Post-operative therapy after hip replacement is mostly performed by the patient getting on with normal life but in most cases it's useful to quickly analyze their progress and suggest avenues for improvement. It is important to assess any deficiencies in the patient's performance and correct them early as arthritis of the hip causes several problems to develop. Muscle power drops around a painful joint, reducing the stability and support for the joint as the pain inhibits natural movement and activity. Lack of normal full movement allows joint restrictions to develop, leading to an abnormal walking pattern.
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 mobilizing and strengthening exercises as required. The walking pattern will be analyzed 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.
Hourly contractions and gentle movements of the hip will get the joint moving and restore some confidence in the patient that they can independently move their leg around, which initially feels very heavy. The physiotherapist and an assistant will mobilize the patient as their condition allows, using crutches or a frame. Early sitting out in a chair is encouraged with a seat high enough to prevent too much hip flexion. As the side of the thigh has been operated this can limit the amount of knee bend so patients are encouraged to regularly slide their feet back towards themselves in sitting.
Giving the patient confidence to independently perform a safe and relatively normal gait pattern is the initial goal of mobilization. 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.
If a patient does not gain in muscle strength which is required then specific exercises can be performed. Initially the patient can be in standing and holding on to a high table or back of chair for balance. The operated leg is bent up gently with the knee coming up forwards for five repetitions, increasing as it gets easier with time. The second movement is to move the straight leg out to the side which strengthens the stabilizing muscles of the buttock. The third movement is to move the straight leg backwards and behind without bending the body forwards to activate the large hip muscles.
If these are not sufficient then the patient can be instructed in exercises on the bed or prescribed hydrotherapy. Hydrotherapy is a very good method for strengthening joint replacements as the water gives good levels of resistance but supports and controls the joints as they move. Floats can be used to strengthen muscles against resistance and gait practiced against the water, giving resistance to the whole process of walking and strengthening the entire pattern. Excessive exercise is not recommended for hip replacements as this can compromise the interface between the cement and the bone inside and shorten the life of the implant.
About the Author:
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.