Hip Replacement Treatment by Physiotherapy
Populations across the world suffer from osteoarthritis (OA), the most common degenerative joint condition in world, causing large amounts of pain, disability and expense. Western developed populations are ageing and as the incidence of OA rises with each decade of life the impact of this condition will be felt ever more strongly. Less developed countries such as China will soon be joining the countries with ageing populations so the need for effective OA treatment will increase greatly. One of the approaches to managing OA is to perform joint replacement.
Of all medical interventions, joint replacement has one of the highest increases in quality of life, transforming a person’s mobility, outlook and independence. Developed in the 1960s to a level where mass treatment was feasible, total hip replacement has matured into a predictable and successful treatment for OA with very good results stretching to 15 years and beyond. Conservative treatments are the mainstay of management of OA but once it becomes severe hip replacement is the only option.
In surgery the degenerative joint is excised and artificial components of alloy steel and plastic are substituted. The hip joint ball is removed and the socket cored out in preparation, the new ball and stem is inserted into pressurized cement in the femur and the new cup is pressed into cement in the socket. The two materials, steel alloy and ultra high density polyethylene, ensure very low friction in the joint similar to the original and contribute to low wear and long life of the joint.
The physiotherapist will review the patient’s medical notes for their post-operative instructions and medical status and then assess the patient’s respiratory and lower limb function. Assessment of leg muscle function and sensory ability is important to exclude nerve injury and the physio will give leg exercises to get the limb moving, although an epidural can slow this process by reducing power and feeling for a while. The patient will be mobilised up into walking by the physiotherapist and an assistant, using a frame or elbow crutches and observing hip safety precautions to avoid dislocation.
Hip flexion, knee extension, buttock and calf exercises are practiced whilst in bed to reactivate the leg muscles and pump the blood around the limb. Routine analgesia is very useful as reduced pain allows easier exercising and mobilising. Patients can now go to the toilet, wash and dress and walk about the ward with a helper if needed, at least three times a day to get their confidence. When sitting, correct height chairs are vital and patients should avoid having their feet up on a stool.
After hip replacement patients require instruction and correction to achieve a normal walking pattern, develop muscular power and improved function. Physiotherapists teach the appropriate gait at the time, often starting with “step to” where the patient moves the walking aid, steps the operated leg forwards and steps up to it with the other leg, a stable and safe pattern. Progression is to ’step through” where the unaffected leg steps beyond the other in an approximation of a normal walking pattern. Patients often progress naturally then to a gait where they move both the crutches and the affected leg forward at the same time and start to walk in a fully natural pattern.
Six weeks or so after the operation the patient will have a good gait, have reasonable muscle power and be able to do most functional activities such as a walk, climb stairs and ride in a car. They may then move on to a stick if stability or balance is difficult or the person is very old. Patients can now return to normal activities but need to maintain the hip precautions: Avoid crossing the legs in sitting. Don’t stand on the affected leg and rotate. Don’t flex the hip suddenly or above 90 degrees, such as by sitting in a low chair, sitting down too fast, crouching or leaning forward quickly to the feet. If an infection develops, for example chest, teeth or bladder, then the doctor should be informed as infections can settle in an artificial joint.
Tags: Health