Louisville NE 68037 & Plattsmouth NE 68048

Total Hip Replacement Rehab

January 31, 2023

Have you been suffering from hip pain? Has it been ongoing for years? Is it limiting your ability to enjoy life? Total hip arthroplasties have been a cure for hip pain since the late 1800’s; however, the FDA approved the first total hip operation in the USA in 1969. Since then, the number of total hip surgeries performed in the USA has grown to nearly 400,000 per year, making it a very common operation today. But what does a total hip arthroplasty entail? How do you know if you need one? Will therapy be recommended afterwards?

                The hip joint is a ball-and-socket joint. It is formed by the acetabulum of the pelvis (the socket) and the head of the femur (the ball), which is the largest bone in the body! The hip takes the brunt of body weight as we walk and complete activities throughout our day. Because of the high demand on this joint, it can have a tendency to wear-down. Arthritis is one of the main reasons for needing a hip replacement. Arthritis can cause excess pain and inflammation in the joint and even limit your motion. This loss of function combined with pain will send patients to the doctor seeking replacement surgery. Fractures can be another reason for a replacement. While fractures typically have the ability to heal without surgical intervention, it becomes more difficult for the healing process to occur in our older age. Weakness within the bones and decreased healing may prompt the doctor to opt for surgery.

A total hip arthroplasty involves replacing the two sections of the pelvis and femur bone that come together to form the hip joint. Both get removed and replaced with metal or ceramic parts to allow for improved function. There are a couple different ways to access the hip joint. Surgeons will choose to use either the anterior approach or the posterolateral approach. With the anterior approach, they make an incision on the front side of the hip and push the muscles aside to reach the bones that need replacing. With this approach, there are some precautions to be aware of following the surgery. You want to avoid flexion and internal rotation (turning your foot inward) at the same time as well as crossing your legs and sitting in low chairs for the first 6 weeks. A posterolateral approach involves an incision on the backside of the hip joint. The doctor will cut through muscle tissue rather than push the muscle aside. The precautions for this approach are similar to that of an anterior approach. Too much flexion, crossing legs, and sitting in low seats or tubs will put you at risk of dislocation.

As with any replacement surgery, your doctor will likely send you to physical therapy afterwards. Each approach has its own protocol in which the physical therapists will use as a guideline to get you back to normal function. Within phase 1 of the protocol, the therapist will work to regain your range of motion and begin muscle activation of the entire leg. Early muscle activation includes isometric training which is engaging muscles without joint movement. The doctor will give you a walker to help with ambulation immediately after surgery. There are no weight bearing restrictions, so as soon as you feel you are able to put all of your weight through your leg, you can! This helps in progressing towards phase 2. Phase 2 of the protocol will include strength training within the entire leg with continued work on range of motion at the hip. Your physical therapist will typically work with you to get you out of the walker and onto a crutch or cane (if needed) at this time. Phase 3 will include resistance training for progressed strengthening of the muscles in the leg. This is also the point where balance training and stretching will be introduced.

Lack of Strength

Once you have completed each phase of the protocol successfully with your physical therapist, you will be able to make a steady return to your daily activities. You may not be up to jumping right into all the activities you did before surgery, but with a gradual return, you will feel better than ever! If you feel you are in need of exercises or surgery for your hip, consult with your primary doctor, local orthopedic specialist, or local physical therapist. They will be able to help set up a plan that best suits your needs. For a consult with a Physical Therapist, call us at Witte Physical Therapy. We have staff here ready and eager to help you take the first step to recovery!