Author Archive: David Greene

Rehab Exercises after Total Knee Replacement

Once you return home after a total knee replacement (TKR), you will need to perform certain exercises to prevent complications, improve motion of the knee, and build strength. Most people have weak leg muscles before surgery because they were not used much due to knee problems. Now that surgery has corrected this knee problem, you will need to have a regular exercise regimen.

Exercise Program

A regular exercise program is used to strengthen weak leg muscles. Your success with rehabilitation relies on your willingness to follow the exercise program developed by your physical therapist. You should perform these exercises 2-3 times each day after surgery. Each exercise must be done 10 times, starting out, and you gradually increase the repetitions by 5 times each week until you reach 20 repetitions. Your schedule will be:

  • Week 1 – 10 repetitions
  • Week 2 – 15 repetitions
  • Week 3 – 20 repetitionsheel-slides

Ankle Pumps and Circles

  • Bend both ankles up, pulling toes toward you.
  • Bend both ankles down, pointing toes away from you.
  • Rotate each foot clockwise and then counterclockwise while keeping toes pointed to the ceiling.

Heel Slides (Knee and Hip Flexion)

  • Bend the hip and knee by sliding the heel up toward buttocks while keeping the heel on the bed.
  • Slide heel back down again while keeping kneecap pointed at the ceiling.
  • Repeat with opposite leg.

Thigh Squeezes (Quadriceps Sets)

  • Tighten muscles at the front of the thigh by pushing the back of your knee down on the bed.
  • Hold for 5 seconds, then relax.
  • Repeat with opposite leg.

Leg Slides (Abduction/Adduction)

  • Slide leg out to the side while keeping kneecap pointed toward ceiling.
  • Slide leg back to the starting position.
  • Repeat with opposite leg.

Lying Kicks (Short Arc Quadriceps)

  • Lie on back with a rolled blanket under your knee.
  • Straighten knee and hold for 5 seconds.
  • Lower leg down slowly and relax.
  • Keep back of knee in contact with blanket.
  • Repeat with opposite leg.

Straight Leg Raises

  • b7a636bc5a5da7a0eafbb497fb8cac4eBend leg with foot flat on the bed.
  • Raise opposite leg up 12 inches with knee straight.
  • Hold for 5 seconds.
  • Slowly lower leg and relax.
  • Repeat with other leg.

Knee Bending (Sitting Knee Flexion)

  • Sit on a chair.
  • Bend knee back as much as you can and hold for 10 seconds.
  • Return to starting position and relax.
  • Repeat with other leg.

Sitting Kicks (Long Arc Quads)

  • Sit on a chair.
  • Lift foot and straighten knee as much as possible.
  • Keep knee level as if you are holding a tray on your lap.
  • Hold for 5 seconds.
  • Lower leg down slowly and relax.
  • Repeat with other leg.

Prolonged Knee Stretch

  • Sit on a chair.
  • Bend knee back as much as possible.
  • Scoot your body forward to increase the stretch.
  • Hold for 30-60 seconds.

Knee Straightening Stretch

  • Sit on a chair with your heel up on a footstool or chair in front of you.
  • Hold this for 30-60 seconds.
  • Repeat with other leg.

Knee Dangling/Swinging

  • Sit on a high chair or bed so that feet don’t touch floor.IMG_5017
  • Bend knees and swing surgical leg back and forth.
  • Do this for 2-3 minutes.

Heel Digs (Hamstring Sets)

  • Bend surgical knee.
  • Tighten muscle at back of thigh by digging heel into the bed.
  • Hold for 5 seconds.
  • Repeat with other leg.

Buttock Squeezes (Gluteal Sets)

  • Tighten buttock muscles by squeezing.
  • Hold for 5 seconds and relax.

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Rehab After a Total Knee Replacement

Total Knee Replacement Rehabilitation

Having a total knee replacement surgery is usually the best option for patients with severe knee arthritis. At present, more than 4.5 million people in the U.S. are living with at least one total knee replacement, and around 1.5 million people with a replaced knee are 50-70 years of age. During the last couple of decades, total knee replacement increased by 84% in the U.S. population, with the current rate 22 per 10,000 persons. The most important part the knee replacement process is rehabilitation.

