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What is a Total Hip Replacement?

September 13 | 2021
Posted by Erin Mills Physiotherapy

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What is a Total Hip Replacement?Anatomy of the hip

 

A Total Hip Replacement (THR) is a type of surgery where a damaged hip joint is replaced with an artificial hip joint.  Doctors can use metal, ceramic or plastic replacement parts for the surgery.

When is a Total Hip Replacement necessary?

A Total Hip Replacement surgery is done when there is so much damage in the hip joint.  These joint changes cause severe pain and interference with daily living.  The damage in the hip may be as a result of osteoarthritis, rheumatoid arthritis or post-traumatic arthritis.  Total hip replacement is recommended when:

  • Walking, going up stairs, and bending to get in and out of chairs is difficult
  • Pain is moderate to severe even while resting and disrupts sleep
  • Joint degeneration has caused stiffness that severely affects the range of motion and function of the hip
  • Conservative treatments such as medication, physiotherapy or using a cane or walker do not alleviate the symptoms

 

What part of the hip is involved in a Total Hip Replacement?

The hip joint is a ball and socket joint.  The ball of the joint comes from the head of the femur, which is the long bone of the thigh.  The ball is called the femoral head.  The socket of the joint is made up of several bones of the pelvis and is called the acetabulum.  Prostheses replace both the ball and socket in a total hip replacement.

What happens immediately after surgery?

After surgery, patients may spend several hours in a recovery room while the surgical anesthesia wears off.  Then the patient will be taken to a hospital room where he or she will spend 1 to 2 days recovering before being discharged.  The patient will be provided with specific post surgical instructions that will

  • Promote healing
  • Prevent dislocations of the hip
  • Help regain flexibility and strength through the limb
  • Reduce the chances of developing blood clots in the legs

What are hip precautions?

Depending on the surgical procedures, patients may be instructed on hip precautions they need to follow to minimize the chances of hip dislocations.  These precautions include:

  • Avoiding crossing the legs
  • Bending the hip up past 90 degrees of flexion
  • Rotation of the hip

How long does it take to recover from a total hip replacement surgery?

Recovery times vary between patients.  There are many different factors that influence the recovery time after hip replacement surgery.  Some of these factors include:

  • Physical fitness prior surgery
  • Weight
  • Age
  • Presence of other medical conditions that affect healing times, such as diabetes
  • Smoking habits
  • Commitment and/or motivation towards rehabilitation

Most patients can get back to most of their light activities by 3 months after their surgery.  For patients who participate in heavier activities, full recovery may take another 2-3 months.  However, in rare cases recovery times will be extended if there are complications from the surgery.

What are some possible complications from THR surgery?

  • Blood clots
    • Blood clots can form in your leg veins after the surgery
    • This can be dangerous situations since a piece of the clot can break off and travel to your lung, heart or brain
    • Blood-thinning medication is prescribed to most patients to help reduce this risk
  • Infection
    • Infections can occur at the site of your incision and in the deeper tissue near the new hip
    • Antibiotics are the first line of defense for infections
    • A major infection near the new hardware may require surgery to remove and replace the prosthesis
  • Fracture
    • During surgery, healthy portions of the hip joint may fracture
    • Smaller fractures may heal on their own with time
    • Larger fractures may need pins, wires or metal plates.
  •   Dislocation
    • Certain positions can cause the ball of the hip joint to become dislodged
    • The surgeon will provide precautions for specific movements and/or positions during the first few months to help minimize this risk
    • If the new hip does dislocate, the doctor may fit the patient with a brace to keep the hip in the correct position
    • Surgery will be required to stabilize the joint if the hip joint keeps dislocating
  • Change in leg length
    • It is possible that a new hip can make one leg longer or shorter than the other
    • The surgeon tries to prevent this as much as possible, but it may be caused by a shortening of the muscles surrounding the hip
    • It is important to do the appropriately stretch and strengthen the muscles involved

What is the role of physiotherapy in the recovery after a THR?

Physiotherapy is integral part of recovery after a total hip replacement from the beginning to the end of recovery.  The surgery corrects the anatomical faults of the joint.  However, the surgery on its own will not fix any range of motion or functional limitations.  The body must adapt to a new joint and learn to move and use the new joint as the original.  This change does not happen immediately.  However, starting early with rehabilitation of the new joint will produce a better outcome.  A physiotherapist guides the patient through this recovery.

When do you start physiotherapy after a THR?

  • Most patients will have their hip precautions in place for up to 6 weeks after surgery.  One of the first things that a physiotherapist will do at the hospital is to go over the precautions with the patient so that they fully understand what they are and their purpose.  More specifically, the physiotherapists will teach the patient how to move safely with these precautions in mind.
  • The patient will likely stay in the hospital for 1-2 days, depending on how they are recovering. The physiotherapist will visit the patient once a day during their stay and work on walking with a walker, going up and down stairs and start them on a program to regain their mobility and strength through their hip.
  • When the patient is more mobile and able to leave the home, they are encouraged to seek out physiotherapy in the community. The physiotherapist will re-assess the patient’s hip and design a treatment plan that furthers their recovery.  They may add some manual stretches and mobilizations and progress the exercises.

What can I do to prepare for my THR surgery?

A lot of orthopaedic surgeons are now encouraging surgical candidates to see a physiotherapist several weeks prior to their surgery.  More specifically, this helps to prepare the joint and surrounding muscles for the surgery.  The research shows that going into the surgery with better range of motion and strength results in a better post-surgical outcome.

Overall, total hip replacement surgeries have positive outcomes and most patients do well.  Following a prescribed rehabilitation program designed by a registered physiotherapist is vital in achieving the best results.  The Registered Physiotherapists at our Mississauga and Etobicoke locations are ready to help you with your recovery.  Call PhysioNow today to book your appointment!

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