Total Hip replacement

. Due to the hip being a robust and stable joint, hip replacement hardware generally doesn’t have the same types of stress applied to it such as something like a knee replacement. .

LIMITATION—SHORT-TERM PHYSICAL

While it is traumatic to have a steel-rod driven into the leg bone, much of the initial movement restrictions are due to the damage sustained by the joint capsule during the procedure.

Why limit extension addiction and external rotation?

To access the proximal femur with a saw and get a new acetabulum glued in, the hip must be dislocated. Dislocating the hip causes significant damage to the joint capsule. The first several weeks post-surgery, surgeons and physical therapists try to limit hip extension, adduction, and external rotation to allow the joint capsule to heal.

LIMITATIONS—LONG-TERM PHYSICAL

Long-term limitations are there to prevent having to repeat the surgery. The total hip procedure involves removing a significant portion of the femur. Bone does regenerate, but slowly.

the exercise limitation most frequently prescribed is to stop running.

TOTAL HIP REHABILITATION

As the initial goal is movement within safe ranges. This begins with most people up and walking around the hospital on the same day as the surgery.

The rehab typically consists of normal daily activities, such as walking (with a walker),

mini-squats with support, and

isometric glute, quad, and hamstring contractions. However, Everything will be depend of patients recovery.

The general recommendation is to move through motions that are comfortable, not causing too much pain.

The goal is using all available ranges of motion, but then also beginning to strengthen the hips.

Houcke et all said that Biomechanical models suggest that the lever arm from the center of joint to center of body mass is approximately three times the length of the lever from the center of joint to abductor muscles. As per theoretically, the abductors must be able to generate a force that is three times greater than bodyweight while walking .

Compensation :

A common movement compensation seen with hip replacements is a hip hike during single-leg activities, such as walking.

Preventing or correcting this movement dysfunction requires not only hip abductor strength but also a focus on core stabilization, coordination, and strength of lower limb muscles.Oblique plays great role for stabilise the pelvic.

First aim is to achieve normal gait cycle. We have written generally exercise prescription,it may vary from one patient to another. Below are the exercises , you may add in your protocol .

There are many protocol available on google but we have written some advance exs routine.

Soft-tissue Work:

Roller massage may be used, but it should be done with a hand-held roller using upper-body strength and not body weight compression.Roll hip flexors, quadriceps, adductors, and hamstrings on both sides for up to 60-seconds.

Standing Y-T-A’s: Stand with feet hip-width apart, perform a slight hip hinge (~45 degrees). Hold this position, focusing on the neutral pelvis and spine, then perform Y-T-A’s with the arms.

Core Activation

Breathing: Beginning supine, with one hand placed or small weight placed on the belly button, breath in and push the belly button into the hand. Breath out slowly as you draw your belly button towards the spine. Repeat the same process prone (if able), except the hand, doesn’t need to be placed on the belly button.

Wall Plank:

Standing at arms distance away from a wall, place forearms on the wall and keep the body straight from ankle to ear. Can progress by either slowly stepping the feet away from the wall or performing on a bench or table.

Balance/Stability:

Staggered Stance Cable/Tubing Row: Begin with feet hip-width Progress upper body by adding in alternating and single-arm rows. Then, progress lower body by narrowing base of support.

Hip Strength:

Weighted Carry: Begin with low-intensity weight on same-side as the new hip. Progress by moving to an overhead carry on the same side. Then move the weight back to a regular carry position on the opposite side. Finally, perform an overhead carry on the opposite side.


To conclude, treat hip replacement patient just like normal humans (also following the doctor’s recommendations). There are structural changes, but in most cases, patient will be able to move and function almost as well as anyone else.

Be cognizant of the initial and long-term limitations, as well as the psychological struggles that are present after any surgery. With time, effort, and attention paid to core and hip stability, along with overall movement quality, the hip replacement patient will be back at it, feeling better than they’ve felt in a very long time.




REFERENCES

Houcke, J. V., Khanduja, V., Pattyn, C., & Audenaert, E. (2017). The history of biomechanics in total hip athroplasty. Indian Journal of Orthopaedics, 51(4), 629.

Knight, S. R., Aujla, R., & Biswas, S. P. (2011, September 6). Total hip arthroplasty–over 100 years of operative history. Orthopedic Reviews, 6(2), e16.

Murphy, L. B., Helmick, C. G., Schwartz, T. A., Renner, J. B., Tudor, G., Koch, G. G., … Jordan, J. M. (2010). One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage, 18(11), 1372-1379.