Hip Replacement (HR)

Hip replacement surgery, also known as total hip arthroplasty, involves removing a diseased hip joint and replacing it by having an artificial joint, known as a prosthesis. Hip prostheses consist of a ball component, metallic or ceramic, along with a socket, which has an insert or liner made from plastic, ceramic or metal. The implants utilized in hip replacement are biocompatible - meaning they're made to be accepted by your body - and they are made to resist corrosion, degradation and wear.
Hip replacement is usually used for people with hip joint damage from arthritis or perhaps an injury. Followed by rehabilitation, hip replacement can relieve pain and restore flexibility and function of your hip joint.
Hip Replacement Rehabilitation
The Hip Replacement Rehabilitation protocols mentioned here for are general and really should be tailored to a particular patients. For example, standing and walking should be limited to toe touch in osteotomy from the femur. Expansion osteotomies allow the insertion of the larger prosthesis, and reduction osteotomies allow narrowing from the proximal femur normally. In patients with one of these osteotomies, weight-bearing should be delayed until some union exists. These patients should avoid SLR (straight leg raise) and side-leg-lifting until, surgeon agrees that it's safe to do so. Hip Replacement Rehabilitation may also have to be adjusted because ofstability. Abduction brace enables you to prevent adduction and flexion in excess of 80 degrees for upto 6 months in the event of recurrent dislocations. Similarly, leg shortening via a hip at the time of revision without or with a constrained socket ought to be protected with an abduction brace before the soft tissues tighen up.
Hip Replacement Rehabilitation Protocol
Goals of Hip Replacement Rehabilitation
• Guard against dislocation from the implant.
• Obtain pain free flexibility within safe limits.
• Gain functional strength.
• Strengthen hip and knee musculature.
• Teach transfers and ambulation independently or with assistive devices.
• Prevent bedrest hazards (eg. pneumonia, decubitus ulcer, pulmonary embolism, thrombophlebitis).
Rehabilitation Considerations in Cemented and Cementless Techniques
In cemented total hip Standing and walking To Toleranance (WBTT) with walker ought to be started immediately after surgery.
Preoperative Instructions
• Instruct on precautions for hip dislocation (mentioned later).
• Provide instructions for transfers interior and exterior bed and chair.
• Avoid deep chairs. Also instruct the individual to look at the ceiling because they sit down to minimize trunk flexion.
• Avoid crossing legs while sitting.
• While rising from the chair scoot to the fringe of the chair after which rise.
• Use elevated commode seat. Elevated seat is positioned on commode at a slant, with higher part behind, to aid in rising.
• For ambulation instruct on utilization of anticipated assistive device.
Postoperative Hip Replacement Rehabilitation Regimen
Patient ought to be made to come out of bed in stroke chair twice daily with assistance within 1 or 2 days postoperatively. Chair shouldn't be of low height. Begin ambulation with assistive device (walker) twice daily.
Weight bearing recomendations in Hip Replacement Rehabilitation
Cemented Prosthesis: Standing and walking as tolerated with walker for atleast 6 weeks, then use cane within the contralateral hand for 4-6 months.
Cementeless Prosthesis: Arrive weight bearing with walker for 6-8 weeks, then make use of a cane in contralateral hand for 6 months. Wheelchair can be used for long distances with careful avoidance of excessive hip flexion more than 80 degrees during wheelchair, this can be achieved by putting a cushion in the wheelchair seat with highest cushion point posterior.
Isometric and bed Exercises (Hip Replacement Rehabilitation)
• Straight Leg Raise (SLR)- Tighten knee and lift leg from the bed, keeping the knee straight. Flex the alternative knee to aid this exercise.
• Ankle Pumps- Pump ankle down and up repeatedly.
• Quadriceps Sets- Tighten quadriceps muscles by pushing knee down and holding for a count of 5.
• Gluteal Sets- Squeeze buttocks together and hold for a count of 5.
• Isometric hip abduction with self resistance while lying.
• Hip abduction adduction- (Prevent initially if patient were built with a trochanteric osteotomy). While lying around the back patient slide the leg to the side. In standing you can do this by moving the lower limb out to the side and back. Perform this exercise while lying somewhere (5-6 weeks postoperatively). The patient ought to be turned 30 degree towards vulnerable to utilize gluteus maximus and medius muscles. Most sufferers would otherwise tend to rotate for the supine position, thus abducting using the tensor fascia femoris.
ROM and Stretching Exercises (Hip Replacement Rehabilitation)
• 1 to 2 days postoperative, begin Thomas stretch to prevent flexion contracture of the hip. Pull the uninvolved leg towards the chest while lying supine around the bed. At the same time, push the involved leg from the bed. This stretches the anterior capsule and also the hip flexors of the involved leg. Perform this stretch 5 times per session, 5-6 times each day.
