Hip Replacement And Exercising

By: David Ravech


Rehabilitation after a hip replacement is usually straightforward but it is important to be aware of the priorities at each stage of the operation and recovery for the best outcome. Because an osteoarthritic hip is painful this has a series of knock-on effects. A painful joint means the musculature which controls that joint cannot work properly so tends to lose some of its strength and support for the joint. The joint may also become tight as the natural movements are not performed and the person may adopt an abnormal gait which becomes an ingrained habit.

Before the operation there is much patients can do to improve their situation in preparation for the replacement with walking practice and exercise. The physiotherapist will assess the joint range of the hip and prescribe joint mobilising and strengthening exercises as required. The walking pattern will be analysed and suggested changes instructed. A poor gait may impel the physiotherapist to issue walking aids such as elbow crutches or a stick, used on the side opposite to the arthritic joint. If this does not allow a sufficiently good walking pattern then a second elbow crutch or stick may be added to do this.

After the operation patients are routinely reviewed by a physiotherapist the day following the procedure. Initial instruction will be in regular contraction of the buttock and quadriceps muscles to reactivate their use and restore some joint movement. Range of motion exercises of the hip might include gentle hip flexion, sliding the heel towards the body as the knee rises. This is a functional movement patients need to be able to perform to move themselves around the bed. Ankle movements are also encouraged to aid circulation, although this effect may be small.

The ability to move the operated leg about is produced by instruction to perform muscle contractions and joint range of movements hourly in the bed. The physiotherapist and an assistant will get the patient out of bed and walking with a frame or crutches. Early sitting in a moderately high seat for the patient is routine, to prevent hip flexion attaining too great a level. The lateral incision up the side of thigh can inhibit patients from stretching that area when they bend their knees in sitting so they need to be encouraged to slide their feet towards themselves regularly while they are sitting.

Giving the patient confidence to independently perform a safe and relatively normal gait pattern is the initial goal of mobilisation. This progresses into teaching a walking technique which approximates as closely as possible to normal walking. Once this has been well learned the patient should walk with a pattern very close to a natural gait, with an observer only understanding they have a restriction by the presence of crutches. The natural sequence of muscle activation is promoted by an involuntary and repetitive function such as walking and this reduces the energy cost of walking and facilitates return of muscle power.

Specific exercises can be added to the patient's regime if a significant weakness in one or more muscles is identified. Standing and holding on to a firm object in front is the best position to start with from a balance and safety point of view. The exercises consists of three movements: raising the knee up in front so the thigh eventually is close to horizontal; abducting the leg to the side whilst kept straight; maintaining an upright posture whilst moving the straight leg behind the body. These exercises strengthen the major moving and stabilising muscles around the hip and pelvis and can easily be performed even by elderly and less strong patients.

Hydrotherapy or more strongly resisted exercises may be necessary in some cases. Joint replacement treatment is very effectively managed in a pool due to both the resistance and the support of the water. Floats attached to the feet increase the forces needed to perform muscle activity in water and the entire walking pattern can be practiced by walking against the water resistance up and down the pool. Hip surgeons are not very keen on significant exercises for total hip replacements, except gait, due to possible implant loosening and reduction in the survival of the implant.

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Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapists in Bournemouth visit his website.

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