| Rehabilitation after a hip replacement is usually | | | | seat high enough to prevent too much hip flexion. As |
| straightforward but it is important to be aware of | | | | the side of the thigh has been operated this can limit |
| the priorities at each stage of the operation and | | | | the amount of knee bend so patients are |
| recovery for the best outcome. Because an | | | | encouraged to regularly slide their feet back towards |
| osteoarthritic hip is painful this has a series of | | | | themselves in sitting. |
| knock-on effects. A painful joint means the | | | | Giving the patient confidence to independently |
| musculature which controls that joint cannot work | | | | perform a safe and relatively normal gait pattern is |
| properly so tends to lose some of its strength and | | | | the initial goal of mobilization. This progresses into |
| support for the joint. The joint may also become | | | | teaching a walking technique which approximates as |
| tight as the natural movements are not performed | | | | closely as possible to normal walking. Once this has |
| and the person may adopt an abnormal gait which | | | | been well learned the patient should walk with a |
| becomes an ingrained habit. | | | | pattern very close to a natural gait, with an observer |
| Pre-operative education and rehabilitation is important | | | | only understanding they have a restriction by the |
| so the person knows what they are trying to | | | | presence of crutches. The natural sequence of |
| achieve with their exercises and gait practice. Range | | | | muscle activation is promoted by an involuntary and |
| of motion and strengthening exercises can be given | | | | repetitive function such as walking and this reduces |
| along with gait correction. If the gait cannot be easily | | | | the energy cost of walking and facilitates return of |
| corrected by instruction, consideration should be | | | | muscle power. |
| given to using a walking aid. Either a stick or a crutch | | | | The physiotherapist may prescribe an exercise |
| can be used depending on the degree of support | | | | regime for the patient if he or she identifies a |
| needed, held in the opposite hand to the arthritic | | | | particular weakness in the hip musculature. The |
| joint. If the patient walks with a good pattern this is | | | | upright position with the patient holding onto a solid |
| sufficient, but if they still walk poorly they may need | | | | object is the safest starting position and promotes |
| two sticks or crutches to achieve a reasonable gait | | | | stability and confidence. Three movements can be |
| pattern. | | | | used to start with: bringing the thigh up towards |
| On the first post-operative day the physiotherapist | | | | horizontal in front of the body; making a sideways |
| assesses and treats the patient both in the bed and | | | | movement of the leg outwards whilst keeping it |
| up mobilizing. Quadriceps and buttock muscle | | | | straight; pushing the leg behind the body whilst |
| contractions performed hourly allow the leg to regain | | | | keeping the body upright and the leg straight. The |
| muscle control to enable movement. Repeated gentle | | | | main hip and pelvic muscles which control hip stability |
| hip flexions by sliding the heel up and down in the | | | | are worked by these movements. |
| bed can help the patient regain control of the leg and | | | | Hydrotherapy or more strongly resisted exercises |
| restore this functional activity which they need to | | | | may be necessary in some cases. Joint replacement |
| master bed mobility. Circulatory improvement is also | | | | treatment is very effectively managed in a pool due |
| encouraged by pumping movements of the ankles | | | | to both the resistance and the support of the water. |
| routinely but the size of this effect may not be very | | | | Floats attached to the feet increase the forces |
| great. | | | | needed to perform muscle activity in water and the |
| Hourly contractions and gentle movements of the hip | | | | entire walking pattern can be practiced by walking |
| will get the joint moving and restore some | | | | against the water resistance up and down the pool. |
| confidence in the patient that they can independently | | | | Hip surgeons are not very keen on significant |
| move their leg around, which initially feels very heavy. | | | | exercises for total hip replacements, except gait, due |
| The physiotherapist and an assistant will mobilize the | | | | to possible implant loosening and reduction in the |
| patient as their condition allows, using crutches or a | | | | survival of the implant. |
| frame. Early sitting out in a chair is encouraged with a | | | | |