The surgical procedure of removing the diseased bone and cartilage of the hip joint, which is the ball and socket joint, and replacing with artificial implants is known as a total hip replacement. Total hip replacement is also known as total hip arthroplasty.
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| Hip Replacement |
Is Total Hip Replacement Surgery Meant for You?
A discussion needs to happen with your family and primary care doctor along with your orthopedic surgeon to decide whether or not to opt for a total hip replacement surgery.
Who is a Candidate for the Surgery?
There is no set rule based on age or weight to opt for this surgery. Recommendation for surgery is made based on the pain and disability of the patient. However, it has been noticed that people between the age group of 50 and 80 years mostly need total hip replacement surgery. Orthopedic surgeons perform the surgery after a thorough evaluation of patients individually. Total hip replacements have mostly been performed successfully on patients of all ages, whether a young teenager with juvenile arthritis or an elderly person with degenerative arthritis.
What Conditions Can Make the Surgery Needed?
The most common reasons include:
- Hip osteoarthritis
- Rheumatoid arthritis
- Post-traumatic arthritis
- Avascular necrosis
- Childhood hip disease
When is Surgery Recommended?
Your doctor may suggest a total hip replacement due to several reasons. People who benefit from this surgery often have:
- Hip pain that lingers while resting.
- Hip pain that limits walking, bending and other regular activities.
- Stiffness in one of the hips limiting the person’s ability to lift or move the leg.
- Inadequate pain relief from physical therapy, walking supports or physical therapy.
- X-rays, MRI scans or other investigations indication significant injury requiring surgery
What are the Complications and Risks of Hip Replacement Surgery?
Like any other surgery, a total hip replacement can have certain complications and risks that include:
- Dislocation
- Infection
- Bleeding
- Blood clots in the lungs or legs
- Leg length difference
- Hip implant loosening
- Need for additional or revision hip surgery
- Nerve injury that can cause numbness, weakness or both
There could be other risks involved depending on your health condition. Thus, it is always advisable to discuss any concerns with the medical doctor before the surgery.
How Long the Replacement Would Last?
Hip replacements can wear out with time. However, depending on various studies, it is expected to last anywhere between 15 and 25 years.
Role of Physiotherapy in Recovering Post THR Surgery
A successful THR surgery is half the battle won. It is essential to opt for physiotherapy rehabilitation to maximize independence and functionality by building up muscle strength around the new joint. Moreover, it helps to minimize complications such as deep vein thrombosis, wound infection, hip dislocation, and pulmonary embolism.
A person may need to undergo physiotherapy for weeks or even months after THR surgery to get back to normal. Therapy starts almost immediately in most cases and sometimes while still in the hospital.
PHYSIOTHERAPY MANAGEMENT
General Principal of treatment
- Prevention
- To control pain
- To prevent further damage
- To improve ROM
- To improve strength, endurance & muscle function
- To improve functional status
- Relief of pain & inflammation
- Prevention of deformity
- Correction of deformity
- Restore & maintenance of joint motion
Treatment for acute phase & chronic phase:
- Pain control: – Electrotherapy modalities should be used.
- superficial heat modalities
- Cryotherapy
- Ultrasound
- TENS
- Stimulation
- Short wave Diathermy
- To prevent further damage
- Properly supported positioning of the involved joints & correct bed posture are important
- To improve ROM
- Active free relaxed rhythmic movements improve the range as well as promote relaxation of joint
- Relaxed passive movements to be started first to mobilize stiff joints
- Hydro therapy & PNF techniques are useful to improving ROM.
- Splints & sand bags may provide additional support to limb.
- To improve strength, endurance & muscle function
- Graduated exercise programmed is initiated which consists of progressive resistance (PRE), strong & sustained session isometrics holding or sustain muscle contractions in static mid-range position of isometric.
- Improve vital capacity
- Deep breathing exercises are important to improve vital capacity.
- Functional mobility
- The functional mobility should be encouraged & maintained.
- Improving functional independence providing aids, modified supports.
- ADLS
- Prevention of deformity
- Splints should be used
- Correction of deformity
- Maintain positions
- Use splints
- Joint motion
- Active & functional therapeutic programme
- Standing & walking
- Orthotics support or walking aid
- Parallel bar
- Splints
- Knee caps
- Lumbar belt
- Grip Strength Exercise.
- Squeeze a small ball (a racquetball works well) with gentle but even pressure several times per day.
DO’s & DONTs
DO’s
- 8-10 hours of sleep, on my back, sitting up. Lots and lots of pillows propping me up, and one for the arm too.
- Sleeping in a sling to avoid movement.
- Ultrasound bone stimulation twice a day.
- 20 minute icing at least once a day.
- Glutamine supplements (5,000 mg/day).
- Vitamin D supplements (1,000 IU/day).
- Calcium supplements (1,000 mg/day).
DONTs
- Sleep on my side, it aggravates the shoulder all night long.
- Lifting weights (even light ones) before four weeks.
- Doing sit-ups.
Your physiotherapist is meant to:
- Closely monitor your progress
- Give you advice and contraindications of your operation
- Help you manage pain
As improvement and progress are seen in the patient, more exercises are added to the regime to enhance strength and endurance further. Walking is a good exercise if done at a moderate speed several times a day. Start with a 5-minute walk at a time and slowly increase up to 20-30 minutes. A cane may be used if needed for walking. However, before taking this step, consult your physician or surgeon for approval.
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