Diagnosis: Total Hip Replacement

 In Exercise and Health

What is a Total Hip Replacement?

The hip joint is a large ball and socket joint that transmits all of the ground forces from the legs to the body, and bears the weight of the upper body. This means that the hip joint is one of the joints in the body that is most prone to wear. Over time, the wear on the hip joint may reach an extent where it cannot heal itself. A damaged hip from degenerative diseases like osteoarthritis can become very painful and debilitating.

The hip joint is one of the joints in the body that is most prone to wear. #performbetter @pogophysio Click To Tweet

A total hip replacement (THR), as its name suggests, is a surgical procedure where the original damaged parts of the hip, namely the head of the femur (the ball) and the acetabulum (the socket), are replaced with metallic prosthetics that replicate the function of the joint.

The aim of a total hip replacement is to alleviate pain and restore sufficient movement of the hip so that patients can do activities such as walking, cycling, swimming and ascend/descend stairs, in order to have a greater independence and participation in life.

Reasons for Total Hip Replacement

There are many diseases of the hip that lead to joint damage, pain and disability. The most common are listed below. The main reason for total hip replacement is pain and loss of mobility which limits everyday activities such as walking and bending.

  • Hip Osteoarthritis
    An age related condition where cartilage within the hip joint wears away, leading to bone to bone contact, joint inflammation and the formation of bony spurs.
  • Rheumatoid Arthritis
    An autoimmune disease where the synovial membrane which lines the joint and produces lubricating fluid, becomes inflamed and thickened, resulting in pain and stiffness.
  • Post-Trauma
    A traumatic injury can damage the cartilage within the hip, which in turn, leads to arthritis. Traumatic can also cause a femoral neck fracture, which can cut off blood supply to the femoral head, leading to avascular necrosis (death of the bone).
  • Osteoporosis and Osteomalacia
    Weak bones are more prone to fracture, and can lead to avascular necrosis
    Paget’s disease in the elderly are generally treated with a THR.
  • Childhood Hip Diseases
    Children who have suffered from perthes disease, or developmental dysplasia of the hip may be more susceptible to arthritis in adulthood

Surgical Outcomes and Risks

Some common risks and complications associated with hip replacement surgery is listed below:

  • Infection
    Patients must be careful with wound care and follow strict infection control practices immediately after surgery.
  • Deep Vein Thrombosis
    The formation of blood clots and embolism post THR is a risk that needs monitoring to prevent secondary complications. Patients may be prescribed with anticoagulants for 7 – 10 days post surgery.
  • Dislocation
    The soft tissues that normally surround the hip and provide stability are cut during surgery. While they are healing, the new hip is less stable and prone to dislocate. Dislocations increase the risk of post surgery complications such as additional surgery, damage to the new hip. Care and lifestyle changes may need to be implemented to reduce this risk.
  • Fracture
    The prosthetics increase stress on the bones they are implanted on and this makes them more susceptible to fractures. Postural changes may need to be implemented to reduce this risk.

Physiotherapy for Hip Replacement

The goal of physiotherapy is to return the patient to their activities of daily life and reduce the risk of post surgery complications.

Physiotherapy normally starts in the hospital immediately after surgery where patients are prescribed exercises to stop the weakening of the muscles around the new hip and weight bearing through the new hip as tolerated. The hospital physiotherapist will also help you to progress over the next 4 to 7 days until you are able to confidently walk up and down a flight of stairs before being discharged.

Postural and lifestyle changes that need to be adopted are not crossing the thighs, avoid hip flexion beyond 90 degrees, avoid sleeping on the surgical side, limiting alcohol consumption and smoking cessation.

For good long term outcomes, physiotherapy programs over 6 to 12 months are recommended. These can help patients gain more range of motion, endurance, improve balance and coordination so they can participate in low impact sports such as swimming and cycling.

Wayne Wu
Student Physiotherapist

References

(AAOSOnlinePubs, 2012; Beckers, Tourwe, Rozenbergs, Everaert, & Buxton, 2016; Minns Lowe, Barker, Dewey, & Sackley, 2009; Wikipedia contributors, 2016)AAOSOnlinePubs (Producer). (2012, December 04, 2016). Dislocation After Total Hip Replacement. [Video] Retrieved from https://www.youtube.com/watch?v=Krt2BMrWV6Q

Beckers, A., Tourwe, J., Rozenbergs, D., Everaert, V., & Buxton, S. (2016). Total Hip Replacement  Retrieved December 04, 2016, from http://www.physio-pedia.com/Total_Hip_Replacement

Foran, J. R. H. (2015, August). Total Hip Replacement  Retrieved December 04, 2016, from http://orthoinfo.aaos.org/topic.cfm?topic=a00377

Minns Lowe, C. J., Barker, K. L., Dewey, M. E., & Sackley, C. M. (2009). Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials. BMC Musculoskeletal Disorders, 10, 98-98. doi: 10.1186/1471-2474-10-98

Wikipedia contributors. (2016, November 29). Hip replacement  Retrieved December 04, 2016, from https://en.wikipedia.org/w/index.php?title=Hip_replacement&oldid=752057409

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