Hip Surgery

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.

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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.

 

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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!

Do I need a Total Hip Replacement?

A total hip replacement is one of the most successful surgeries of modern medicine. This procedure is very effective for improving range of motion and relieving pain. The orthopedic surgeon in Chandler AZ follows certain guidelines to determine of you are ready for a total hip replacement.

The main goals of hip replacement are to stabilized the hip and offer pain relief. Leg-length equality is a Hip painpriority after the first two goals are established. Hip replacement parts in the U.S. are most often press-fit into the bone. To limit small cracks in the bone, the surgeon uses special implants and techniques.

Conservative Treatment Measures

Patients with hip arthritis or injury are often managed with conservative treatments. The orthopedic specialist will not perform a total hip replacement unless you have failed with these measures:

  • Physical therapy – Used to strengthen weak hip muscles and improve hip function, physical therapy involves strategic exercises. Many patients with hip arthritis often respond to physical therapy.
  • Corticosteroid injections – The doctor can injection the hip joint with an anti-inflammatory corticosteroid solution. These injections are usually given in a series of 3, which are spaced 3-4 months apart.
  • Anti-inflammatory drugs – Acetaminophen is the gold standard drug for arthritis. Anti-inflammatory drugs, such as ibuprofen and naproxen, can help alleviate the pain associated with inflammation.

Candidates for Total Hip Replacement

The Arizona orthopedic surgeon will decide if or not you are ready for a total hip replacement. Candidacy is based on:

  • Groin, hip, buttock, and knee pain – Patients with serious hip arthritis often have pain deep down in the groin region. This pain is relieved with a hip replacement. In addition, knee pain can occur because nerves that supply the knees run by each hip. When affected by inflammation, the nerves canstockphoto13092914can cause knee pain. Buttock and hip pain also can occur.
  • Bone-on-bone arthritis – The orthopedic surgeon will take some x-rays to see if the bone ends of the hip are touching. Pain occurs when the femur ball (thigh bone) does not fit properly in the socket.
  • Marked interference with daily activities – Surgery is considered when you have marked interference with daily activities. Patients will have trouble climbing stairs, putting on socks and shoes, and may need a cane for walking.
  • Trouble sleeping – Hip pain can affect ability to sleep, despite the use of pain medications.
  • Ability to participate in recovery – The patient having a total hip replacement must be able to participate in the rehabilitation program. Recovery takes around 3-6 weeks, and involves intense exercises and strengthening maneuvers. The doctor will consider a person’s ability to participate in the recovery process.

Total Hip Replacement Candidates

In years past, orthopedic surgeons in AZ reserve hip replacement surgery for persons age 60 years and older. This was because older people are less active and will not put stress on the artificial hip as a younger person would. In recent years, doctors have found that total hip replacement is useful for younger persons as well. New technology has improved surgical techniques and prosthetic components, allowing the new hip to withstand more strain and stress.

Hip replacement surgery involves a new hip that can last for as long as 20 years. A person’s overall health status and activity level are important in predicting the success of total hip replacement. A recent study shows that people who choose to have this surgery before advanced joint deterioration occurs tend to have an easier time with recovery.

The top orthopedic surgeons in Arizona at OSPI offer hip and knee replacements which are top notch. Often they are outpatient, allowing for rapid recovery getting people back to work and recreational activities fast! Call us today.

Resources

National Institute of Arthritis and Musculoskeletal Diseases (2016). Questions and answers about hip replacement. Retrieved from: http://www.niams.nih.gov/health_info/hip_replacement/

 

FAQs on Total Hip Replacement

If you suffer from hip pain, stiffness, and limited physical activities, you may need a total hip replacement. When the hip is damaged from a fracture, long-standing arthritis, or other conditions, the cartilage wears away and pain occurs. Hip replacement surgery is a successful surgery for improving functionality.

What are the reasons for getting a hip replacement?

The decision to have a total hip replacement (THR), also called total hip arthroplasty (THA), is made by you in conjunction with your primary care doctor, your family members, and your orthopedic surgeon. There is no age or weight restrictions for canstockphoto13092914this procedure, and most patients are 50-80 years old. This surgery may be for you if you have:

  • Hip pain that affects everyday activities, such as bending or walking.
  • Hip pain that occurs at rest, and often interferes with sleep.
  • Hip stiffness that affects the ability to move or lift the leg.
  • Pain that continues in spite of usual therapies (medicines, physical therapy, and injections).

What causes hip pain?

