Patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments will usually require total hip replacement surgery, also referred to as total hip arthroplasty. Severely degenerated joints can be treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty). After surgery, it is extremely important to begin physical therapy immediately. In fact, it is common for physical therapy to begin the day after surgery.
In this series, we will discuss total hip replacement therapy. Although this is considered one of the most successful surgeries conducted in the world today, immediate physical therapy following surgery is a critical component that cannot be stressed enough.
What is a total hip replacement?
A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The hip joint is composed of a ball and socket joint. The socket is a cup-shaped structure in the pelvis called the acetabulum. The ball is the head of the thighbone (femur). Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal or ceramic ball and stem inserted into the femur bone and an artificial plastic or ceramic cup socket. The metallic artificial ball and stem are referred to as the femoral prosthesis and the plastic cup socket is the acetabular prosthesis. The prosthesis is inserted into the central core of the femur, then fixed with a bony cement called methylmethacrylate. Alternatively, there is a prosthesis that does not use cement. Instead, this prosthesis has microscopic pores which allow bone material to grow into the prosthesis stem from the normal femur. This "cementless" hip lasts much longer and is especially suited for younger patients.
Total Hip Joint Replacement Rehabilitation
Patients should begin therapy immediately following total hip joint replacement surgery. It is common to begin some minor physical therapy while sitting in a chair the first day after surgery. Over time, rehabilitation will incorporate stepping, walking, and even climbing. Initially, the patient will require the use of supportive devices such as a walker or crutches. While exercise is taking place, the therapist will monitor the patient’s level of pain. Although some degree of discomfort is normal, in most cases, the patient will quickly gain substantial relief from the preoperative pain for which the total hip replacement was performed.
Physical therapy is extremely important in the overall outcome of any joint replacement surgery. The goals of physical therapy are to:
Scarring of the tissues around the joint cause contractures. Contractures do not permit full range of motion and therefore impede mobility of the replaced joint. Patients are instructed in specific body posturing techniques, such as sitting and using an elevated toilet seat. Heavy lifting, bending at the waist, and unusual stress activities are discouraged. Patients are instructed not to cross their legs because of the risk of dislocating the replaced joint. They are instructed to use a pillow between the legs when lying on the non-operated side in order to prevent the operated lower extremity from crossing over the midline. Patients are instructed in specific home exercise programs to strengthen the muscles around the buttock and thigh. Patients usually attend outpatient physical therapy for some period of time while incorporating home exercises regularly into their daily living.
Occupational therapists are also part of the rehabilitation process. These therapists educate the patients about the adaptive equipment that is available and the proper ways to do their "ADLs" or activities of daily living. They also review precautions with the patients related to everyday activities.
Next week, we will go over other post-operative procedures and discuss the patient’s prognosis of success.
And remember: if you are in need of post-operative total hip replacement therapy, the professionals at Excel Rehabilitation Services on Burnside Ave. in Gonzales, Louisiana will provide one-on-one care from an experienced physical therapist!