Total hip replacement rehabilitation is not a complex process but it is useful for a skilled eye to be kept on the progress of the patient if the outcome is going to be optimal. The muscles around a painful joint weaken due to lack of use and this reduces the support of the joint given by them. Tightness may develop in the joints due to the restrictions in the movements which are limited by the pain and so the patient may develop an abnormality of gait to cope with the pain and tightness.
Before the operation there is much patients can do to improve their situation in preparation for the replacement with walking practice and exercise. The physiotherapist will assess the joint range of the hip and prescribe joint mobilising and strengthening exercises as required. The walking pattern will be analysed and suggested changes instructed. A poor gait may impel the physiotherapist to issue walking aids such as elbow crutches or a stick, used on the side opposite to the arthritic joint. If this does not allow a sufficiently good walking pattern then a second elbow crutch or stick may be added to do this.
Physiotherapy assessment and treatment of the patient begins on the first day after the operation with encouragement to perform hourly contractions of the major quadriceps and buttock muscles. This aids restoration of the patient's leg control and enables joint movement to be performed. Sliding the knee and heel up and down the bed allows practice of repeated hip flexion and joint control which improves the ability to mobilise both around the bed for self care and in and out of bed. Routine ankle pumping exercises are traditionally taught for the same reason and to improve circulation but the effect of this may be small.
The ability to move the operated leg about is produced by instruction to perform muscle contractions and joint range of movements hourly in the bed. The physiotherapist and an assistant will get the patient out of bed and walking with a frame or crutches. Early sitting in a moderately high seat for the patient is routine, to prevent hip flexion attaining too great a level. The lateral incision up the side of thigh can inhibit patients from stretching that area when they bend their knees in sitting so they need to be encouraged to slide their feet towards themselves regularly while they are sitting.
Initially mobilisation should produce a safe and acceptable walking pattern and after the initial period the physiotherapist will progress to teaching as close to a normal gait as possible. Once the patient has achieved a step-through gait and are walking well their gait pattern should be very close to normal with the addition of a pair of crutches the only clue they have had an operation. Muscle activation is normalised by the natural rhythm of an automatic activity such as walking and a correct sequence of muscle activity lowers the energy requirements for walking and increases muscle strength.
If a patient does not gain in muscle strength which is required then specific exercises can be performed. Initially the patient can be in standing and holding on to a high table or back of chair for balance. The operated leg is bent up gently with the knee coming up forwards for five repetitions, increasing as it gets easier with time. The second movement is to move the straight leg out to the side which strengthens the stabilising muscles of the buttock. The third movement is to move the straight leg backwards and behind without bending the body forwards to activate the large hip muscles.
Hydrotherapy or more strongly resisted exercises may be necessary in some cases. Joint replacement treatment is very effectively managed in a pool due to both the resistance and the support of the water. Floats attached to the feet increase the forces needed to perform muscle activity in water and the entire walking pattern can be practiced by walking against the water resistance up and down the pool. Hip surgeons are not very keen on significant exercises for total hip replacements, except gait, due to possible implant loosening and reduction in the survival of the implant. - 14130
Before the operation there is much patients can do to improve their situation in preparation for the replacement with walking practice and exercise. The physiotherapist will assess the joint range of the hip and prescribe joint mobilising and strengthening exercises as required. The walking pattern will be analysed and suggested changes instructed. A poor gait may impel the physiotherapist to issue walking aids such as elbow crutches or a stick, used on the side opposite to the arthritic joint. If this does not allow a sufficiently good walking pattern then a second elbow crutch or stick may be added to do this.
Physiotherapy assessment and treatment of the patient begins on the first day after the operation with encouragement to perform hourly contractions of the major quadriceps and buttock muscles. This aids restoration of the patient's leg control and enables joint movement to be performed. Sliding the knee and heel up and down the bed allows practice of repeated hip flexion and joint control which improves the ability to mobilise both around the bed for self care and in and out of bed. Routine ankle pumping exercises are traditionally taught for the same reason and to improve circulation but the effect of this may be small.
The ability to move the operated leg about is produced by instruction to perform muscle contractions and joint range of movements hourly in the bed. The physiotherapist and an assistant will get the patient out of bed and walking with a frame or crutches. Early sitting in a moderately high seat for the patient is routine, to prevent hip flexion attaining too great a level. The lateral incision up the side of thigh can inhibit patients from stretching that area when they bend their knees in sitting so they need to be encouraged to slide their feet towards themselves regularly while they are sitting.
Initially mobilisation should produce a safe and acceptable walking pattern and after the initial period the physiotherapist will progress to teaching as close to a normal gait as possible. Once the patient has achieved a step-through gait and are walking well their gait pattern should be very close to normal with the addition of a pair of crutches the only clue they have had an operation. Muscle activation is normalised by the natural rhythm of an automatic activity such as walking and a correct sequence of muscle activity lowers the energy requirements for walking and increases muscle strength.
If a patient does not gain in muscle strength which is required then specific exercises can be performed. Initially the patient can be in standing and holding on to a high table or back of chair for balance. The operated leg is bent up gently with the knee coming up forwards for five repetitions, increasing as it gets easier with time. The second movement is to move the straight leg out to the side which strengthens the stabilising muscles of the buttock. The third movement is to move the straight leg backwards and behind without bending the body forwards to activate the large hip muscles.
Hydrotherapy or more strongly resisted exercises may be necessary in some cases. Joint replacement treatment is very effectively managed in a pool due to both the resistance and the support of the water. Floats attached to the feet increase the forces needed to perform muscle activity in water and the entire walking pattern can be practiced by walking against the water resistance up and down the pool. Hip surgeons are not very keen on significant exercises for total hip replacements, except gait, due to possible implant loosening and reduction in the survival of the implant. - 14130
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in Cambridge, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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