Tag Archives: Total Hip Replacement

Hip Pain, Physiotherapy, Total Hip Replacement Surgery

Total Hip Arthroplasty: What you Need to Know!

March 6,2025 Sharon Tierney Leave a comment

What is a total hip arthroplasty?

Total Hip Arthroplasty (THA), or a hip replacement surgery is a procedure that replaces damaged bone and cartilage in the hip joint. Instead, it replaces it with prosthetic components mainly using two techniques. The type of technique used will be discussed between you and your surgeon and is influenced by demographic and lifestyle factors.

1: Cemented: Used more in geriatric (older) populations or patients who have a more sedentary lifestyle

2: Non-cemented: Indicated for younger populations, or patients having active lifestyles

Why do people get hip replacements?

On the left shows a healthy hip with an intact joint surface, the middle shows degeneration of the surfaces in the hip, the final image shows the outcome of the surgery where the hip surfaces are replaced.

Usually, the reason people get hip replacement is due to severe osteoarthritis (OA) that is causing high pain, loss of function, and disability. For example, when someone is having trouble walking and being independent with their daily activities due to issues with hip OA. Other reasons may include rheumatoid arthritis induced cartilage or bone damage, after a slip and fall on the hip (especially in older populations), and femoral neck fractures. However, some people may be ineligible for this surgery if they have peripheral vascular disease, history of blood clots, an ongoing infection, or septic arthritis.

Generally, hip replacements/THAs are safe procedures with great outcomes. Post-surgery, the most common complications to watch for include deep vein thrombosis which is a blood clot in the leg, or a post-surgical infection in the joint.

Physiotherapy Rehabilitation After Total Hip Arthroplasty

Total hip arthroplasties are highly effective surgical procedures designed to alleviate pain and restore function in patients with severe hip arthritis or hip joint damage. Initially, post-operative rehabilitation is crucial to ensure the continued success of the surgery and to optimize the patient’s recovery. Physiotherapy plays a vital role in this rehabilitation process, helping patients regain strength, mobility, and overall function. Read on to learn more about the phases of rehabilitation with Physiotherapy!

1. Immediate Post-Operative Phase

First, the immediate post-operative phase begins as soon as the patient wakes up from anesthesia. Then, physiotherapists start with gentle exercises to promote blood circulation and prevent complications such as deep vein thrombosis (DVT). Simple movements like ankle pumps, quadriceps sets (squeezing the big thigh muscle), and gluteal sets (squeezing the buttocks muscles) are encouraged. These exercises are designed to improve blood flow, reduce swelling, and initiate muscle activation without putting undue stress on the new hip joint.

Early mobilization is a critical component during this phase. Within 24 to 48 hours after surgery, patients are usually assisted to sit up and begin walking with the help of a walker or crutches. The goal is to start weight-bearing activities as tolerated, promoting healing and preventing stiffness.

2. Early Rehabilitation Phase

The early rehabilitation phase spans the first few weeks after surgery. During this period, physiotherapists focus on gradually increasing the intensity and range of exercises. Patients are taught specific hip-strengthening exercises such as leg raises, hip abductions, and gentle stretching. Additionally, simple balance and coordination exercises are also introduced to enhance stability and prevent falls.

Not only this, but pain management is a significant focus during this phase. Physiotherapists work closely with the medical team to ensure that pain is adequately controlled, allowing patients to participate actively in their rehabilitation. For example, ice therapy, electrical stimulation, and manual techniques may be used to manage pain and reduce inflammation.

3. Intermediate Rehabilitation Phase

The intermediate phase, typically from 4 to 12 weeks post-surgery, aims to build on the progress made in the early phase. Now, physiotherapy sessions become more intensive, incorporating resistance training and functional exercises. Furthermore, activities such as stationary biking, swimming, and gentle aerobics are introduced to improve cardiovascular fitness and endurance.

During this phase, the focus shifts towards improving gait and mobility. For example, patients practice walking without assistive devices, concentrating on proper walking mechanics and posture. Also, stair climbing and descending exercises are introduced to further enhance functional independence.

