Hip Replacement
A total hip replacement is a surgical procedure to repair the hip-joint by partly (Hemi-arthroplasty) or fully (Bipolar-hemiarthroplasty) replacing the original hip joint with prosthetic substitutes.
Care needs to be taken with this operation because of the invasive nature of this procedure ,it is cautiously deliberated if surgery is advised, to take account of age, medical problems, hip disease, activity status and possible fracture characteristics
Treatment following a hip replacement
Directly following hip replacement surgery the hip is usually covered with a dressing and a drainage tube is used to remove excess fluid from the wound.
A pillow is usually placed between the legs to keep the hip in place. Antibiotics and blood thinning medications are usually given to reduce the risk of infection and blood clot formation.
Strong pain relief is administered often via a patient controlled analgesia (PCA) pump allowing the patient to administer their own dose of pain relief on demand.
A urinary catheter is sometimes inserted.
Early breathing and coughing exercises and exercises to move the feet and other leg are encouraged as soon as possible, along with the use of compressive TED stockings, to reduce the risk of clot formation and lung complications following a hip replacement.
A special bed may be used to prevent the hip from bending beyond 90 degrees. An abduction pillow may also be used to keep the legs shoulder width apart and to prevent rotation of the hips.
Gentle exercises are usually prescribed by the physiotherapist to encourage healing, mobility and strength. It is common for patients to begin physiotherapy exercises Day 1 after surgery. This progresses to standing, walking and climbing stairs with the use of walking frames or crutches as guided by the treating physiotherapist and surgeon.
Stitches may be dissolvable or are usually removed approximately 10 days after surgery.
Patients who have had a hip replacement are instructed to avoid crossing the leg beyond the midline of the body (e.g. not crossing the leg over the other leg), bending the hip beyond 90 degrees and twisting the hip and leg excessively as these movements may alone or in combination, dislocate the hip.
Following hip replacement surgery and discharge from hospital, most patients heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance.
Crutches are usually required for days to weeks as guided by the surgeon and treating physiotherapist. Patients are usually instructed to sleep with a pillow between their legs. Activities which place large amounts of stress through the hip should be avoided particularly those which involve crossing the legs, bending the hip beyond 90 degrees, excessive twisting and weight bearing activities (such as prolonged standing or walking, lifting, squatting, jumping, running etc).
Avoiding aggravating activities allows the healing process to take place in the absence of further damage.
Following a hip replacement, patients usually benefit from following the R.I.C.E. Regime. The R.I.C.E regime is beneficial in the first 72 hours following surgery or when inflammatory signs are present (i.e. morning pain, pain with rest, or new swelling).
For a hip replacement, this primarily involves resting from aggravating activities, and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients who have undergone a hip replacement should perform regular flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome.
Emphasis is placed on restoring hip range of movement and gluteal strength. Quadriceps, hamstring and calf strengthening exercises are also important to improve the control of the hip joint with weight-bearing activities.
Hydrotherapy exercises are often indicated to improve movement and strengthen the hip in a low weight bearing environment. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.
Manual "Hands-on" Therapy from the treating physiotherapist such as massage, joint mobilization, dry needling and electrotherapy are important to improve scar tissue flexibility and range of movement. This is particularly important in the first 6 – 12 weeks following a hip replacement.
Review with an occupational therapist may be indicated to teach strategies to improve function and mobility around the home this may include the use of appropriate aids, high chairs, rails etc.
In the final stages of rehabilitation for patients with a hip replacement, a gradual return to activity can occur as guided by the treating physiotherapist provided there is no increase in symptoms.