This week, we will conclude our examination of post-operative therapy for total hip replacement surgery. We will discuss postoperative instructions to the patient and the prognosis of success of the procedure.
Physical Therapy Management
Therapy management is defined by the surgical approach and the general state of the patient. Whether the patient desires to gain physical fitness or wishes to recover for recreational activity should also be taken into account when establishing the rehabilitation program.
The risk of dislocation after a total hip arthroplasty is great because the stabilizers of the hip such as the capsule, ligaments and muscles are heavily traumatized. But there is also a size difference between the prosthesis and the bones which increases the risk. The average diameter of the head of a human femur is 46mm, but the prosthetic femur head can range between 32mm-38mm. This reduced size makes it easier to dislocate until the stabilizing tissues have healed and adapted to the smaller size. This process can take up to 6 weeks to complete.
Because of the high risk of post-operative dislocation, patients should be taught a set of essential precautions and exercises to which they should adhere.
Patient Postoperative Instructions
To ensure longevity of the replaced hip, patients should be well-educated in post-operative care. Strenuous exercises such as running or contact sports can reinjure the replaced hip and are thus discouraged. Swimming is an ideal exercise for improving muscle strength and promoting mobility and endurance.
Patients should always notify doctors and caregivers that they have an artificial joint. Because infections elsewhere in the body could pass through the bloodstream and seed infection into the hip prosthesis, antibiotics are always recommended during any invasive procedures, whether surgical, urological, gastroenterological, or dental.
Patients will continue to use supportive devices as monitored and recommended by the therapist and attending physician. Medications are likely to be prescribed to prevent blood clots in the legs (deep vein thrombosis). This may even include self-injections of heparin or Lovenox (enoxaparin) the patient can receive at home. Medications can be prescribed for pain, sleep, and muscle relaxation. The doctor will determine how long a patient needs to take these medications.
Over time, patients will become more confident and less dependent on supportive devices. Patients are instructed on how to look for signs of infection, including:
The doctor's office should be notified immediately if any of these changes are observed or if there is an injury to the affected hip injury. The attending physician will inspect the wound site regularly. Several weeks after the operation, the sutures will be removed.
As a prosthesis ages, the metallic parts of the joint will grind against each other, causing the joint to shed metallic particles into the body. These metallic substances in the body can further erode away the metal portions of hip replacements. More importantly, high levels of these substances in the blood can indicate heavy wear of the prostheses or toxicity of the blood. A doctor will periodically test the patient’s blood to monitor the level of these substances in the body. If high levels of cobalt are measured in blood of the patient, an MRI of the hip should be performed to be sure that a pseudotumor is not developing.
Total Hip Joint Replacement Prognosis
Hip joint replacement surgery is one of the most successful joint surgeries performed today. In well-selected patients the procedure should last for at least 15 years. New devices and techniques have been dramatically improving long-term results. The future will provide newer techniques which will further improve patient outcomes, mobility, and lessen the potential for complications.
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!