Strengthening exercises for the hip and surrounding muscles are progressively intensified. At the same time, core strengthening exercises are also incorporated to improve overall stability and support the hip joint.

4. Late Rehabilitation Phase

The late rehabilitation phase, typically beyond 12 weeks post-surgery, focuses on preparing the patient for a return to normal activities and, if possible, sports. Now, physiotherapy sessions aim to restore full strength, flexibility, and function. Advanced balance and proprioception exercises are introduced to ensure the patient can handle more complex movements and environments.

At this stage, patients may engage in low-impact sports such as golfing, cycling, and swimming. High-impact activities, such as running or jumping, are generally discouraged to protect the new hip joint from excessive wear and tear. However, each hip rehabilitation is different and should be discussed with your surgeon to understand your specific limitations.

Education on lifelong joint protection and healthy lifestyle choices is an essential part of this phase. Patients are taught strategies to prevent injury and maintain joint health, such as maintaining a healthy weight, avoiding high-impact activities, and incorporating regular exercise into their daily routine.

Getting a hip replacement soon?

If you are getting a total hip replacement soon and are looking for some advice and help, look for PhysioNow! Physiotherapy can help you maximize your strength and function prior to surgery to ensure that recovery is as smooth as possible. Then, after the surgery, we will work with you to return your hip back to its normal function with an individualized care plan. Our Physiotherapists are ready to get you started. Book with PhysioNow for your first assessment and treatment today!

General Category, Hip Pain, Total Hip replacement, Total Hip Replacement Surgery

Hip Replacement Surgery Techniques: Which One is Better?

December 23,2024 Sharon Tierney Leave a comment

Anterior vs. Traditional Technique in Hip Replacement Surgery

Images from left to right showing the degeneration of a hip joint and what it looks like after the total hip replacement surgery

Hip replacement surgery is a common procedure to relieve pain and improve function for patients with hip arthritis or other degenerative conditions. Fortunately, there has been significant advancements in this field in recent years. For hip replacement surgery techniques, there are two primary techniques used. First, there is the anterior approach. Alternatively, there is the traditional/lateral approach. Overall, each method has its own set of benefits and challenges, influencing recovery time, pain levels, and long-term outcomes. In this blog, we will explore both techniques to help patients understand their options and their upcoming surgery.

The Anterior Approach

The anterior approach for hip replacements, also known as the “frontal approach,” is a relatively newer method in which the surgeon accesses the hip joint through an incision made at the front of the hip. Notably, this technique does not require cutting through muscles or tendons that attach to the hip joint, which can lead to a faster recovery and potentially less pain post-surgery. Additionally, the anterior approach allows for the use of minimally invasive techniques, which means smaller incisions and less soft tissue disruption. This article from Yale Medicine offers more information about the anterior approach.

Advantages:

Faster recovery: Because fewer muscles and tissues are disturbed during surgery, patients often experience less postoperative pain and a quicker return to normal activities like walking
Lower risk of dislocation: The anterior approach reduces the risk of hip dislocation since the joint is not manipulated as much during surgery
No muscle cutting: The procedure involves no cutting of major muscles or tendons, leading to a less traumatic recovery and less muscle loss.

Disadvantages:

Limited surgeon experience: The anterior approach requires specialized training and experience. Surgeons need to be adept in using this technique, which is still relatively new compared to the traditional approach
Difficult for certain patients: The anterior approach may not be ideal for patients with certain body types, such as those that are obese or have very muscular builds. The position of the hip joint may be more challenging to access in this population
Numbness at the thigh: In this approach the nerve that gives us sensation at the front of our thigh gets stretched, and some numbness may be present. Usually, this resolves in a couple months

The Traditional (Posterior/Lateral) Approach

The traditional technique involves making an incision either at the back (posterior) or the side (lateral) of
the hip. In these approaches, the surgeon must cut through muscles and tendons that attach to the
hip joint. While this technique has been used for decades, it is associated with a longer recovery time
and a higher risk of complications such as dislocation in the early months after surgery.