• Patient may start with exercising on stationary bicycle based on trunk stability having a high seat 4-7 day postoperative. Until successful completing a full arc on the bicycle, the seat ought to be set as high as possible. The seat might be progressively lowered to improve hip flexion within safe parameters.
• Perform extension stretching from the anterior capsule in waiting extending the involved leg as the uninvolved leg is mildly flexed in the hip and knee, based on the walker. Slowly thrust the pelvis forward and also the shoulders backward for a sustained stretch from the anterior capsule.
Abduction Pillow
Keep an abduction pillow between your legs while in bed. Make use of the abductor pillow while asleep or resting during sex for 5-6 weeks, it may then be safely discontinued.
Bathroom Rehabilitation
Permit bathroom privileges with assistance as well as an elevated commode seat. Teach bathroom transfers once the patient is ambulating 10-20 feet beyond room. Always use elevated commode seats.
Assistive devices utilized in Hip Replacement Rehabilitation
Use "reacher" or "grabber" to help retrieve objects on the ground. Do not bend to use slippers. Shoe horn and loosely fittings shoes or loafers.
Transfer Guidances
• Bed to Chair- Avoid leaning toward get out of chair or off bed. Slide hips toward the edge of the chair first, then arrived at standing. Do not cross legs when pivoting from supine to bedside position. Therapist or nurse assists until capable of singing safe, secure transfers.
• Bathroom- Use elevated toilet seat with assistance. Continue assistance until capable of singing safe, secure transfers.
Transfer to Home
• Instruct patient to travel within the back seat of 4 door sedan, sitting or reclining lengthwise over the seat, leaning on a single or two pillows underneath the head and shoulders to prevent sitting in a deep seat.
• Avoid sitting with hip flexed a lot more than 90 degrees to avoid posterior dislocation.
• Urge those with no four-door sedan to sit on two pillows using the seat reclined.
• May begin driving 6 weeks postoperative, when agreed through the surgeon.
Stair learning Hip Replacement Rehabilitation
• Going up stairs- Step-up first with the uninvolved leg, keeping crutches around the step below until both feets take presctiption the step above, then bring both crutches on the step. If available contain the handrail.
• Going down stairs- Place crutches around the step below, then step down using the involved leg, after which with the uninvolved leg. If at all possible, hold the rail.
Exercise Progression in Hip Replacement Rehabilitation
• At 5-6 week, begin standing hip abduction exercises with pullys, sports cords or weights. May also perform side stepping having a sports cord around the hips, in addition to lateral step ups having a low step, if clinically safe. Progress hip abduction exercises before the patient exhibits an ordinary gait with good abductor strength.
• Perform prone lying extension exercises from the hip to strengthen the gluteus maximus. These could be performed with the knee flexed (to isolate the hamstrings and gluteus maximus) along with the knee extended to bolster the hamstrings and gluteus maximus.
• Initiate general strengthening exercises, develop endurance and perform cardiovascular exercises.
Instructions for Home in Hip Replacement Rehabilitation
• Continue using the previous exercises and ambulation activities. Still observe precautions.
• Install elevated toilet seat at home.
• Supply walker for home.
• Review rehab specific for home situation, like- steps, stairways, narrow doorways.
• Ensure home physical rehabilitation has been arranged.
• Avoid driving for minimum 6 weeks.
• Patient must have prescription of prophylactic antibiotics which may be needed eventually for dental or urologic procedures.
Managing Problems After Total Hip Replacement
-Trendelenburg Gait(weak hip abductors)
• Concentrate on hip abduction exercises to bolster abductors.
• Evaluate leg-length discrepancy.
• Make the patient get up on involved leg with flexed opposite knee. If opposite hip drops, have patient attempt to lift and hold in order to reeducate and work gluteus medius muscle.
-Flexion Contracture from the Hip
• Avoid placing pillow underneath the knee after surgery.
• Walking backward helps stretch flexion contracture. Perform Thomas Stretch 30 times a days.
The above mentioned mention Hip Replacement Rehabilitation Protocol ought to be tailored to individual patients need and performed in guidance of the physical therapist.
Precautions After Total Hip Replacement
Following points should be explained clearly during Hip Replacement Rehabilitation. AVOID
• Crossing your legs or bringing them together(adduction).
• Bringing the knee too near to your chest- extreme hip flexion ( you are able to bend until you gets to your knee).
• Turning the foot in toward another leg (internal rotation).