Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physiotherapist.

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Hip Replacement Physical Therapy Guide

Hip Replacement Surgery

If your hip has been extensively damaged by arthritis, a fracture, or any other joint conditions, common activities such as walking or getting in and out of a chair may become painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks in the morning. You may even feel uncomfortable while resting, sitting on a sofa. If medications, changes in your everyday activities, and the use of walking supports do not adequately help relieve your symptoms, you may consider a hip replacement surgery. Hip replacement surgery is an extremely safe and effective procedure that can relieve your hip pain, increase range of motion, and help you get back to enjoying normal, everyday activities. A hip replacement was first performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 300,000 total hip replacements are performed each year in the United States!

Anatomy Of The Hip

The hip is one of the body’s largest joints which allows lower limb movement such as walking, running or jumping. It is a ball-and-socket joint; the socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the head of femur, which is the upper end of the thighbone. The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily and freely. A thin tissue called synovial membrane surrounds the hip joint. In a healthy persons hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement. Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

Common Causes of Hip Pain

The most common cause of chronic hip pain and disability is arthritis, however

  • Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It typically occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage that cushions the bones of the hip gradually wears away. The bones then rub against each other, causing the hip pain and stiffness.
  • Rheumatoid arthritis. RA is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can irreversibly damage the cartilage, leading to pain and stiffness.
  • Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
  • Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis. The lack of blood may cause the surface of the bone to collapse, and arthritis will result.
  • Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

Benefits Of A Hip Replacement

The main benefit of hip replacement surgery is pain relief! Other benefits include improvement of function, allowing patients to walk easier and further. Daily activities should become more comfortable and quality of life improved. Some patients may find an improved range of movement in the hip straight after the surgery although this can not be guaranteed, and is usually achieved following an exercise programme like the one below. Many patients report that the function and pain relief from their hip replacement continues to improve for up to 18 months following the surgery.

Risks And Complications Of A Hip Replacement

The majority of patients will recover extremely well following their hip replacement surgery without significant problems. As with all operations however, there are some risks that might occur and these include:

  • Infection: Infections may require further hospitalisation and treatment.
  • Deep Vein Thrombosis: All operations on the lower limbs carry a risk of blood clots forming in the deep veins of the leg, follow the advice below to reduce the risk of developing a DVT.
  • Stiffness: Sometimes the hip actually becomes stiff after surgery due to scar tissue forming inside the hip.
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Planning For Home

Several modifications can be made to make your home easier to navigate, and tasks easier to complete during your recovery. The following items may help with your daily activities, although it is advised you discuss this with an Occupational Therapist to receive a full assessment:

  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips

What Are My Treatment Options?

There are many treatment options available to people who undergo hip replacement surgery! Like all injuries, it requires a mix of rest, exercise and gradual return to normal function to be successful.

Rest & Time

Immediately after surgery, you will find yourself less able to complete the activities you normally do such as housework / working. Following the hip replacement surgery you should commence the RICE protocols:

  • Rest. Rest, relax and protect the hip replacement. Stop, change, or take a break from any activity that may be increasing your pain.
  • Ice. Ice packs will help reduce pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.
  • Compression. Wrapping the thigh with a compression sleeve will help decrease swelling and improve recovery time.
  • Elevation. Elevate your feet to reduce swelling and bruising.

Physical Therapy

Although rest is a vital component of the recovery process following a hip replacement surgery, it doesn’t mean the affected leg has to be completely immobilised for long periods. In fact,  that will make things much worse! The best way to recover following surgery? Exercise! 

Hip Replacement Exercises

1) Ankle Pumps

The biggest and most dangerous risk patients face following a total hip replacement is a deep vein thrombosis or DVT in the calf muscle. This risk can be managed via a compression stocking, or more importantly, through exercise and movement.

How to do it:

  • In either sitting or standing (harder), point your toes down as if you were going up on your tip toes. Hold for 10 seconds.

Repeat multiples times throughout the day.

2) Static Quads

Maintaining strength in the leg is very important for the hip to function properly once the swelling and pain has gone down. It will also allow you to get back to a normal walking pattern quicker. Static quads are the easiest exercise to strengthen the quads.

How to do it:

  • Place a towel under the straight (operated) leg.
  • Tighten your thigh muscles and imagine you are pushing your knee cap down into the towel.
  • Hold for 15 seconds and release.

Repeat multiple times throughout the day!

3) Glute Squeezes

It’s also mightily important to maintain the muscular strength in your glute (bottom) muscles to assist with functional tasks such as climbing stairs or getting up from a chair. Strong glute muscles will also reduce the chance of your new hip from dislocating, so get squeezing!

How to do it:

  • In either sitting or standing, Squeeze your bottom muscles for 5-10 seconds.

Repeat multiples times throughout the day.

4) Heel Slides

Hip flexion will be limited following surgery so it is important to keep it as mobile as possible, whilst following the hip precautions below. An easy method to practice hip flexion mobility is when in bed, by sliding your heel up towards your bottom.
How to do it:
  • Lying down in bed.
  • Slowly bend your knee, dragging your foot upwards towards your bottom as far as comfortable.
  • You may find it easier if you place a plastic bag underneath the moving foot so it slides easier.

Repeat 10 reps, three times throughout the day.

5) Straight Leg Raises

How to do it:

  • Lying down on a comfortable surface
  • Whilst keeping your affected leg as straight as possible, slowly raise it upwards as far as you feel comfortable.
  • Hold for 10-30 seconds

Repeat 10 reps, 3 sets, twice a day.

6) Mini Squats

A great exercise that will progress your ability to perform daily activities such as standing up from a chair, going up and down stairs etc.

How to do it:

  • Stand up with something stable (like a kitchen counter) in front of you for support.
  • Slowly bend your hips and knees as if you were sitting down. Stop half way, before pushing yourself back upright.

Repeat 10 reps, 3 sets, twice a day.

Hip Replacement Precautions

To reduce the risk of your hip dislocating it is vitally important to avoid certain movements. Dislocation of the hip is where the ball shaped head at the top of the thigh bone (femur) slips out of the cup shaped socket (acetabulum) of the hip joint. Try to follow these precautions for a minimum of six weeks (or until permitted to do so as instructed by your Consultant/Physical Therapist).

  1. Do not bend at the hip more than 90 degrees (a right angle)
  2. Do not cross your operated leg across the middle of your body.
  3. Do not twist your operated leg.
2017-08-26T22:30:33+00:00