Physical Therapy Working For You: Total Hip Replacements

Disease Process


A total hip replacement (THR) is usually done as the surgical treatment option for advanced osteoarthritis of the hip.

During a THR, the head (top) of the femur (upper leg bone) is removed and replaced with a metal implant. The socket (in the pelvis) has all of the remaining cartilage and some of the bone removed and replaced with a plastic cup.

For Who?:

A total hip replacement is usually recommended for people who have severe osteoarthritis (OA) in the hip, have had severe trauma to the hip (such as a fracture or multiple dislocations), or have some other destructive joint disease (such as rheumatoid arthritis or avascular necrosis).


How do I know when I am ready for a Total Hip Replacement?

Common symptoms of severe arthritis of the hip joint include:

  • Swelling of the joint
  • Hip pain
  • Loss of motion
  • Decreased ability to bear weight on the hip



Risks:

The following are common risks associated with a total hip replacement:

  • Blood clots
  • Difficulty with urination
  • Nausea and vomiting
  • Fracture of bone during or after surgery
  • Decreased motion in the hip or scarring
  • Local skin or joint infection
  • Loosening of the prosthesis (replacement parts)
Your doctor should fully discuss the surgery and all associated risks, as well as benefits before scheduling you for your surgery.

Recovery:

The typical recovery period for a total hip replacement is 3-5 days in the hospital, 2-4 weeks of skilled or home physical therapy and sometimes outpatient physical therapy. If you live alone, you will need to arrange for someone to stay with you the first two weeks or so to help you with all of your daily activities (such as dressing, bathing, and preparing food), or plan a stay in a short-term skilled rehab facility where you will receive therapy until you are independent enough to go home.
 

How Can Physical Therapy Help

The physical therapist is an integral part of the recovery following a total hip replacement. They will work with each patient in a variety of settings towards the final goal gaining as much function as possible.

In the hospital:

  • Will probably see the patient 2 times a day
  • Work on transfers in and out of bed, to and from a chair, and to and from a wheelchair.
  • Start range of motion (ROM) exercises on the hip and knee, work on strengthening exercises with both legs.
  • Educate patient on the use of ice for pain and swelling.
  • Work on walking short distances with the appropriate assistive device (such as a walker).
  • Make sure the patient understands and is able to properly demonstrate “hip precautions” (motions such as crossing the legs, bending down to far or rolling the leg inward) that help protect the new hip joint until the muscles around it have healed and been strengthened.
In a short-term / skilled rehabilitation center:
  • Work on increasing ROM and strength.
  • Increase distance of walking and progress to a less restrictive device such as a cane.
  • Practice going up and down stairs if needed.
  • Continue with icing to help decrease swelling and pain.
  • Work on balance.
  • Make sure patient is independent with all transfers (bed, chair, tub / toilet) and prepare patient for return home.
  • Continue with hip precautions.
In the home:
  • Work on increasing ROM and strength.
  • Increase distance of walking and progress to a less restrictive device such as a cane.
  • Practice going up and down stairs if needed.
  • Continue with icing to help decrease swelling and pain.
  • Work on balance.
  • Continue with hip precautions.
  • Make sure patient is independent with all transfers (bed, chair, tub / toilet) and prepare patient for outpatient therapy. Some patients may have recovered enough at home and feel comfortable with their exercises and choose not to go to outpatient PT. be sure to discuss this decision with you health care providers.
At an outpatient center:
  • Continue working on strengthening the hip and recovering range of motion.
  • Continue working on walking (possible add the use of a treadmill for distance and endurance).
  • Progress to a cane or no device during walking.
  • Make sure patient is safe with stairs.
  • Use modalities and continue with icing to help decrease swelling and pain.
  • Continue working on balance.

For more information on physical therapy, please visit Physical Therapy Working For You.

Patient Resources

Medicinenet.com
American Academy of Orthopedic Surgeons




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