Advantages:

Widespread use: The posterior and lateral approaches are well established and widely used,
meaning most surgeons are highly skilled in these techniques
Better for complex cases: This technique may be better suited for patients with more complex
hip deformities or for those who have had previous hip surgeries
Lower risk of nerve injury: The traditional method has a lower risk of damaging nerves, as the
surgical site is farther from nerve pathways

Disadvantages:

Longer recovery: The muscles and tendons that are cut during the surgery take time to heal. Accordingly, this may delay recovery, increases the risk of pain, and requires more rehabilitation.
More post-op restrictions: While the posterior approach offers excellent access to the hip joint, it is associated with a higher risk of hip dislocation early on. To minimize risk, your surgeon may give you a list of restricted movements known as hip precautions for 6-8 weeks

Which hip replacement surgery technique is right for you?

Choosing between the anterior and traditional techniques for the hip replacement depends on a variety of factors. For example, your surgeon’s analysis of the situation, your body type, and any underlying health conditions. You and your surgeon will have a consultation to discuss the best option for you. The anterior approach may be chosen for patients who are in relatively good health and can handle a faster recovery. However, for those with more complex cases or other health concerns, the traditional posterior approach remains a reliable choice.

In conclusion, both the anterior and traditional techniques for hip replacement surgery offer distinct advantages and limitations. First, patients should have a detailed discussion with their surgeon to determine the most appropriate surgical approach for their situation. With advances in surgical techniques, hip replacement remains a highly effective treatment. Ultimately, it can improve your quality of life and restore your mobility. Importantly, the success of both types of surgery are dependent on receiving the proper physiotherapy treatment post-operatively. PhysioNow is a leading provider of post-operative care for Total Hip and Knee Replacement Surgeries. Pre-book with PhysioNow today for your first session after your operation!

Physiotherapy, Total Hip replacement, Total Hip Replacement Surgery

Total Hip Replacement Treatment: Get Better with Physiotherapy!

December 2,2024 Sharon Tierney Leave a comment

HIP REPLACEMENT TREATMENT will help speed up your recovery process. While healing and recovery time will vary between patients, proper management can minimize complications and optimize your function. Supervised Hip Replacement Treatment by a Registered Physiotherapist will help to restore your strength and range of motion.

This guide can help you better understand your exercise and activity program after a hip surgery. At PhysioNow, our Registered Physiotherapists will help you return to your daily activities. To ensure your safe recovery, be sure to check with your Physiotherapist at PhysioNow or surgeon before performing any of the exercises shown.

Safety Precautions after a Total Hip Replacement

After hip replacement surgery, precautions must be taken to allow proper healing. It is important that you follow the safety precautions your surgeon gave you for the given time period, usually 6-12 weeks. Depending on the surgical procedure and approach used for your hip replacement, the precautions may be different or even not at all! Your surgeon and Physiotherapist in hospital will help teach you these initial precautions, and your outpatient Physiotherapist will remind you of them. Below are some of the most common hip precautions and some tips on how to adhere to them. Again, these precautions may not apply to you so make sure you check with your surgeon and Physiotherapist specifically!

Avoid more than 90 degrees of hip flexion
- Use a raised toilet seat
- Use a cushion when sitting in a chair so that your hips are higher than your knees
- Don’t lean forward from a sitting position ex. putting on shoes, use a shoe horn instead
No crossing your legs or ankles
- Avoid twisting your body, move your feet to turn your whole body
- Avoid sitting cross logged
- Sleep with a pillow between your knees
- Avoid sitting cross legged or one leg over the other

How much weight can you put on your new hip?

Your surgeon will decide your weight bearing status based upon the following:

The type of surgery and prostheses used
The condition of the your natural bone
How the prostheses was fixated to the natural bone

Follow instructions from your surgeon at the hospital and at home upon discharge. Initially you will be advised to put a small percentage of weight on the affected leg and use a gait aid such as a walker or cane to help. With proper exercise and keeping safety precautions in mind, you should be able to restore strength to your new hip over time.

