosthetic head on a shaft, and the joint surface of the acetabulum is lined with a bowl-shaped synthetic joint surface.
What are its causes
Total hip replacement is a common orthopedic procedure utilised following:
- Osteoporosis and osteomalacia
- Neck of femur fractures (NOF)
- Rheumatoid arthritis
- Avascular necrosis
How can physiotherapy help for hip replacement post surgery?
The management of a patient it can be classified as preoperativeand postoperative.Both moments need an intensive physiotherapist action. The Preoperative management includes the prescription of exercise before the operation. The most important factors defining the therapy management are the surgical approach and the clinical state of the patient. The aim of post-operative rehabilitation is to define the functional needs of the patient and to improve strength and range of motion. If a patient has elected for surgery following their pathology then a client will present with muscle atrophy and loss of strength: particularly in the gluteal musculature and quadriceps.
Early postoperative rehabilitation after a total hip replacement is very important and it is focused on resorting to mobility, strength, flexibility and reducing pain.
Physiotherapy can improve strength, mobility and gait speed after the operation and help prevent complications.
Physiotherapy maximizes the patient’ function which is associated with a high probability of earlier discharge. It provides pain relief, promotes rehabilitation and the reintegration of patients into normal activities and reintegration into social life
Physical activity and early weight bearing have been clinically proven to increase the bone quality around the prosthesis, improve the fixation of the prosthesis and decrease the incidence of loosening.
Patients after replacement are at risk of hip dislocation. They must be evaluated by the Physiotherapist. Patients are encouraged to avoid excessive ranges and combination of the following hip movements: Extension, Abduction, External rotation, Weight-bearing restrictions as per surgeon
Expectations of exercise programme:
There are different protocols in the management of hip replacement. Different surgeons have different protocols regarding post-operative management. Therefore, it is essential to abide to this and also to discuss further with the physiotherapist.
Day 1 post-surgery: Education about muscular relaxation. Revision of precautions and contraindications. Bed exercises: Circulation drills. Upper limb exercises to stimulate the cardiac function. Maintenance of the other leg. Active-assisted heel slides, hip abduction/adduction. Bed mobilisation. Transfer to sit over the edge of the bed. Sit to stand with mobility assistive device. Re-education of the gait with a mobility assistive device as tolerated (weight bearing status as determined by the surgeon) Sitting out in a chair for a maximum of 1 hour. Positioning when transferred back to bed
Day 2 post-surgery:Patient should start with bed exercises and/or mobility assistive device. It is very important to incorporate balance exercises. Sitting in a chair.
Day 3 post-surgery:Completion of bed exercises as long as increasing mobility without need of assistance. A focus on progression of mobility distance with or without device is recommended. A focus on introduction of stair climbing and increased time spent out in chair is recommended.
Post-surgery: 6 weeks: Patients with hip replacement are followed up by an orthopedic surgeon. A slow return to normal gait unassisted with introduction of strength exercises.
After 6 weeks:A focus on functional exercise with an increased in stability and proprioceptive work alongside endurance, flexibility, speed and neurological coordination.