The most common causes of chronic hip pain and disability are:

  • Osteoarthritis – This involves wearing away of protective cartilage that covers the bone ends. Without adequate cartilage, the bones rub against one another, which leads to stiffness and pain.
  • Rheumatoid arthritis – This autoimmune disease causes synovial membrane (joint lining) inflammation and damage to the cartilage. The recurrent inflammation permanently damaged the joint.
  • Post-traumatic arthritis – After a hip fracture or injury, the cartilage is damaged, which leads to chronic hip pain.
  • Avascular necrosis – Any injury to the hip can limit blood flow to the head of the femur (thigh bone). A dislocation or fracture can lead to avascular necrosis, where the lack of blood causes the bone to collapse.
  • Childhood hip disease – Some infants are born with hip problems. While the hip conditions are treated during childhood, they may cause arthritis later in life.

What happens during the total hip arthroplasty?

During the hip replacement procedure, the damaged cartilage and bone are removed and replaced with artificial components (called prostheses). The steps include:

  • Replacing the femoral head – The damaged upper portion of the femur is removed and replaced with a metal stem. The prosthesis is placed into the center of the femur and either “press-fit” into the bone or cemented there. A metal or ceramic ball is used to replace the femoral head.
  • Replacing cartilage surface of socket – The hip socket is called the acetabulum, and it is removed and replaced with a metal socket. Screws or cement is used to hold this component in place.
  • Inserting the spacer – A ceramic, metal, or plastic spacer is positioned between the new femoral head (ball) ad socket. This allows for a smooth gliding motion.

What home planning should I do?

Before having a total hip replacement, you should arrange to have someone drive you home from the hospital. In addition, you may need someone to stay with you for a few days. The following items can help you with activities after surgery:

  • A raised toilet seat
  • Securely fastened handrails in bath or shower
  • Handrails along stairs.
  • Reclining chair or stable chair with ottoman
  • Long-handled sponge
  • Shower hose
  • Shower chair
  • A “reacher” that lets you grab objects
  • Firm pillows

What can I expect during recovery?

You may need to stay in the hospital 1-3 nights. The nurses will work with you to control pain, and a physical therapist starts to work with you to help you learn exercise to improve hip flexibility and mobility. The orthopedic surgeon wants you to get up and walk around (with help) as soon as possible. You should be able to resume normal activities within 3-6 weeks after surgery. Sutures or staples will be removed 7-14 days after your surgery. You must avoid getting wounds wet, and use bandages to prevent irritation to the wounds.

Do THA procedures work?

Total hip arthroplasty has been proven to decrease pain and increase function in persons with severe hip arthritis. In one clinical study, researchers evaluated THA in people who are in their 80s. They found that 80% of study participants were pain-free after recovering from surgery, and could walk without assistance at the follow-up. They concluded that total hip replacement was safe and effective for elderly people.

The top hip replacement doctors in Arizona are with OSPI. They offer anterior approach procedures that are available outpatient or next day going home. Call us today!

 

Anterior Hip Replacement Surgery FAQs

How is anterior hip replacement surgery performed?

Anterior hip replacement is a relatively new surgical method that, unlike the posterior or posterior lateral approach, the patient lies on their back and not on their side. Access to the hip is made through a four-inch incision to the outside area of and just below the groin. After the incision is made, the surgeon locates two muscles, which are pushed to the side in order to allow access to the area. The hip is then replaced, including the ball and socket and other components. Unlike other surgical procedures, no muscles are detached or split. Thus, before closing the canstockphoto13092914incision no repair has to be done to any muscles. Upon completion of the replacement the incision is closed.

How is anterior hip replacement different from traditional hip replacement surgery?

Generally speaking, it is a less involved procedure. There is no cutting or splitting of muscles, access to the area is easier, and fewer muscles are involved. Traditional surgery includes making an incision from the buttocks that curves around to the outside of the hip. Then the buttock muscles are split and four other muscles are detached. All of these muscles must be repaired after the hip is replaced. With anterior hip replacement surgery, no muscles are split or detached, and only two are pushed to the side during surgery.

What are the benefits of anterior hip replacement surgery?

Any successful hip replacement surgery will improve a patient’s quality of life by allowing them to be more mobile, physically active, and involved in activities associated with work and leisure. However, there are benefits that are related specifically to the anterior hip replacement method.

Because muscles from the back of the hip are not cut, there is minimal muscle trauma, which allows for faster healing and reduced pain. Plus, due to the fact that muscles are not detached, there is less risk after surgery of the patient suffering a hip dislocation.

Post-surgery discomfort is also reduced due to the location of the incision, which is below and in the outer region of the groin area for the anterior method. Traditional technique involves the buttock muscles, which, weeks after the surgery is complete, affects sitting and sleeping. Finally, there is more comfort in terms of equal leg length, as the anterior method makes it easier for the surgeon to obtain optimum balance between the legs.

What precautions must be taken after anterior hip replacement surgery and are they different than those taken after traditional hip replacement surgery?

