Physiotherapy for Total Hip Replacement

Total Hip Replacement Physio Rehab

A hip replacement, also known as a hip arthroplasty. Is a procedure where damaged bone, comprising the joint is removed and replaced with prosthetic components. In a total hip replacement, the head of the femur is replaced with a prosthetic head attached to a shaft. And the joint surface of the acetabulum is covered with a synthetic liner. It is a surgery with very high success rates with 95% of patients experiencing significant pain relief after surgery when combined with effective total hip replacement physio. It is estimated that 58% of total hip replacements last 25 years.

Surgeons use various techniques for total hip replacements. Techniques which you may hear described as either an anterior, lateral, or posterior approach. Dependent on the location of incision used to gain access to the hip.

Physiotherapy is an essential part of rehabilitation before and after a total hip replacement. Physiotherapy treatment can greatly speed up the recovery process.

What is the most common reason for needing a hip replacement?

The most common reason for needing a hip replacement is osteoarthritis which causes damage to the joint. This condition leads to destruction of the joint surfaces resulting in loss of range of motion, stiffness, and pain. Another cause for needing a hip replacement is rheumatoid arthritis, an inflammatory form of arthritis that also damages the joints. Hip fractures can also warrant a replacement, and in rarer instances, a hip replacement may be required due to a tumour in the hip. Or, osteonecrosis where the blood supply to the bone is compromised.

What are some signs of needing a hip replacement?

The following are some symptoms that signify that you may benefit from a hip replacement:

• Persistent pain
• Pain in bed at night
• Pain that increases with walking, running, and hiking
• Limited range of motion and stiffness
• Difficulty standing on one leg
• Leg length discrepancy
• No lasting relief from conservative treatment

If you have a combination of these symptoms, and have already tried a period of conservative treatment, including exercise therapy, myofascial release, joint mobilisations, and pain-relieving modalities. Your doctor, physiotherapist, or other healthcare practitioner may consider imaging to determine whether you are a candidate for a hip replacement. You may be referred on to an orthopaedic consultant for further assessment.

How can physiotherapy help before a hip replacement?

Individualised physiotherapy sessions prior to hip replacement surgery have been shown to be highly effective in reducing the number of sessions needed post-op. Allowing for a quicker return to function and discharge from treatment post-surgery.

The goal of physiotherapy prior to surgical intervention, also known as prehab, is to maximise stability and strength of the muscles around the joint. As well as in other parts of the body, such as the arms and core, to help with moving in bed and using crutches after surgery. Prehab is also important for improving proprioception and balance and maximising cardiovascular fitness after surgery.

The role total hip replacement physio rehab

Your total hip replacement physio treatment will likely begin on the day of surgery. Once you are stable and have recovered from anaesthesia.

The goal is to start walking with the assistance of a physiotherapist and an aid such as crutches or a walking frame by the day after surgery. Rehabilitation protocols can vary between surgeons. Some enhanced recovery programmes aim to mobilise patients within six hours post-surgery. While others may advise beginning ambulation the following day.

Your physiotherapist will guide you on precautions to take after surgery as well as teach you exercises to begin in bed to facilitate firing of the muscles. And guide you regarding safe and effective range of motion for the hip, knees, and ankles.

Often an early programme will include isometric Gluteal and Quadriceps strengthening. You will likely be able to return home on day three post-surgery. Assuming you don’t have any complications and are able to ambulate independently with an assistive device.

Total Hip Replacement physio rehab once discharged from hospital

Once you are home, you will begin an outpatient rehabilitation programme such as we would carry out here at Sydney Physio Clinic. Consisting of gradual progression of range of motion, strengthening and gait training exercises. Your physiotherapist will help you to wean off crutches by progressing your balance, proprioception, and confidence. So by four to six weeks post-surgery you should be able to walk independently without an assistive device.

You should avoid twisting on your operated leg and avoid forceful movement to end of range for three months following surgery. Dependent on the technique of hip replacement that you have had, and your surgeon’s particular protocol, precautions will vary slightly. Your physiotherapist will be able to guide you with this.

1. Robertson NB, Warganich T, Ghazarossian J, Khatod M. Implementation of an accelerated rehabilitation protocol for total joint arthroplasty in the managed care setting: the experience of one institution. Advances in Orthopedic Surgery. 2015;387197.