The greatest demand for total knee replacement is not coming from the elderly demographics. Rather, it is younger people who have weight issues. There is a strong relationship between knee osteoarthritis and having a high body mass index. More people ages 18 to 64 years are having severe knee pain and loss of mobility related to being overweight.

General Considerations

  • Patients are weight-bearing as tolerated with a walker, crutches, or cane until they can walk without assistance.
  • Early emphasis is on developing full extension equal to the opposite leg soon as possible.
  • No active or passive flexion motion greater than 90 degrees until stitches are removed.
  • Early exercise will focus on recruitment of proper quadriceps set.
  • Keep incision site clean and dry.b7a636bc5a5da7a0eafbb497fb8cac4e
  • Avoid submerging in a pool, tub, or sauna until wounds are healed.
  • Avoid jumping, twisting, pivoting, or rigorous activities.

Week 1

  • You will return to see the Arizona orthopedic surgeon to change the dressing and review health status.
  • Icing, leg elevation, and swelling control are implemented. Swelling control can be achieved using a compression wrap and circumferential massage.
  • Soft tissue treatments and gentle mobilization are implemented by physical therapist.
  • Exercises include gluteal sets, gait training, and balance/proprioception maneuvers. Straight leg raise exercises with quad sets are began, and passive/active range of motion exercises are started.
  • Goals of therapy are to increase range of motion < 90 degrees, and to decrease swelling and pain.

Weeks 2-4

  • You will return to the Gilbert orthopedic surgeon’s office to have staples/stitches removed and for a check-up.canstockphoto7424057
  • The therapist will continue with soft tissue treatments and gentle mobilization, avoiding flexion or patella contracture.
  • Exercises are continued, including progress flexion range of motion, functional exercises, gait training, and balance/proprioception maneuvers.
  • Aerobic exercise is began as tolerated (cycling, swimming).
  • Goals include decreasing swelling and edema and range of motion < 10 degrees extension to 100 degrees.

Weeks 4-6

  • You will follow-up with the orthopedic surgeon.
  • Gentle mobilization and soft tissue treatments continue.
  • Exercises continue, such as functional exercises (weight machines and walking outside), balance/proprioception maneuvers, and swimming after incisions are closed.
  • Goals include walking without a limp and range of motion < 5 degrees extension to 110 degrees.

Weeks 6-8

  • Continue soft tissue treatments, joint mobilizations, and patellar glides to increase range of motion.
  • Add lateral training exercises, and incorporate single leg exercises as tolerated.
  • Goals include patient walking without limp, and range of motion 0-115 degrees.

Weeks 8-12

  • Continue joint mobilizations, soft tissue treatments, and patellar glides to increase range of motion.
  • Begin activity specific training, such as gardening, sports, and household chores.
  • Low impact activities after week 11.
  • Patients are weaned into a home and gym program with emphasis on their particular sport/activities.
  • Goals include return to functional activities and range of motion within functional limits.

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Resources

Health Research Funding (2016). 23 Amazing Total Knee Replacement Statistics. Retrieved from: http://healthresearchfunding.org/23-amazing-total-knee-replacement-statistics/

Intermediate and Long-Term Quality of Life after Knee Replacement

Osteoarthritis (OA) is one of the main causes of functional disability and chronic pain in older people. OA is related to environmental factors, aging, lifestyle changes, and genetic predisposition. When the knee is affected canstockphoto10845760by arthritis, many people undergo knee replacement procedures.

The goal of total knee replacement is to improve overall quality of life and return patients to a higher level of functioning than before surgery. Most people will heal well without problems if they follow their rehabilitation program. Some activities are permitted and others are not:

  • Permitted: Swimming, golf, dancing, water aerobics, cross-country skiing, cycling, hiking, light labor (involves standing and walking), and sedentary occupations.
  • Not permitted: Jogging, running, impact exercises, contact sports, sports that require pivoting and twisting, and heavy labor.

Post-Operative Exercise

golf swingPost-operative exercise may be detrimental to the success in recovery after a total knee arthroplasty (TKA). You will begin to receive physical therapy in the hospital, and will continue at home, outpatient, or in a skilled nursing facility. A home exercise program is provided before hospital discharge.

