Hip Replacement Treatment by Physiotherapy
ByOsteoarthritis (OA) is the commonest joint degeneration condition in the world, resulting in huge amounts of pain and suffering, work loss, expense and disability. Ageing of western developed populations, soon to be followed by some developing countries such as China, will place an increasing burden on medical services as the occurrence of OA rises steadily with age. There will be an increasing need to provide medical and physiotherapy treatment for OA over the next 50 years and for many thousands of people this will involve joint replacement.
Quality of life improvements after medical interventions vary but for joint replacement are some of the highest of all medical procedures. Hip replacement has a long history but the 1960s saw its development into a reliable procedure, with modern developments making it a predictable and very successful treatment for hip osteoarthritis. It is used to manage a variety of complex hip conditions with excellent outcomes at fifteen years and beyond. Conservative treatment is always instituted initially but if the joint degeneration becomes severe then joint replacement is the remaining 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.
Toes, ankles, quadriceps, hip flexion and buttock exercises continue to restore normal muscle activity to the legs and maintain the circulation. Routine painkillers should be taken as this helps patients get up and about and once safe they can get up three times a day or more with a helper to walk, toilet and wash. Usual precautions are taken and when sat out the chair must be the correct height and normally patients do not put their feet up whilst sitting.
Physiotherapists routinely teach and correct patients’ gait after hip replacement to improve joint movement, muscle strength and a normal walking pattern. On getting a patient up initially the physio will teach the “step to gait”, instructing the patient to place the crutches forward at first, place the operated leg between the crutches then following it by stepping to it with the unoperated leg. This technique is steady but slow and used when safety is key, and the next progression is to a “step through gait” where the unoperated leg then moves through past the operated leg into a more normal gait. The most advanced gait sees the operated leg and the crutches moving together at the same time and gait approaching normal.
Six weeks from discharge patients have usually developed a normal gait, good muscle power and have returned to many functional abilities including riding in a car, mounting stairs and normal walking. A stick can be used if the person is elderly or feels they have poor balance or stability. Sensible activities can now be performed as long as the precautions are observed: Avoid having the legs crossed in sitting. Standing on the operated leg and rotating the body is risky. Bending the hip more than 90 degrees should be avoided in such activities as sitting down quickly, sitting in low seats, crouching down or leaning forwards to the floor quickly. Inform a doctor if an infection develops in an area such as the teeth, bladder or chest, as these can track to a new joint.
