| Total hip replacement has matured into a routine | | | | positive Trendelenberg sign. |
| operation for the relief of hip pain and disability due | | | | The abnormal Trendelberg gait imposes unnatural |
| to hip arthritis, giving some of the greatest quality of | | | | forces on the hip and requires side flexion of the |
| life increases of all medical procedures. Typically | | | | spine to hold balance on each step. The abnormal gait |
| performed in older people, many get a good result | | | | which results fails to strengthen the hip abductors |
| from their hip replacement surgery but many do not | | | | and remedy the problem. With hip problems we tend |
| reach their greatest potential due to lack of follow up | | | | not to extend our hips fully so the gait cycle is |
| rehabilitation in the post-operative period. | | | | shortened as the hip extensor muscles fail to attain |
| An osteoarthritic hip joint is likely to cause a degree | | | | full movement and power. A restriction in hip joint |
| of pain and disability for a year or more before the | | | | movement and the presence of muscular weakness |
| person comes to operation. This period of difficulty | | | | makes mobility more difficult and can make the |
| can cause influential changes in the tissues around the | | | | outcome of the operation less satisfactory in the |
| hip which can be relevant in the postoperative period. | | | | absence of rehabilitation. |
| Pain and weakness can make us use our joints less, | | | | Patients typically have impaired balance and |
| avoiding pushing them to the ends of their | | | | coordination even before they have their joint |
| movement, a process which gradually reduces the | | | | replacement operation, with some improvement |
| joint's range of motion. Adaptive shortening occurs in | | | | occurring as the hip's function moves more towards |
| the hip's ligaments, as the structures shorten in | | | | normal after the joint has been replaced and the |
| response to the fact that the joint is not being put | | | | mechanical function of the hip is restored towards |
| through its full range any more in the normal daily | | | | normal. Other impairments usually include the sense of |
| pattern. | | | | joint position sense, an important ability the lack of |
| When a hip joint is not used in the normal way or | | | | which compromises balance and makes falling more |
| through its full range the muscles which power it will | | | | likely. |
| lose some of their strength. The hip joint is designed | | | | Physiotherapists assess a patient's hip function and |
| to bear weight and to move the body around which | | | | ability to get through their normal daily work, looking |
| involves high levels of power, provided by the largest | | | | at the deficiencies in the joint so they can plan the |
| muscles in the body, the gluteal muscles. The ability | | | | rehabilitation. Noting the gait of the patient will be the |
| to run, walk, get up from a chair, climb stairs and go | | | | first thing in the assessment, moving on to checking |
| uphill is facilitated by the power of the gluteal muscles | | | | movements of the hip, knee and spine to check for |
| to a great extent. If these muscles weaken they can | | | | any restrictions due to joint stiffness. An abnormal |
| reduce a person's independence to an important | | | | gait can be habitual and the physiotherapist will |
| degree. | | | | analyse and correct the gait pattern towards normal. |
| The hip abductors, a smaller muscle group of the | | | | Excessive range is not encouraged in hip |
| gluteal muscles, are important in controlling the side to | | | | replacements due to the risk of dislocation. Next the |
| side stability of the pelvic girdle in gait, with | | | | muscle power in all the surrounding muscles will be |
| weakness of these muscles interfering with walking. | | | | tested and then the person's balance reactions and |
| Standing on one leg in walking we hold the opposite | | | | joint position sense. Once the assessment is |
| side of the pelvis up to avoid it dropping and make | | | | complete the physiotherapist will give the patient a |
| bringing through the moving leg more difficult. The hip | | | | programme including joint mobility, strengthening, and |
| abductor muscles do this and if weak we feel | | | | balance and gait correction. Many with hip |
| unstable in walking and tend to lurch towards the | | | | arthroplasty do not reach their best potential due to |
| weak side, making us lean our trunk towards the | | | | a lack of rehabilitation care after the operation. |
| other side to restore balance. This is described as a | | | | |