Total Hip Replacement, Procedure of Total Hip Arthroplasty

Total Hip Replacement:

Definition:

Total hip replacement is also known as Total hip arthroplasty, in total hip replacement procedure damaged bone and cartilage is removed and replaced with prosthetic components, damaged femoral head is removed and replaced by a metal stem that is placed in the hollow center of femur. The most common reason for total hip replacement is osteoarthritis.

total hip replacement

Pre-Operative Management:

Patient Education:
  • Information for patient about joint disease and operative procedure in non-medical terminology.
  • Post-operative precautions for hip dislocation.
  • Rationale including positioning & weight bearing.
  • Transfer instructions like in & out of bed and chair to minimize trunk flexion.
  • Mentally prepare patient for the painful active stage ahead.

Post-Operative Management:

It is divided into 4 phases:

  1. Immobilization phase
  2. Maximum Protection phase
  3. Moderate protection phase
  4. Minimum Protection Phase & resumption of full activity

1.Immobilization Phase:

  • Position of patient is supine in bed and operated limb need to be placed in slight abduction and neutral rotation.
  • Abduction pillow or wedge is usually used to maintain this position.
  • To prevent a flexion contracture of the operated hip, avoid use of pillow under knee.

2.Maximum Protection Phase:

(Usually day of or day after surgery)

  • Prevent vascular and pulmonary complications.
  • Prevent post operative dislocation or subluxation of operated hip.
  • Achieve independent functional mobility prior to discharge.
  • Maintain a functional level of strength & muscular endurance.
  • Prevent atrophy of musculature in operated limb.

3.Moderate Protection Phase:

(Rehabilitation begins at 4-6 weeks)

  • Regain strength of hip abductors and extensors.
  • Improve cardiopulmonary endurance by progressive stationary cycling, swimming & water aerobics.
  • Restore ROM through Thomas test position in supine, Passive stretch of  hip flexors & stretching anterior capsule while patient is in standing.
  • Improve postural stability, balance and gait.

4.Minimum Protection Phase & Resumption of ADLs:

( 12 weeks Post-operative )

  • Extended rehabilitation and modification of activities.
  • Return to sport activities.

Weight Bearing Considerations:

It depends upon method of fixation and surgical approach: Cemented Total Hip: Weight bearing to tolerance with walker immediately after surgery and carry on at least 3-6 weeks, then use a cane in contra lateral hand for 4-6 months. Non-Cemented Total Hip: Touch down weight bearing with walker for 6-8 weeks then use a cane in contra lateral hand for 4-6 months.

Total Hip Replacement in Physiotherapy
Total Hip Replacement in Physiotherapy

Instructions for home:
  • Continue previous exercises and ambulation activities.
  • Continue to observe hip precautions.
  • Install elevated toilet seat in home.
  • Avoidance of trunk flexion.
  • Avoidance of driving for 6 weeks.


Common Gait Faults after THR:

  • Trendlen-burg gait (weak hip abductor)
  • Flexion contracture of hip.
  • Avoidance extension of involved leg.

Outcomes of THR:

  • Pain Relief
  • Patient satisfaction
  • Quality of life
  • Physical functioning


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