Hip Replacement

The Continuing Relationship Between Physical Therapy and Regenerative Medicine

In regenerative medicine, stem cells are used to treat damaged or destroyed tissues and organs. These stem cells come from the patient themselves and are a “blank state” which can be turned into several different variations of cells including bone, ligament, tendon or muscle.

Given that the main goal of both regenerative medicine and physical therapy is to restore the normal functioning of a diseased or injured tissue it is only appropriate that the two therapies – physical therapy and regenerative medicine – combine forces.Regenerative medicine aims to help the body heal itself more effectively. The study of using a tissue, cellular, organ and medicine substitutes to restore biological function lost as a result of injury, disease, congenital abnormalities or age has brought together a variety of scientists – many with overlapping backgrounds – in the field of regenerative medicine.

Once the regenerative medicine is administered via injection or other procedure, patients are often encouraged to continue physical therapy – as the strength gained from the stem cell therapy enhances their ability to complete physical therapy.

Furthermore, in cases such as artificial organs and medical devices, the relationship between the two fields is also important. A major problem with organ transplant is that there is no way to know if the body will reject the organ or not, and unfortunately, there is no way to prevent it either. However, the great benefit to regenerative medicine, and specifically stem cell therapy and the like, is that the materials used to aid in the healing process are taken directly from the patient – via their blood, bone marrow, or other appropriate sample collected for the needed materials.

However, following the introduction of a new organ or a medical device – even if the organ is one grown from the own patient – physical therapy is still a vital part of the rehabilitation process. Physical therapy has the strong power to enhance the healing potential. As a result of physical therapy, the body can maximize the functional interaction between the host and the donor object – rather it is an organ or a medical device. Following a form of regenerative medicine treatment, physical therapy should be appropriately positioned so that it can optimize the patient’s post-transplant recovery.

Oftentimes, regenerative medicine treatment options are also used for problems such as back pain, knee pain, and other debilitating chronic pain. Typically, the patient was probably receiving physical therapy prior to regenerative medicine treatment options – or had at least tried it as an option. However, to continue to increase the mobility and give the stem cells the best chance at being successful, physical therapy should continue to be an important part of the patient’s regimen.

As the two fields continue to work in close contact with one another, it is also imperative that scientists and rehabilitation specialists continue to work to develop clinically relevant protocols.

When combined, physical therapy and regenerative medicine can continue to optimize the quality of life for those patients suffering from chronic pain or other ailments which have previously inhibited them from doing things.

Total Hip Replacement Rehabilitation

Total hip replacement surgery involves removing damaged cartilage and bone from a painful hip and replacing this with prosthetic components. The hip is a ball-and-socket joint, with the ball being the head of the femur (thigh bone) and the socket being a portion of the pelvic bone. Also called total hip arthroplasty (THA), hip replacement is typically done because of damage from arthritis. The main part of the hip replacement process is rehabilitation.

Before Surgery

Rehabilitation begins before your total hip arthroplasty. A physical therapist teaches you about what to expect from the surgery and gives you exercises to precondition your body. Flexibility and strengthening maneuvers are used to make your recovery easier. The therapist may do a home visit to advise you on how to make your environment safe for your recovery.

Immediately after Surgery

Right after a total hip replacement, you will have some weakness, numbness, itching, soreness, pain, and stiffness of the hip and leg. Postoperative pain can continue for up to 6 weeks. However, this is managed using a variety of techniques and medications. Right after surgery, you are monitored in the recovery area for 1-2 hours before being moved to a hospital room.

Rehabilitation continues after surgery. A physical therapist will teach you how to put weight on the affected leg, how to use an assistive device (crutches, walker, cane), and how to move from bed to chair, and up from a chair. The therapist will not allow you to turn the leg inward, cross your legs, or bend forward more than 90 degrees.