Weeks 1-2: Anticipate discharge from the hospital after 3-5 days. Continue using walker with instructions from the therapist. At this time, you will start walking 300 feet, begin to straighten the knee, dress independently, and perform simple homemaking tasks. Home exercises will be advanced with your therapist.

Weeks 2-4: During this time, you will gradually increase independence. The home exercise program involves progressive ambulation using the cane, resuming driving if you had a left knee replacement, independent showering, and walking around ¼ mile.

Weeks 4-6: During this time, your physical therapist will have you bending the knee to 90 degrees, using a cane as needed, walking up stairs, and straightening the knee completely.

Weeks 6-12: You will continue home exercises. During this time, you will progress to walking one mile, climb stairs, and resume usual activities, such as swimming and bowling.

Clinical Studies

Many clinical studies regarding total knee replacement have studied quality of life after surgery. Considered a highly successful operation, technical outcomes from total knee replacement are excellent. In a recent study evaluating intermediate and long-term quality of life following surgery, researchers conducted a large review of studies. They found that both intermediate and long-term post-operative quality of life were superior to the pre-Hiking2operative level in analyses.

In the review of clinical reports, researchers found that most patients were satisfied with the knee replacement surgery and reported substantial improvement in daily functional activities. In addition, the benefits were related to health-related quality of life as well as disease-specific quality of life. Four validated measurement tools were used to assess quality of life: the Western Ontario and McMaster’s Universities Osteoarthritis Index, the Knee Society Score, the Center for Epidemiological Studies Depression Scale, and the visual analogue scale for pain.

Another study evaluated self-reported outcomes in the first year after total knee replacement and attempted to determine which factors influenced patient quality of life. The results showed that after 6 weeks, all patients reported significant improvement for all measured parameters in relation to quality of life.

To examine health-related quality of life after total knee arthroplasty, researchers in a Singapore hospital interviewed patients. Data were collected from almost 5,000 patients. The patients who had total knee replacement all had improved pain scores. In addition, two years after surgery, the majority of patients showed improved physical functioning scores.

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Resources

Ko Y, Narayanasamy S, Wee HL, et al. (2011). Health-related quality of life after total knee replacement or unicompartmental knee arthroplasty in an urban asian population. Value Health, 14(2), 322-328.

Papakostidou I, Dailiana ZH, Papalychroniou T, et al. (2012). Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskel Dis, 13, 116.

Shan L, Shan B, Suzuki A, et al. (2015). Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Am, 97(2), 156-168.

Managing Pain after Total Hip Replacement

People who undergo a hip replacement surgery often have problems with post-operative pain. For many, pain management is a matter of managing your expectations. Surgery on a hip requires a significant period of rest in order for the body to fully recover and regain strength. Post-operative pain after hip replacement is shorter for a hip replacement than for a knee replacement surgery.

Rest

In the first week of recovery, the patient should rest often and be active only in short spurts. The more rest the  body gets during this crucial time, the better for your recovery. Usually, after 10 days, hip joint pain has gone away and soft tissue pain lessens. Some people may use a cane for up to 4 weeks post-surgery. After 4-6 weeks, most patients can return to usual activities without pain.

Ice

Ice is used to provide pain relief and reduce swelling. For hip replacement patients, use gel packs and keep them in the freezer. During recovery, you will need to change these packs frequently. Remember that gel packs can burn the skin, so wrap them in a soft, thin cloth. Also, elevate your leg and rest during icing.

Medications

Patients are typically sent home with strong narcotic analgesics at first. The orthopedic surgeon will have you scheduled for a follow-up to remove staples/sutures and refill pain medicines as needed. Take the medication as needed, and follow post-operative instructions. If the medication is not effective for your pain, talk with your doctor about increasing the dosage or changing your medication.

Elevate Legs

Elevating your legs will help reduce pain and swelling. Put your feet higher than your hips to offset some of the physical discomfort in the legs. In bed, prop your legs up on pillows at the end of the bed. Regularly elevating the legs several times each day, along with icing and medication, will help manage post-operative pain.

Regional Pain Medication

Regional anesthesia is associated with fewer complications than general anesthesia. The regional method avoids central nervous depression, and has a different spectrum of effects on the heart and lungs. Regional anesthesia provides excellent pain relief, allows for painless weight-bearing and range of motion exercises, and enhances overall patient satisfaction.