Total Hip Replacement Treatment Guide for Weeks 1 to 4

1) ANKLE PUMPS:
Slowly point the toes as far as possible then pull them back toward you as far as possible.
Repeat this exercise several times a day, as often as every 10 to 15 minutes.

2) ANKLE ROTATIONS:
Move your ankle inward toward your other foot and then outward away from your other foot.
Repeat 5 times in each direction.
Perform 3 to 4 sessions a day.

3) BUTTOCK CONTRACTIONS/GLUTE SQUEEZE
Tighten your buttock muscles.
Hold for 5 second. Repeat 10 times.
Perform 3 or 4 sessions a day

4) HIP ABDUCTION
Slide your leg out to the side as far as you can and then back.
Repeat 10 times.
Perform 3 or 4 sessions a day

5) QUADRACIPS SET
Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds, repeat 10 times.

6) STRAIGHT LEG RAISES
Tighten your thigh muscle with your knee fully straightened on the bed. Lift your leg several inches off of floor. Hold for 5 to 10 seconds. Slowly return, repeat 10 times.

STANDING EXERCISES
Make sure you are holding on to a firm surface such as a bar attached to your bed or a wall when performing standing exercises.

8) STANDING KNEE RAISES
Lift your operated leg only few inches off the floor, below your waist.
Hold for 2 to 3 seconds, and put your leg down. Repeat 10 times both legs.
Perform 3 or 4 sessions a day.

9) STANDING HIP ABDUCTION
While standing, raise your leg out to the side. Keep your knee straight and maintain your toes pointed forward the entire time. Slowly lower your leg so your foot is back on the floor.
Repeat 10 times on each leg.
Perform 3 or 4 sessions a day.

10) STANDING HIP EXTENSIONS
Standing tall and keeping knee straight, extend one leg back without leaning forward or arching your back. Return to the starting position.
Repeat 10 times for each leg.
Perform 3 or 4 sessions a day.

Progressing After 4 Weeks

Always attempt any exercises within your pain tolerance. After 4 weeks, individual healing times vary and some people may be ready to attempt more demanding exercises and start getting back to physical activity. As a result of the variability of progression, it is recommended that you contact our Registered Physiotherapist at PhysioNow to help you with your safe recovery. They will be able to customize your program to your current level. Overall, hip replacement surgery can be a rewarding experience, as it will allow you to return to your daily living activities.

Registered Massage Therapy is another excellent treatment after having had a Total Hip Replacement. The muscles in the low back and hip area tend to get quite tight after surgery and Registered Massage Therapists are very skilled at releasing this muscle tension. As a result, this will help your pain and may speed up your recovery time! We have Registered Massage Therapists available daily Monday to Saturday.

If you are considering having hip replacement surgery, check out this link to the Mayo Clinic with some extra information that may be useful.

Hip Pain, Physiotherapy, Total Hip replacement, Total Hip Replacement Surgery

I’m having a hip replacement! Do I need physiotherapy?

October 11,2024 Sharon Tierney Leave a comment

A hip replacement can be daunting but with the right information and preparation, you can make the recovery very smooth. In this blog we’ll describe the essentials you should know before, during, and after your surgery, and the importance of Physiotherapy Treatment throughout the process. If you are worried about your upcoming surgery, read on to ease your fears!

What is a hip replacement?

A total hip replacement, or Total Hip Arthroplasty (THA), is a procedure that replaces damaged bone and cartilage and replaces it with prosthetic components. Specifically, there are two techniques.

Cemented: For more elderly populations or patients who have more sedentary life
style
Uncemented: For a younger population or patients that have a more active lifestyle

Usually, an uncemented style is preferred as it usually results in more natural movement of the hip and less complications after the surgery. However, it takes a lot longer to heal than a cemented technique. Usually, it takes about 3+ months for there to be a strong fixation between the implant and the bone, whereas cemented is almost instantaneous at the sacrifice of future mobility.