Prior to and following posterior hip replacement surgery, there are numerous precautions that surgeons must discuss with their patients. They must be taken after surgery is performed, and are numerous. These precautions do not apply to those who undergo the anterior hip replacement procedure.

The reason for taking the following safety measures is to guard against dislocating the new hip, which is a common complication. Precautions include:

  • For the first four to six weeks after surgery, a pillow must be placed between the legs when sitting or lying down.
  • For the first four weeks, patients who are recovering must sleep on their back with a pillow between their legs
  • Hips or knees must not be bent beyond 90 degrees during this time.
  • Leg crossing, inward turning of toes, and tying of shoes are also prohibited.
  • Low chairs or couches should not be sat on.
  • To preserve to 90-degree rule, patients are encouraged to use an elevated toilet.

With anterior hip replacement, the risk of dislocation is virtually eliminated. Thus, as noted, there is no need to follow the precautions outlined above.

In what ways is rehabilitation different for anterior hip replacement surgery than it is for posterior?

First of all, due to the fact that the above addressed precautions have been eliminated, rehabilitation for anterior hip replacement is much different than that for the posterior process. Muscle trauma is greatly reduced with the anterior method, which makes for a rehabilitation timeline that is much faster.

A patient having undergone anterior hip replacement surgery finds it’s much easier to use a walker, and, two to three weeks after the operation, they can progress to using a cane. Within four to five weeks, a patient is usually walking without the aid of a cane, and they can resume normal activity very shortly after that.

With posterior hip replacement surgery a patient utilizes a walker for the initial four to six weeks and then a cane for three to four more weeks. They will often be walking independently after approximately 10 weeks. A patient may resume their normal activities in about 12 weeks.

How invasive is anterior hip replacement surgery?

Although anterior hip replacement surgery is less invasive than the posterior method, it is still considered to be a major operation and invasive surgery. This is due to the fact that anterior hip replacement surgery involves a patient being put under an anesthetic, and their being exposed to blood loss and the cutting of bone. Plus, the joint area is opened up. All of these factors involve a certain amount of risk.

ospi_smallDo all orthopedic surgeons perform anterior hip replacement surgery?

No, not all orthopedic surgeons use this technique. Most surgeons have been trained in posterior hip replacement, which is a very effective method. It is still the most common technique used. In order to perform anterior hip replacement surgery, a doctor will have to be exposed to other surgeons knowledgeable about and experienced in the procedure. This costs money and takes time. Plus, a hospital would have to invest in special equipment, including an operating table designed for the procedure.

Is anterior hip replacement surgery more expensive and does my insurance cover it?

Anterior hip replacement surgery is more expensive, however, it does not cost a patient any more money to have this type of surgery performed. All insurances cover both types of procedures.

OSPI is the top orthopedic practice in the East Valley. Chandler and Gilbert orthopedic surgeons at the practice offer anterior hip replacement surgery along with cutting edge procedures such as stem cell therapy procedures. Most insurance is accepted, call 480-899-4333 for more information and scheduling with top orthopedic surgeons Gilbert, Chandler and Mesa trusts.

How to recover after a total hip replacement in Gilbert AZ

Total hip replacement is a procedure where the ball and socket joint that you have naturally in your body is replaced with a plastic cup and metal ball, both of which simulate the normally functioning joint very well. If you are considering undergoing a hip replacement, you must recognize that this is an elective procedure and should be looked at as a last resort. Recovery from it is particular, and you must be cognizant of what things you can and cannot do after your surgery.hip arthritis picture

When you have a full total hip replacement surgery it takes a few hours in the operating room with a Gilbert orthopedic surgeon. You will be required to stay in the hospital for two to three days. The day of your surgery you will be groggy from the anesthesia.

The day after your surgery you should be able to start eating, and the physical therapists will get you out of bed. On the second and third day, you will increase your walking, and then be discharged from the hospital to your home or a rehabilitation center.

The discharge will come with explicit instructions from the medical staff on what things you can and cannot do following your surgery. Not only will you have to follow these instructions but you will be given medication to help manage the pain. You should not sit too low or lift anything over ten pounds. There is a risk of dislocation if this is not followed.

As time goes on, your ability to walk will gradually improve. Your orthopedic surgeon in Gilbert will see you in the office at the two week point, and at regular intervals after that. In addition, x-rays will be taken at certain time points to make sure the components are in satisfactory position.

Over 90% of hip replacements at OSPI end up with a satisfactory outcome. Patients are able to get back to increased recreational activities, and the chronic pain is dramatically decreased.

At OSPI, most insurance is accepted by the Board Certified total hip and knee specialists in Gilbert AZ. The expert treatments are performed in a contemporary setting, call 480-899-4333 today!

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