Epidural Analgesia

Epidural analgesia can consist of an opioid, an anesthetic, or a combination of both. This method of administering pain medication allows the patient to have a continuous low-dose infusion that is effective for controlling post-operative pain. The continuous infusion allows the analgesia to be more precisely titrated to a level of pain Exercise-senior-couple-199x300stimulus, and to rapidly terminate should problems occur.

Oral and Injectable Agents

After a total hip replacement, some medications used include:

  • Oral or IV Toradol
  • Oral anti-inflammatory drugs (ibuprofen, naproxen, and ketoprofen)
  • COX-2 inhibitors – Mobic Celebrex
  • Oral and IV opioids (oxycodone, morphine)

Post-Operative Rehabilitation

Patients are mobilized out of bed on the day after surgery. The patient works with a physical therapist to learn how to get up and down from bed, how to use the walking device (walker, crutches, or cane), and performs exercises for strengthening and flexibility. The therapist teaches thee patient how to avoid pain with the new hip, and what activities to avoid.

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Resources

Maheshwari AV, Blum YC, Shekhar L, et al. (2009). Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res, 467(6), 1418-1423.

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How Does a Knee Get Replaced?

How do they Replace a Knee?

Knee replacement surgery is performed due to chronic knee pain and loss of mobility. According to the Center for Disease Control and Prevention (CDC), in 2010 alone, almost 700,000 total knee replacements were performed on adults age 45 years and older. Total knee replacement (TKR) has nearly doubled in prevalence over the last couple of decades, especially for women (a 99% increase).

Steps in a Total Knee ReplacementKnee pain 3

Step 1: Administering anesthesia – Knee replacement surgery is usually performed with you under general anesthesia. The doctor will discuss this with you before the surgery. You will be given medications through an intravenous (IV) catheter, and an intubation tube will be placed in your airway.

Step 2: Prepping the knee – After all excessive hair over the knee is clipped or shaved, the skin over the knee is cleaned with an antiseptic solution.

Step 3: Making incision – The orthopedic surgeon will make a 4- to 6-inch incision in the knee area.

Step 4: Removing damaged surfaces – The damaged knee joint and surface will be removed. This involves specialized instruments used to remove cartilage and bone pieces from the joint.

Step 5: Insert prostheses – The artificial components are made of plastic and metal. Most artificial knee components are cemented into the joint. The prosthesis attaches to the bone using a special cement. The components include a tibial component (resurface top of tibia or shin bone), a femoral component (resurfaces end of femur or thighbone), and a patella component (resurfaces the patella or kneecap).

Step 6: Checking motion and implants – After the implants are in place, the surgeon checks range of motion and prostheses stability.

Step 7: Closing incision – The incision is closed using surgical staples or sutures. Depending on the situation, a tiny catheter with drain may be placed in the incision to remove fluid. A sterile, dry bandage dressing is applied over the knee.

How Long does a Total Knee Replacement Last?

A common reply to this question is that a total joint replacement typically lasts 15-20 years. Most current data suggest that both knee and hip replacements have an annual failure rate of around 0.5%. This means that if you have a total knee replacement today, you have a 95% chance of it lasting 10 years, and an 85% chance that it will last 20 years.

canstockphoto10845760

Types of Implants

The orthopedic implant industry has continued to develop innovative technologies to improve the outcomes of total knee replacement. However, many studies show that there is no clear advantage of any of these designs in relation to improving clinical outcomes. Some designs are:

  • Gender specific – This refers to a modified implant design that accounts for the anatomic difference between women’s and men’s knees. Most companies have some modifications in these designs to allows for sizing options so the prosthesis will fit accurately in relation to the patient’s anatomy.
  • Rotating platform – This refers to a plastic component that independently rotates on a metal tray. The plastic bearing will lock into the tray, and was designed to reduce wear on the bearing. In addition, this device can reduce the rate of loosening of metal components and better replicate the normal knee function and movement.
  • Computer technology – There are studies that have evaluated the emerging technologies in knee replacement surgery along with the success of the procedure using computer technology. Computer, robot, and custom cutting guides are used for accuracy in implant placement, as well as a more efficient surgery.

