Normal Hip Anatomy
The hip is known as a “ball and socket” joint. It consists of the head of femur (the ball) and the acetabulum (the socket formed by pelvic bones). The “ball and socket” joint allows the leg to move into many different directions.
Cartilages cover the head of the femur and the acetabulum to allow smooth movements at the hip joint. Synovial membrane, which surrounds the joint, releases fluids to lubricate the joint.
Hip ligaments provide stability to the hip and restricts excessive hip movements. Hip muscles (e.g. the gluteals) provide strength for active movements.
The purpose of Total Hip Replacement:
1. Pain relief
2. Correct hip deformity
3. Increase hip function (resume normal daily activities)
Who needs Total Hip Replacement?
The normal functioning hip can be disrupted with:
-Osteoarthritis (wear and tear of hip cartilages)
-Post traumatic arthritis (hip cartilage damaged after injury)
-Rheumatoid arthritis (body's immune system destroys its own cartilages)
With the above diseases, the hip cartilages are damaged. When cartilage loss reaches the limit, the person suffers from pain when he walks or moves around. It would also cause the hip to deform, and the hip cannot perform normal daily function.
When medication, change of activity level and physical therapy have not been effective enough to solve the problems, total hip replacement becomes an option for the patient.
Expectations for Total Hip Replacement
What you should expect:
-Dramatic reduction of hip pain
-Significant improvement in the ability to perform activities of daily living
-Excessive weight and pressure put onto the new joint would cause it to become loosened and painful.
-Weaker muscles after surgery
-Avoidance of certain activities for the rest of your life, like high impact sports and running
-Despite the better physical function, you should not expect that the procedure would bring you back to the prearthritis stage.
-Long lasting of the joint (over 10 years) if used properly
Components of the New Hip
The new hip is composed of the:
1. Artificial socket (high density plastic)
2. Artificial ball (stem made up of strong stainless metal or ceramic)
Physical therapy for Total Hip Replacement
First Part: Acute Care in Hospital
Main aim: Prevent possible post operative complications:
–Preventing joint infection:
-Keeping the wound clean
–Preventing blood clot formation in leg veins:
-Frequent lower leg exercises, stockings
–Preventing stiff hip:
-Start walking exercise and gentle hip mobilization exercise since the day after surgery
–Prevent lung infection:
-Deep breathing exercising and coughing exercises
Second Part: Subacute Care in Hospital/ Clinic
–Regain range of motion
–Regain hip strength and function
Second Part: Components
–Stretching, mobilization and strengthening exercises
-For regaining flexibility, range of motion and strength at the operated leg
–Specific therapist instructed training, exercise and/or manual maneuvers
-Aims to regain range of motion and eventually function of the hip
-Ability to stand, transfer, walk, climb stairs and perform daily activities with your operated leg.
–Electrical stimulation, ice and heat
-Aims to relieve pain and control inflammation of the hip
Other Important Components
Fall prevention is important, it usually includes:
-Strengthening exercises of the legs,
-Walking aid prescription
Wound care and diet are other important factors to address for patients with total hip replacement.
Points to Note
-Patients with THR should avoid crossing their legs, excessively turning their legs inward or outward, and over-bending their hip (over 90 degrees) because of the possibility to dislocate the hip.
-Patients should notify doctor if the hip is found to be hot, painful and swollen.
-Patients with THR should not soak their operated part into water until the wound is cleaned and dried, A bandage should be placed on wound for protection before healing is complete.
Home Exercises for Total Hip Replacement
Home exercises for THR should be prescribed by the physical therapist. A proper evaluation of the condition should precede.
1. Quadriceps setting
-Start with lying, with a rolled towel placed under the heal
-Press down onto the towel, so that the upper thigh muscle is tightened
-Hold for 5-10 seconds
2. Terminal knee extension
-Start with lying, with a rolled towel placed under the knee
-Lift the heel off bed to straighten the knee, have the knee as straight as possible
-Hold for 5-10 seconds
3. Gluteal setting
-Start with lying flat on your tummy
-Hold one leg in straight position and lift it up from the supporting surface
-Hold for 5 seconds
1. Active hip and knee flexion
-Start with lying on your back
-Slice operated leg towards buttock
-Repeat 10 times
-Start with lying on your back, legs together
-Spread legs (move each of them outward), so that your operated leg is out to the side
-Repeat 10 times
Do's and Don'ts for Clients with THR
-Grasp chair arms when raise up from chair
-Use extra pillow when sit so that your operated hip do not bend over 90 degrees
-Put a pillow between your legs when turn towards your non- operated side
-Keep your operated leg forward when get up from a chair
-Bend your hip excessively when sitting
-Sit on chair without arms
-Sit on low seat
-Turn your knee cap inwards
-Cross your operated leg over to the other side of the body
-Lie down without pillows between your legs