Hospital Care

While in the hospital, your physical therapist will visit you 2 times each day and help restore function and prevent injury to your new hip. The therapist continues to work with you to learn how to turn in bed, how to walk with the assistive device, and how to perform a range of motion and strengthening exercises.

Subacute Recovery

Whether you are moved to a skilled nursing facility or return home, physical therapy continues. You progress to walking, climbing stairs, transferring from a car, increasing balance, and full movement of the new hip. Specific muscle strengthening exercises are used to improve standing and walking ability.

Once your new hip is strong, you are encouraged to fully bear weight on the hip and walk more. The physical therapy sessions continue to focus on stretching, mobility, and strength. The therapist aims to return you to your pre-surgery functional status and improve your quality of life. After 6 weeks, you may be allowed to climb ladders, lightly job, pull carts, and lift objects.

Normal Activities

As soon as the orthopedic surgeon gives you the go-ahead, you can return to usual and normal activities. This means you can walk as much as you wish, swim after sutures are removed, and participate in golf, cycling, and household chores. Return to driving, sexual activity, and air travel will depend on your rehabilitation success.

You are permitted from doing some things after a total hip replacement. To ensure proper healing and prevent hip dislocation, don’t:

  • Try to pick something from the floor while sitting.
  • Cross legs at the knees for at least 8 weeks.
  • Lean forward while sitting.
  • Bend at the waist beyond 90 degrees.
  • Reach down and pull up blankets when lying in bed.
  • Turn feet inward when you bend down.

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.

OSPIblogbanner(3)

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.

Save

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.

Save

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.

Anterior versus Posterior Total Hip Replacement

The surgical approach to total hip replacement (THR) may impact the surgical outcome. Total hip replacement is a common surgery, with more than 300,000 procedures performed in the United States each year. Traditionally, most total hip replacements have been done using the Hip painposterior approach, in which the surgeon accesses the hip joint through the buttocks or side. More recently, surgeons are using the anterior approach, which involves entering the hip joint through the front thigh region.

According to researchers, both direct anterior and posterior surgical approaches for THR yield excellent results as reported by patients. The surgical approach is not the singular variable that makes a difference in a 6-month post-operative outcome. Patients considering total hip replacement should ask the orthopedic surgeon about which approach is best for them. A decision will be made based on the risks and benefits of the surgical approach for the individual patient.

Clinical Studies

In a recent clinical study, involving 275 patients who had a total hip replacement between 2012 and 2014, the average age of patients was 65 years. Using certain outcomes for evaluation, researchers compared the two groups regarding pre- and post-surgical pain, function in recreation, function in daily living, and hip-related quality of life. According to results, there were no significant differences between the two groups.

In another study, researchers compared radiographic, clinical, and surgical outcomes among patients undergoing total hip arthroplasty performed via the posterior versus anterior approach. After evaluating 17 studies and 2,300 patients, researchers found that there was a significant difference in favor of the anterior approach regarding dislocations and length of stay after surgery.

canstockphoto38482995Researchers have found that the extent of muscle damage is different for each surgical approach as well. In a randomized clinical trial, researchers compared the two procedures. The main end point was the ability to walk unlimited distances and climb stairs at 6 weeks, 3 months, 6 months, and one year post-operative. At the 6-week follow-up, the direct anterior group had more patients walking limitlessly and climbing stairs compared to the direct posterior group. The differences were not as significant later on in the recovery process. However, the direct anterior approach was found to provide earlier restoration of function after total hip arthroplasty.

Another group of researchers evaluated 88 procedures (41 anterior and 47 posterior approaches for THA). The length of stay after surgery was shorter for the anterior group than the posterior group. The duration of surgery was longer, however, for the anterior approach group. Both groups performed similarly on questionnaires regarding pain and clinical outcome measures at the 6-month follow-up.