Resources

Center for Disease Control and Prevention (2015). Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010. Retrieved from: http://www.cdc.gov/nchs/data/databries/db210.htm

Intermediate and Long-Term Quality of Life after Hip Replacement

Hip osteoarthritis (OA) causes severe disability and pain. If hip OA is treated successfully with a total hip arthroplasty, patients will have significant improved quality of life.

Researchers conducted a follow-up study to assess the quality of life and functionality of 250 people an average of 16 years after total hip Hip painreplacement. The Harris Hip Score, WOMAC screening, Functional Comorbidity Index, and the SF-36 questionnaire were used to assess the participants. The questionnaire showed that the results compared positively with results from untreated persons with severe hip arthritis. In addition, patients reported a 96% post-operative satisfaction rate.

In this study, hip function and comorbidities were found to be the most important determinants of physical measures on the SF-36. Additionally, patients who had undergone total hip replacement had some long-term impaired quality of life and hip functionality, but they did perform significantly better than untreated patients.

What to Expect

During the recovery period, there are some things you can do to improve recovery outcomes and quality of life after the hip replacement. These include:

  • Wound care: During home recovery, you should keep the wound area dry and clean, and dress it according to doctor’s instructions.
  • Swelling: Mild to moderate swelling may occur up to 3 months post-surgery. To reduce selling, you must elevate your leg slightly and use ice packs. Wearing compression stockings can help to decrease leg swelling.
  • Medications: Take all medications as directed by your doctor. Use pain medicine before physical therapy sessions to improve participation during the exercises. In addition, avoid any over-the-counter drugs and supplements that could interfere with prescribed medicines.
  • Weight-bearing: Use a walker, crutches, or cane as recommended by your physical therapist. Full weight-bearing is often allowed right after surgery, but this depends on the doctor’s choice and your health status.
  • Driving: It is not safe to resume driving until you quit taking pain medication. In addition, you should wait until your strength and reflexes return to normal. Usually, you can resume driving after 3 weeks.
  • Sexual activity: Please consult your doctor about resuming sexual activities, as this varies for each patient. Depending on the type of surgery you have undergone, sexual activity is restricted for several weeks.
  • Return to work: If you have a sedentary job, you may be able to resume work activities within a few weeks. This decision will be made by the orthopedic surgeon depending on your progress in rehabilitation.

canstockphoto4842007

The Longevity of a New Hip

Total hip replacement is one of the most successful orthopedic surgeries done today. However, people are having hip replacements at a younger age, and wearing of the new joint surface can become a problem after 15-20 years. Revision surgery is becoming more common to maintain quality of life. This involves repeating the surgery, only this time, the artificial components are replaced with new ones.

If medication and physical therapy does not relieve pain and disability, or if the new hip shows damaged around the artificial components, the surgeon may consider revision surgery for you. This is done when bone loss, wearing of joint surfaces, or joint loosing occurs. Hip revision may be required after infection, fracture, or injury to the joint.

Resources

Galasso O, Costa GG, Recano P, & Cerbasi S (2011). Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskel Dis, 12, 222.

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Physical Therapy for Chronic Orthopedic Problems

Chronic pain affects millions of Americans. Many orthopedic conditions are chronic, and they cause serious pain. Physical therapy is a good way to alleviate pain and improve quality of life.

Manual Therapies

Physical therapy involves manual therapies for pain relief, as well as exercises for strengthening and flexibility. Manual physical therapy is a specialized kind of treatment delivered with the therapist’s hands as opposed to a machine or device. Many patients come to their first physical therapy appointment expecting to get ultrasound and hot packs. However, the therapist first assesses your condition before canstockphoto47029630devising a treatment plan.

The physical therapist is interested in why a muscle or structure is not functioning properly, and see back exercises as more than the driving mode of recovery. Exercise is viewed as a complement treatment to manual therapy. With manual therapy, the therapist uses his/her hands to apply pressure on muscle tissue and to manipulate joints, which is used to decrease back pain caused by tension, spasm, or joint dysfunction.

Many physical therapists have the option to use manual therapy, but many do not spend the time to become efficient in this area of practice. Patients should request manual therapy, which is used to relieve pain. However, because this treatment is not standard, insurance reimbursement may be limited.

Manual therapy is used for joint pain. Joints that do not have adequate mobility or range of motion can benefit from physical therapy. Certain musculoskeletal conditions cause limitations, which in turn, creates discomfort, pain, and altered function. Manual physical therapy involves restoring motion to stiff joints and reducing muscle tension so the patient can regain a natural movement without pain.

