| Osteoarthritis (OA) is the commonest joint | | | | assistant, taking care of the hip precautions, stand |
| degeneration condition in the world, resulting in huge | | | | them up and walk them a short distance with elbow |
| amounts of pain and suffering, work loss, expense | | | | crutches or a frame. |
| and disability. Ageing of western developed | | | | Toes, ankles, quadriceps, hip flexion and buttock |
| populations, soon to be followed by some developing | | | | exercises continue to restore normal muscle activity |
| countries such as China, will place an increasing burden | | | | to the legs and maintain the circulation. Routine |
| on medical services as the occurrence of OA rises | | | | painkillers should be taken as this helps patients get |
| steadily with age. There will be an increasing need to | | | | up and about and once safe they can get up three |
| provide medical and physiotherapy treatment for OA | | | | times a day or more with a helper to walk, toilet and |
| over the next 50 years and for many thousands of | | | | wash. Usual precautions are taken and when sat out |
| people this will involve joint replacement. | | | | the chair must be the correct height and normally |
| Medical interventions can be rated on a scale which | | | | patients do not put their feet up whilst sitting. |
| calculates the improvement in quality of life which | | | | After hip replacement patients require instruction and |
| results and here hip replacement comes out top of all | | | | correction to achieve a normal walking pattern, |
| treatments. The 1960s saw its development into a | | | | develop muscular power and improved function. |
| standard treatment for hip arthritis but the 21st | | | | Physiotherapists teach the appropriate gait at the |
| century has seen the technique evolve into a | | | | time, often starting with "step to" where the patient |
| complex and predictable approach to many hip | | | | moves the walking aid, steps the operated leg |
| conditions, with excellent fifteen year plus results. | | | | forwards and steps up to it with the other leg, a |
| Once conservative treatments have been exhausted | | | | stable and safe pattern. Progression is to 'step |
| due to a worsening joint then joint replacement | | | | through" where the unaffected leg steps beyond the |
| becomes the standard choice. | | | | other in an approximation of a normal walking pattern. |
| Total hip replacement involves removal of the | | | | Patients often progress naturally then to a gait |
| arthritic joint surfaces and their replacement with | | | | where they move both the crutches and the |
| metal and plastic components. The top of the femur, | | | | affected leg forward at the same time and start to |
| the ball of the hip joint, is removed and the socket is | | | | walk in a fully natural pattern. |
| reamed out to make it bigger to accept the new | | | | Once they return for their follow up appointment at |
| part. Cement is pressurized into the bony areas and a | | | | six weeks after operation patients have often |
| steel alloy femoral component with a ball and stem is | | | | achieved a good gait, reasonable hip strength and |
| inserted down the femur and a plastic cup of ultra | | | | returned to some activities of daily living. The physio |
| high density polyethylene into the socket. The | | | | may advise a stick if they are unsteady, slow or |
| metal-plastic interface allows very low friction and | | | | older, and they can gradually regain their previous |
| wear, ensuring a long life for the joint. | | | | abilities provided they observe the precautions to |
| On return from operation the physiotherapist will | | | | prevent hip dislocation: Avoid hip flexion over 90 |
| check the patient's operative record, medical | | | | degrees by not sitting down in low seating, not sitting |
| observations and assess the patient. Initial physio | | | | down or standing up too quickly, not bending over to |
| treatment consists of checking respiratory status and | | | | the floor quickly and not crouching. Weight bearing |
| the muscle power and feeling in the legs to exclude | | | | on the leg and rotating the body weight is unwise. |
| nerve injury. Exercises are given to restore normal | | | | Get medical advice if an infection develops e.g. in the |
| movement although an epidural can cause loss of | | | | bladder, chest or teeth, as this can transfer to an |
| movement in the legs and delay progress. The | | | | artificial joint. Avoid crossed legs in sitting. |
| physiotherapist will then mobilise the patient with an | | | | |