By Mr. Javier Waterman, Registered Physiotherapist
What are the Indications for Surgery?
Your doctor may recommend hip replacement if you have significant pain, inflammation, and damage to your hip joint due to conditions such as:
- Osteoarthritis (most common)
- Rheumatoid arthritis
- Osteonecrosis (avascular necrosis)
- Injury such as hip fracture
- Tumour in the hip joint
Complications & Contraindications:
- Deep Vein Thrombosis (DVT)
- Leg Length Discrepancy
- Infection
- Septic Arthritis
- Severe cases of Peripheral Vascular Disease
What approach will your surgeon take?
The surgical approach your doctor will recommend depends on several factors, including how the surgeon will gain access to the hip, the type and style of the implant and how it will be attached, and your age and activity level, and the shape and health of the hip bones. The likelihood of future surgery also figures into the decision because some surgical approaches and types of implant attachment can make a revision surgery easier or more challenging. The three most common approaches for THR are:
- Posterior (PA): A most common surgical approach for THR. The major advantage of this approach is the avoidance of the hip abductors.
- Direct Anterior (DA)
- Direct lateral (Hardinge) or anterolateral: Often considered to be a balance between the two other approaches
Parts of a Hip Replacement Implant (Hip Prosthesis), the hip replacement implant has two parts:
- A ceramic ball attached to a metal stem, which is inserted into the thigh bone (femur) for stability.
- A metal cup (typically made of titanium) with an inner plastic layer, which is attached to the socket part of the hip joint (acetabulum) to allow the prosthetic joint to rotate smoothly.
Pre-operative Strengthening (Pre-Habilitation):
Your physiotherapist or a qualified strengthening professional aims to reduce your number of post-operative visits and the time taken for hospital discharge. Prehabilitation plays a significant role towards improving pre-operative quality of life as you await your surgery.
- Helps to develop a patient-specific rehabilitation programme to follow post-operatively.
- Benefits: decreased length of stay, decreased anxiety levels, improved self-confidence and established a relationship of trust between the physiotherapist and patient.
Post-operative Physiotherapy:
Your session with your physiotherapist will begin on the day of the surgery as it has been found that this leads to a decreased length of stay within the hospital, reduces pain and improves function. The aim of post-operative rehabilitation is to address your functional needs and to improve mobility, strength, flexibility and reduce pain. Surgery will correct the joint problems but associated muscle weakness that was present before the surgery will remain and require post-operative rehabilitation.
Discharge Criteria:
- independent ambulation with an assistive device
- independent transfers
- independent Activities of Daily Living (e.g., going to the bathroom)
- stairs with supervision
- appropriate home assistance (spouse, family, visiting nurses)
Home planning:
Several modifications can be made to make your home easier for you to navigate. These are listed below:
- Securely fastened safety bars or handrails in the shower or bath.
- Secure handrails along all stairways.
- A stable chair for your early recovery with a firm seat cushion (allows knees to remain lower than hips), a firm back, and two arms.
- A raised toilet seat.
- A stable shower bench or chair for showering.
- A long-handled sponge and shower hose.
- A dressing stick, a sock aid, and a long-handled shoe horn.
- Firm pillows for chairs, sofas, and cars that enable you to sit with their knees lower than their hips.
- Removal of all loose carpets and electrical cords from the areas walked in the home.
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