Types of Manual Physical Therapy Techniques

Manual physical therapy techniques are aimed at relaxing restricted joints and tense back muscles. The goal of therapy is to increase flexibility and decrease back pain. The types of movement include:

 

  • Soft tissue work – This involves application of pressure to the soft tissues, such as subcutaneous tissue and muscles. This massage maneuver and pressure relaxes the muscles, breaks up scar tissue, increases circulation, and eases soft tissue pain.

 

  • Mobilization and manipulation – This uses measured movements of varying speed (slow to fast), distances (called amplitude), and force (gentle to forceful) to pull, push, and/or twist bones and joints into position. This helps loosen tight tissues in and around the joint, helps with alignment and flexibility, and reduces pain in the joint and surrounding tissues.

Other Therapy Maneuvers

Some commonly used physical therapy maneuvers include:

 

  • Soft tissue mobilization – Muscle tension will decrease joint motion and cause muscle spasms. For these patients, the therapist will use soft tissue mobilization (STM), which breaks up inelastic or fibrous muscle tissue, such as scar tissue form a back injury, and moves tissue fluids. The therapist will localize the area with the most tissue restriction through assessment. Once this is identified, the restrictions are mobilized with STM.blog_shoulder-physical-therapy-hawkgrips-instrument-assisted-soft-tissue-mobilization-iastm

 

  • Strain-counterstrain – This technique focuses on correcting abnormal neuromuscular reflexes that cause postural and structural problems, resulting in tender points. The therapist finds these points and holds the muscle area down. Through mild stretching, this allows the body to reset its muscle to a normal tension level.

 

  • Joint mobilization – This involves loosening up a restricted joint and increasing the range of motion by providing speed (velocity) and increasing distance of movement (amplitude). These mobilizations move the bone surfaces on each other in ways the patient cannot move the joint himself.

 

  • Muscle energy techniques (METs) – These maneuvers are designed to mobilize restricted joints. METs utilize a voluntary contraction of the patient’s muscles against a controlled counterforce, which is applied by the therapist from a precise position and in a specific direction. The operator takes the joint to a new level where the patient them contracts the muscle.

OSPI offers top orthopedic services in the East Valley with Board Certified doctors. Physical Therapy is offered along with chiropractic and pain management too!

Basics of Hip Joint Replacement

Hip joint replacement, also called total hip arthroplasty, is a procedure used to replace a damaged or worn hip joint with artificial components (prostheses). This surgery is often performed following a hip fracture or for patients with severe and advanced arthritis.

What types of arthritis affect the hip joint?hip arthritis picture

Three main types of arthritis affect the hip joints. These include:

  • Osteoarthritis – Degenerative joint disease, or OA, affects older individuals. This type of arthritis may cause joint cartilage break down.
  • Rheumatoid arthritis – Severe, deforming type of arthritis that causes synovial lining inflammation and excessive synovial fluid.
  • Traumatic arthritis – This results from an injury or trauma, and it causes cartilage damage.

Will I have a big scar after the surgery?

The traditional approach to hip replacement involves a 6 to10 inch incision over the hip joint. Newer approaches, such as minimally invasive and the anterior approach, involve two smaller incisions. The doctor will tell you which approach is best for you.

How do I prepare for hip replacement surgery?

When you meet with the surgeon, he will discuss the procedure and review the risks and benefits. Because bleeding is a risk, you must hold all blood-thinners for a few days before the surgery. The doctor takes a detailed medical history, inquires about allergies, goes over your medications, and conducts a physical examination. If not available, routine hip x-rays are done. Because this is a major surgery, you will have some preliminary tests (urinalysis, bloodwork, and EKG).

canstockphoto38482995What happens the day of the surgery?

You must arrange to have someone drive you home from the hospital and help you for a few days. Because anesthesia is given, you must fast for 8 hours before the procedure. After you change into a gown, a nurse places an IV catheter in your arm to administer medications. You will be given a mild sedative before going to the surgical room.

What happens during hip replacement surgery?

