Management Of Hip Replacement By Physiotherapists

Osteoarthritis (OA) is the commonest joint degeneration condition in the world, resulting in huge amounts of pain and suffering, work loss, expense and disability. Ageing of western developed populations, soon to be followed by some developing countries such as China, will place an increasing burden on medical services as the occurrence of OA rises steadily with age. There will be an increasing need to provide medical and physiotherapy treatment for OA over the next 50 years and for many thousands of people this will involve joint replacement.

Of all medical interventions, joint replacement has one of the highest increases in quality of life, transforming a person’s mobility, outlook and independence. Developed in the 1960s to a level where mass treatment was feasible, total hip replacement has matured into a predictable and successful treatment for OA with very good results stretching to 15 years and beyond. Conservative treatments are the mainstay of management of OA but once it becomes severe hip replacement is the only option.

It is used to manage a variety of complex hip conditions with excellent outcomes at fifteen years and beyond.

On return from operation the physiotherapist will check the patient’s operative record, medical observations and assess the patient. Initial physio treatment consists of checking respiratory status and the muscle power and feeling in the legs to exclude nerve injury. Exercises are given to restore normal movement although an epidural can cause loss of movement in the legs and delay progress. The physiotherapist will then mobilise the patient with an assistant, taking care of the hip precautions, stand them up and walk them a short distance with elbow crutches or a frame.

Toes, ankles, quadriceps, hip flexion and buttock exercises continue to restore normal muscle activity to the legs and maintain the circulation. Routine painkillers should be taken as this helps patients get up and about and once safe they can get up three times a day or more with a helper to walk, toilet and wash. Usual precautions are taken and when sat out the chair must be the correct height and normally patients do not put their feet up whilst sitting.

Physiotherapists routinely teach and correct patients’ gait after hip replacement to improve joint movement, muscle strength and a normal walking pattern. On getting a patient up initially the physio will teach the “step to gait”, instructing the patient to place the crutches forward at first, place the operated leg between the crutches then following it by stepping to it with the unoperated leg. This technique is steady but slow and used when safety is key, and the next progression is to a “step through gait” where the unoperated leg then moves through past the operated leg into a more normal gait. The most advanced gait sees the operated leg and the crutches moving together at the same time and gait approaching normal.

Six weeks from discharge patients have usually developed a normal gait, good muscle power and have returned to many functional abilities including riding in a car, mounting stairs and normal walking. A stick can be used if the person is elderly or feels they have poor balance or stability. Sensible activities can now be performed as long as the precautions are observed:

* Avoid crossing the legs in sitting.

* Don’t stand on the affected leg and rotate.

* Get medical advice if an infection develops e.g. in the bladder, chest or teeth, as this can transfer to an artificial joint.

* Avoid crossed legs in sitting.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about physiotherapy, physiotherapy, physiotherapists in Birmingham, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.