Before your surgery, the orthopedic surgeon will complete an extensive evaluation including a past medical history, physical examination, hip x-rays, and certain blood and diagnostic tests to establish fitness for surgery. Careful consideration will be given to how much pain the patient has and how often pain limits bending, walking, and resting. In addition, the surgeon will evaluate what measures have helped alleviate hip symptoms in the past.

How the Procedures Vary

During both anterior and posterior THR procedures, the head of the femur must be removed and replaced with a metal stem, as well as a ceramic or metal ball. The damaged cartilage and bone are removed from the hip socket and replaced with a metal prosthesis. Finally, a plastic spacer is placed between the new socket and ball to allow for a smooth gliding motion.

With the posterior approach, the hospital stay is usually 2-8 days, depending on the patient’s health condition, the severity of hip damage, and the surgeon’s recommendations. The incision will be 10-12 inches long, running from the outer buttock. Some muscles around the hip joint are cut and repaired, and recovery is 2-4 months. People who have this procedure have to follow specific precautions for 6-12 weeks, which include no internal rotation (turning leg inward), no crossing the leg, and no bending past 90 degrees.

With the anterior approach, the hospital stay is shorter (2-4 days), and the surgical incision is along the front aspect of the hip. The incision is shorter with this procedure (4-5 inches), and recover time is only 2-8 weeks. There are no specific precautions with the anterior approach, which makes it a more desirable procedure. With both procedures, patients must use an assistive device (walker or cane) while moving about, and physical therapy is required to improve strength, range of motion, and mobility.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top hip replacement with surgeons performing both anterior and posterior procedures. Most insurance is accepted, with some of the procedures offered as an outpatient or a one day stay. Call us now!

Resources

Barrett WP, Turner S, Leopold J (2013). Prospective randomized study of direct anterior vs posterolateral approach for total hip arthroplasty. J Arthroplasty, 28:1634–8.

Higgins BT, Barlow DR, Heagerty NE, & Lin TJ (2015). Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty, 30(3), 419-434.

Martin CT, Pugely A, Gao Y, et al. (2013). A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty, 28:849–54.

 

How is a Hip Replacement Performed?

How do surgeons replace a Hip?

Total hip replacement is a successful and cost-effective surgery. This procedure offers relief of pain and improvement in function in patients with hip arthritis. Currently, a hip replacement can last for up to 20 years. According to a recent clinical study, the prevalence of total hip replacement in the United States is 1%, with 2.5 million people having a hip replaced each year. Total hip replacement is an excellent treatment option for many people.

Anesthesia

You may be able to choose which type of anesthesia given during surgery. The two options typically are:Hip pain

  • Epidural (spinal) anesthesia – Involves placement of a small catheter into the epidural space near the spinal cord that delivers medication to numb the lower body. This is often combined with administration of a sedative.
  • General anesthesia – This involves use of an intravenous medication to put the patient to sleep. The patient will have no pain or memory of the surgery.

The Procedure

Once you are moved to the operating area, you will be given anesthesia. The hip region will be shaved and cleaned with an antiseptic solution. Once you are asleep, the surgeon will make an incision on the top of the hip (anterior), on the side of the hip (lateral), or on the back of the hip (posterior). The surgeon then displaces, detaches, and/or manipulates the muscles and soft tissues to expose the joint.

One the hip joint is visualized, the upper aspect of the femur (thigh bone) is removed, and the natural socket (acetabulum) is hollowed out to fit the femoral head (top of femur bone). The socket is fitted into the hollow region of the pelvis, and a short, angled metal shaft with a smooth ball is fitted into the thigh bone. The ball will fit into the socket to move the thigh in a normal fashion. The cup and stem are usually fixed with a special cement.

Once all changes are made, the muscles and soft tissues are returned to usual position. This may require suturing and reattachment techniques. After the incision is closed using surgical staples or sutures (stitches), the area is covered with a sterile, dry bandage. The patient is usually placed in compression stockings that inflate to prevent blood clots.