Physiotherapy rehabilitation before the surgery

You may have been seeing a Physiotherapist prior to the surgery to maximize your function, strength, and mobility. In some cases, Physiotherapy Treatment can delay or even remove the necessity of a hip replacement! However, in the cases where we know surgery is inevitable, Physiotherapy Treatment helps you preserve and “prehab” the hip to ensure you come out of the surgery as easily as possible. In this case, treatment may include:

Manual therapy for pain relief and mobility
Other pain-relieving strategies like electrotherapy, cryo and heat therapy
Therapeutic exercises to maximize your hip’s potential prior to surgery
Gait and balance training
Braces, gait aids and other movement strategies to minimize pain and fatigue

Physiotherapy rehabilitation after a hip replacement

Total hip arthroplasties (THAs) are highly effective procedures with a very smooth recovery process these days. Most patients are able to leave the hospital after a day if there are no complications. Furthermore, there can be immediate improvements in function and pain, especially in patients that had severe hip arthritis or hip joint damage prior to the surgery. However, as amazing as the outcomes can be, post-operative rehabilitation is crucial to ensure that you get there.

In the immediate post-operative phase

The immediate post-operative phase begins as soon as you wake up from anesthesia. Initially in the hospital, Physiotherapy starts right away and gets you moving as soon as possible. Hospital Physiotherapy may look like:

Gentle exercises to promote blood circulation and minimize swelling
Starting early muscle activation with exercises
Assessing and preventing complications such as deep vein thrombosis (blood clots)
Early functional movements such as moving in bed, sitting or standing at the bedside, walking with a gait aid, stairs
Assessing you for discharge from the hospital and ensuring it is safe for you to return to your home
Teaching you your hip restrictions (if any, and as indicated by your surgeon)

In the early rehabilitation phase

The early rehabilitation phase spans the first few weeks after surgery. During this period, you will likely be attending an outpatient Physiotherapy clinic. In Ontario, you are entitled to some coverage under OHIP after a THA. Hospitals will give you a referral to Physiotherapy clinics in the area where you may continue your rehab after leaving the hospital. Our clinic, PhysioNow sees many post-operative patients just days after their surgery. In this stage, areas of treatment include:

A Physiotherapist helping their patient with their range of motion into hip flexion

Increasing the intensity and difficulty of exercises
Scar/incision care and how to manage it at home
Increasing the weightbearing ability of your hip
Gait, coordination, balance training
Education on using gait aids like walkers, canes, rollators
Effective pain management using modalities or manual therapy

Intermediate Rehabilitation Phase

The intermediate phase, typically from 4 to 12 weeks post-surgery, aims to build on the progress made in the early phase. Physiotherapy sessions become more intensive, and the focus shifts to normalizing your strength and mobility and starting to reintroduce activities of your normal life and hobbies that you enjoy. Physiotherapy Treatment may include:

Treatment will start to include more weightbearing exercises

Incorporating resistance training, weights and functional exercises such as stairs practice
Cardiovascular training with lower intensity activities including stationary biking, swimming, walking
Gait training without mobility aids, or swapping to aids that give less support
Harder balance exercises including dynamic balance with movements, unstable surfaces
Manual therapy to try to restore full range of motion in the hip

Late Rehabilitation Phase

The late rehabilitation phase, typically beyond 12 weeks post-surgery, focuses on
preparing the patient for a full return to normal activities, high intensity activities and, if applicable, sports. Physiotherapy sessions will include:

Whatever your sport or preferred activity is, the goal of Physiotherapy is to get you back to it!

Advanced balance and proprioception exercises mimicking complex movements and environments
A back to sport plan that will gradually expose you and increase your tolerance to high impact activities ex. running, jumping for basketball or volleyball
Practice of specific sport skills in the clinic ex. plyometrics, quick direction changes
Education on how to take care of your hip long-term

Having a hip replacement surgery soon?

Look for PhysioNow! It is important to make sure that your hip is as strong as possible prior to the surgery. After the surgery, your Physiotherapy will be a progressive process tailored to your individual needs. PhysioNow accepts OHIP patients after a hip or knee surgery, and also offers direct billing for extended health care benefits if you need to continue your treatment for longer. We have 10 spacious locations across the GTA from Burlington to Etobicoke and in between. Book with us today for your first assessment and treatment, or a free 15 minute consult!