When you are asleep from anesthesia, the medical workers will clean your hip region using an antiseptic. The surgeon makes incisions and uses special instruments to remove the diseased and damaged hip bones. The prosthesis is inserted into the thigh bone, and the cup is placed into the hip joint socket. After all changes are made, the incisions are closed using sutures. The doctor will place a small drain and bandage over the surgical site.

What happens after my hip surgery?

After your operation, you are taken to the recovery room. A nurse monitors your pulse, breathing, and blood pressure, and once you are alert, you are taken to the hospital room. A nurse helps you to bed and administers pain medication as necessary. The physical therapist will meet with you and discuss your exercise rehabilitation plan. Some patients are moved to a rehabilitation center for recovery, whereas others will go home.

What modifications will I need at home?

After your hip replacement surgery, you will need certain modifications. The physical therapist will do a home visit before you have surgery to ensure you have the right modifications. These include:

  • Safety handrails in the bath/shower
  • Proper handrails along the stairs
  • Raised toilet seat
  • Shower chair
  • Stable chair with firm back and knee rest
  • Sock aid
  • Dressing stick
  • Long-handled sponge
  • Shower hose
  • Reaching stick
  • Firm pillows
  • Removal of all loose carpets and cords

Orthopedic and Sports Performance Institute offers top hip replacement doctors in Gilbert AZ. Most insurance is accepted, call us today!

Life after a Total Hip Replacement

Hip osteoarthritis (OA) is a cause of disability and severe pain, but it can be successfully remedied with a total hip replacement (THR). Also called total hip arthroplasty (THA), many short- and long-term studies show substantial improvements in health-related quality of life using from THR to treat OA.

Around 20% of THR procedures are performed in people younger than 60 years of age. The general increase in life expectancy among the population further increases a need for hip replacement. Greater attention should be paid to long-term results of hip replacement surgery.

Activities to Avoid

Once you have completed the post-surgical rehabilitation process, you will have near normal range of motion in the new hip, as well as adequate strength to perform most activities of daily living. Because THA is a successful procedure, you will return to a high level of function. However, to avoid damaging the new hip, you should take certain precautions.canstockphoto38482995

Patients who have a total hip replacement can return to activities such as walking, swimming, golf, driving, stationary cycling, and gardening. Remember to listen to what your body is telling you during exercise. If you have pain or swelling that last for over 24 hours, you need to see a healthcare provider. You must avoid certain high-impact activities, including:

  • Running
  • Vigorous walking
  • Downhill skiing
  • Tennis

Longevity of the New Hip

It is difficult to predict the life of a total hip implant, and lifespan is related to many factors. With surgical complications, new injury, and severe wear, the new hip can only last a short time, but this only affects a small percentage of people. The vast majority of new hips last for many years (10-20), providing patients improved function, pain relief, and increased mobility.

Researchers and prosthesis manufacturers continue to work to improve the long-term outcomes of a total hip replacement. Oxinium technology from Smith & Nephew is a high-performance material shown to reduce acetabular component wear by 60%. With less implant wear, the life of a new implant will be extended, which reduces the need for future surgeries.

Quality of Life Studies

canstockphoto316893To evaluate long-term quality of life and functionality in 150 patients who had an average of 16-year longevity after a THA, researchers used a validated questionnaire. In addition, The Harris Hip Score, WOMAC score, and Functional Comorbidity Index was used. Researchers found that THR had a 96% patient satisfaction rate, and patients had positive results compared to untreated people with severe hip OA. It was concluded that patients who underwent THA have better quality of life and hip functionality and perform physically better than untreated persons with advanced OA of the hip.

In another study, age was evaluated as an impactor of health-related quality of life after total hip replacement. Researchers evaluated patients from the Swedish Hip Arthroplasty Register who had THRs due to osteoarthritis between 2008 and 2010. They used a questionnaire to evaluate pain scores, patient satisfaction, and other factors. After deriving data from over 27,000 patients, they found that patients’ outcomes were fairly unaffected by age unless the patient was in his/her late sixties or older. They concluded that health-related quality of life was affected by age, with improvement decreasing in the elderly.

Resources

Gordon M, Greene M, Frumento P, et al. (2014). Age- and health-related quality of life after total hip replacement: decreasing gains in patients above 70 years of age. Acta Orthop, 85(3), 244-249.

Mariconda M, Galasso O, Costa GG, et al. (2012). Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskel Disord, 12, 222.

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