Materials Used

Stryker-Hip-Revision-Surgery-Myositis-Ossification-ComplicationsProsthetic components may be cemented or uncemented. With the uncemeted method, the parts are made from a material with a rough surface. This allows bone to grow into the component to hold it in place (press-fit). The prosthetic parts may be held in place using acrylic cement.

Most prosthetic components are made using a high-density polythene (plastic) for the socket, titanium alloys for the femoral shaft (stem), and a ball made of chromium, cobalt, and/or molybdenum. Some surgeons use a metal ball and socket, because they do not wear as quickly as plastic components.

Choosing your Prosthesis

There are more than 60 different kinds of prostheses (implants). The options are usually only limited to around five, however. The surgeon will advise you won which type will best suit your health condition. The National Institute for Health and Care Excellence (NICE) recommends implants known to have at least a 95% chance of lasting 10 years. The orthopedic surgeon will discuss your options with you.

Recovery

After your total hip replacement, you will remain in the hospital for 2-6 days, depending on your health condition and progress. You will be discharged home or to a skilled nursing facility for rehabilitation. It takes around 3-6 weeks to recover from a hip replacement, and incisions and tissues are still healing after a year. It is important to participate in physical therapy and a strenuous exercise program to regain full hip function.

OSPI offers top orthopedic surgeons who are hip and knee replacement specialists in Gilbert and Chandler AZ. Patients are seen from all over the Valley including Mesa, Queen Creek, Maricopa, Scottsdale and Phoenix. Most insurance is accepted, call us for an evaluation today!

Physical Therapy After Total Hip Replacement

One of the most commonly performed orthopedic surgeries is a total hip replacement (THR). The surgical techniques and prosthesis used for a THR have improved over the years, allowing the patient to now achieve optimal recovery and less pain. Physical therapy is an important aspect in a successful, full recovery after hip replacement.

In the Hospital

Right after your total hip replacement, a physical therapist begins working with you to restore joint motion and strength. Initially, therapy begins in physical therapy1the hospital the day after surgery. A therapist shows you how to get in and out of bed, ways to get into the shower and car, and how to walk using a walker or crutches. In addition, the therapist has you perform simple exercises in bed to prevent blood clots, such as gluteal squeezes and tightening the thighs.

After a hip replacement, some patients received additional physical therapy in a rehabilitation facility before going home. This will depend on the age of the patient, what the home environment is like, and functioning when discharged from the hospital. The physical therapist works with the patient using exercise equipment for strengthening and mobility. Balance exercises are used to decrease risk of falling. In addition, the physical therapist uses heat to warm up tight muscles and ice to reduce soreness and swelling.

Avoiding Dislocation

After a total hip replacement, there are some considerations the physical therapist follows to help you decrease risk of dislocating the new hip. With the posterior approach hip replacement, you cannot bend the hip past 90 degrees, must avoid crossing your legs, and cannot rotate the hip inward. Maneuvers to assist with avoiding these activities include use of a raised toilet seat and shower chair, use of a pillow between the knees, and using an orthopedic device to put on shoes and socks.

Home Physical Therapy

Once you go home, the physical therapist will visit you 3-4 times each week to improve hip strength, mobility, and flexibility. Common therapy exercises include:

  • Buttock contractions – Tighten muscles and hold to a count of 5.
  • Abduction exercise – Slide leg out to the side as far as possible and then back.
  • Quadriceps set – Tighten thigh muscles and try to straighten knee. Hold for 5-10 seconds.
  • Straight leg raises – Tighten thigh muscles with knee straight. As muscles tighten, lift leg sever inches from bed and hold for 5-10 seconds.
  • Standing exercises – These include standing knee raises, hip abduction, and hip extensions.
  • Walking and full weight-bearing – These exercises are used to help you perform light everyday activities.

physical_therapy

Recovery at Home

Don’t be surprised if you feel fatigued right after surgery. This will improve over the next few weeks, however. You should arrange to have someone help you out for 1-2 weeks after your total hip replacement. The exercises given to you by your physical therapist are an essential part of recovery.

