| Total hip replacement rehabilitation is not a complex | | | | upper thigh can limit the bend of the knee due to |
| process but it is useful for a skilled eye to be kept | | | | pain. Routine practice knee flexion is important to |
| on the progress of the patient if the outcome is | | | | restore movement, by sliding the foot back towards |
| going to be optimal. The muscles around a painful | | | | and under the chair as able in sitting. |
| joint weaken due to lack of use and this reduces the | | | | Initially mobilisation should produce a safe and |
| support of the joint given by them. Tightness may | | | | acceptable walking pattern and after the initial period |
| develop in the joints due to the restrictions in the | | | | the physiotherapist will progress to teaching as close |
| movements which are limited by the pain and so the | | | | to a normal gait as possible. Once the patient has |
| patient may develop an abnormality of gait to cope | | | | achieved a step-through gait and are walking well |
| with the pain and tightness. | | | | their gait pattern should be very close to normal with |
| Physiotherapists start with rehabilitation and education | | | | the addition of a pair of crutches the only clue they |
| of patients pre-operatively so they are well prepared | | | | have had an operation. Muscle activation is normalised |
| for the operation and understand what they need to | | | | by the natural rhythm of an automatic activity such |
| do. Joint restriction is assessed with strengthening | | | | as walking and a correct sequence of muscle activity |
| and mobilising exercises given for the hip and the gait | | | | lowers the energy requirements for walking and |
| checked and corrected as necessary. If the gait is | | | | increases muscle strength. |
| poor then the physiotherapist will consider a walking | | | | Specific exercises can be added to the patient's |
| aid such as a crutch or stick, in the hand opposite to | | | | regime if a significant weakness in one or more |
| the affected joint. If a good walking pattern is not | | | | muscles is identified. Standing and holding on to a firm |
| established with this a second stick or crutch may be | | | | object in front is the best position to start with from |
| necessary to attain a suitable gait with pain relief. | | | | a balance and safety point of view. The exercises |
| On the first post-operative day the physiotherapist | | | | consists of three movements: raising the knee up in |
| assesses and treats the patient both in the bed and | | | | front so the thigh eventually is close to horizontal; |
| up mobilising. Quadriceps and buttock muscle | | | | abducting the leg to the side whilst kept straight; |
| contractions performed hourly allow the leg to regain | | | | maintaining an upright posture whilst moving the |
| muscle control to enable movement. Repeated gentle | | | | straight leg behind the body. These exercises |
| hip flexions by sliding the heel up and down in the | | | | strengthen the major moving and stabilising muscles |
| bed can help the patient regain control of the leg and | | | | around the hip and pelvis and can easily be |
| restore this functional activity which they need to | | | | performed even by elderly and less strong patients. |
| master bed mobility. Circulatory improvement is also | | | | If these are not sufficient then the patient can be |
| encouraged by pumping movements of the ankles | | | | instructed in exercises on the bed or prescribed |
| routinely but the size of this effect may not be very | | | | hydrotherapy. Hydrotherapy is a very good method |
| great. | | | | for strengthening joint replacements as the water |
| As the operated leg often feels very heavy and | | | | gives good levels of resistance but supports and |
| difficult to control, the repeated movements and | | | | controls the joints as they move. Floats can be used |
| contractions improve the patient's ability and | | | | to strengthen muscles against resistance and gait |
| confidence in moving their leg with good control. | | | | practiced against the water, giving resistance to the |
| Mobilisation of the patient into standing will be | | | | whole process of walking and strengthening the |
| performed by the physiotherapist and an assistant, | | | | entire pattern. Excessive exercise is not |
| with walking a short or longer distance achieved | | | | recommended for hip replacements as this can |
| depending on the patient's ability. A relatively high | | | | compromise the interface between the cement and |
| sitting position is advised to limit extremes of hip | | | | the bone inside and shorten the life of the implant. |
| flexion. The operative site on the outside of the | | | | |