| Total hip replacement has matured into a routine | | | | other side to restore balance. This is described as a |
| operation for the relief of hip pain and disability due | | | | positive Trendelenberg sign. |
| to hip arthritis, giving some of the greatest quality of | | | | The abnormal Trendelberg gait imposes unnatural |
| life increases of all medical procedures. Typically | | | | forces on the hip and requires side flexion of the |
| performed in older people, many get a good result | | | | spine to hold balance on each step. The abnormal gait |
| from their hip replacement surgery but many do not | | | | which results fails to strengthen the hip abductors |
| reach their greatest potential due to lack of follow up | | | | and remedy the problem. With hip problems we tend |
| rehabilitation in the post-operative period. | | | | not to extend our hips fully so the gait cycle is |
| An osteoarthritic hip joint is likely to cause a degree | | | | shortened as the hip extensor muscles fail to attain |
| of pain and disability for a year or more before the | | | | full movement and power. A restriction in hip joint |
| person comes to operation. This period of difficulty | | | | movement and the presence of muscular weakness |
| can cause influential changes in the tissues around the | | | | makes mobility more difficult and can make the |
| hip which can be relevant in the postoperative period. | | | | outcome of the operation less satisfactory in the |
| Pain and weakness can make us use our joints less, | | | | absence of rehabilitation. |
| avoiding pushing them to the ends of their | | | | Coordination and balance can also be compromised |
| movement, a process which gradually reduces the | | | | and is often not particularly good before the joint |
| joint's range of motion. Adaptive shortening occurs in | | | | replacement. Insertion of a normal joint into the hip |
| the hip's ligaments, as the structures shorten in | | | | does normalise the joint and immediately improves |
| response to the fact that the joint is not being put | | | | the mechanical actions of the muscles acting upon it. |
| through its full range any more in the normal daily | | | | However, the feedback from the hip area, the joint |
| pattern. | | | | position sense, may be poor and leave the patient |
| A second consequence of the pain and the stiffness | | | | with poor balance and a tendency towards the risk |
| is the development of weakness in the large muscles | | | | of falling. |
| which serve the hip joint. The hip is a weight bearing | | | | Physiotherapy assessment of a hip problem covers |
| joint involved in moving the bodyweight around and it | | | | many aspects of joint function which relate to the |
| generates very high forces in activity. To manage | | | | ability to perform routine daily functional activities. |
| this the hip has the largest muscles in the body either | | | | The pattern of gait will be noted and corrective work |
| attached to it or nearby to it. The hip extensors, | | | | prescribed to improve the cycle of walking as an |
| including the glutei, are large powerful muscles which | | | | abnormal gait can be habitual and easily improved. |
| facilitate walking, running, stairs and getting up from a | | | | Knee, hip and spinal ranges of motion will be assessed |
| seated position. Loss of power in these muscles can | | | | to ascertain whether stiffness or any limitation is |
| be disabling and threaten independence. | | | | interfering with normal movement. |
| The hip abductors, a smaller muscle group of the | | | | Large ranges of movement are discouraged in the hip |
| gluteal muscles, are important in controlling the side to | | | | due to the possibility of dislocation and so the |
| side stability of the pelvic girdle in gait, with | | | | physiotherapist checks the hip muscle power in all the |
| weakness of these muscles interfering with walking. | | | | muscles around the joint and the joint position sense |
| Standing on one leg in walking we hold the opposite | | | | and balance. The physiotherapy rehabilitation will |
| side of the pelvis up to avoid it dropping and make | | | | consist of hip joint mobilising exercises, strengthening |
| bringing through the moving leg more difficult. The hip | | | | work, gait correction and balance practice. Hip |
| abductor muscles do this and if weak we feel | | | | arthroplasty generally gives a very good outcome |
| unstable in walking and tend to lurch towards the | | | | but this could be improved at times by rehabilitation. |
| weak side, making us lean our trunk towards the | | | | |