You should be able to stop using crutches or a walker, and resume normal leisure activities within 6 weeks of the surgery. However, it could take up to 12 weeks for pain to completely resolve. Your new hip is continuing to recover for up to 2 years after the operation, which involves scar tissue healing and restoration of muscles.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top surgeons specializing in joint replacement (hip and knee), along with sports medicine too. Most insurance is accepted with patients being seen from all over the Valley including Mesa, Chandler, Queen Creek and Scottsdale too! Call us today.

Recovery after Anterior Approach Total Hip Replacement

Anterior hip replacement is a less invasive approach to hip joint surgery. With the anterior approach to total hip replacement, the orthopedic  surgeon in Gilbert AZ accesses the joint from the anterior (front) of the hip as opposed to the lateral (side) or posterior (back). The anterior approach allows the Arizona hip surgeon to make repairs and replacements without detaching tendons, muscles, or soft tissue.

Small Incision

The anterior approach to hip replacement was first described in the 1940s. This approach is gaining in popularity, and advocates for anterior approach total hip replacement consider its advantages to be earlier restoration of walking, low dislocation rates, and muscle-sparing ability. The ModularEndoprosthesisprocedure begins with the patient lying on his/her back. The surgical incision is slightly lateral to the front superior iliac spine of the pelvis. The 4- to 5-inch incision runs toward the lateral aspect of the ipsilateral knee. After moving soft tissue and muscle, replacement is made.

Because the anterior total hip replacement surgery uses a small incision, and muscles are moved rather than cut, the result is less trauma and damage to the hip soft tissues. Recovery time is usually faster with the anterior approach than traditional surgery, and patients report less post-operative pain. After only 2-3 weeks, patients begin walking without assistance, which is compared to 5-6 weeks with posterior hip replacement surgery.

Length of Hospital Stay

After the minimally invasive hip replacement, you will stay 1-4 days in the hospital. You may stay longer if you have serious health conditions, severe hip arthritis, and complications during the procedure. The length of stay varies from patient-to-patient, but the anterior approach to hip replacement is usually related to a shorter length of hospital stay than the posterior or lateral approaches.

Physical Therapy

Physical therapy begins the day of surgery. To strengthen the hip joint, you must do small exercises, such as contracting buttock and leg muscles and ankle pumps. The therapist works with you to learn exercises that help regain full hip movement. You will work with the therapist two times each day. Once you return home, the physical therapist will see you 3-4 times each week.

 

Golf

Home Recovery

After you leave the hospital, you should have family or friends stay with you for a few days. You will need help with errands and household activities. In addition, you cannot drive for 2-4 weeks, so you will need transportation home from the hospital, to follow-up appointments, and to the pharmacy. It is also important to stock up on easy to prepare foods, such as frozen, canned, and premade meals.

Incision Care

Your anterior incision will be closed with staples or sutures, which are removed around 10-14 days after surgery. The surgical site will be numb, sore, bruised, and/or swollen for a few days. You may experience itching or pulling of the incision site as well. We recommend using an icepack for 10-20 minutes several times a day to relieve discomfort. In addition, avoid using any lotions or creams on the hip area. To keep the incision clean and dry, avoid showering until your wounds are healed. You can bathe, however.

Physical Activity

Being physically active is an important aspect for recovery. Within 2-4 weeks, you will be able to resume your daily routine and normal activities. During the first week, you will start walking with a walker and advance to using a cane. To avoid falls and injuries, you should only walk in areas where there are handrails, no loose rugs, and no cords. You may begin driving after 2-3 weeks, depending on how you progress.

 

OSPI offers the top hip specialists in Arizona, specifically the East Valley. Hip replacements done by the anterior approach need an expert to be done well. Call OSPI today, most insurance is accepted!

JOIN OUR E-MAIL LIST!