Hip Replacement and Physiotherapy
With people living longer and wanting to stay active longer a large number of people will these days have a hip replacement and as a home visit physiotherapy service across Staffordshire and the West Midlands we see a large number of patients who are at present recovering from a hip replacement. Our home visit physiotherapy service is based in Lichfield and serves surrounding areas such as Sutton Coldfield, Tamworth, Rugeley, Walsall and Cannock.
This page attempts to give patients who have had a hip replacement or are currently considering having one, some more detail about the procedure and how physiotherapy may be able to help and contribute to recovery and rehabilitation.
Firstly it is useful to understand a little bit more about the anatomy of the hip joint which is made up of 2 bones the femur (thigh bone) and the pelvis (innominate bone). The femur articulates with the pelvis via a ball and socket joint formed by the head of femur (the ball part of the joint) and the acetabulum (the socket part of the joint). There are also many muscles around the hip that enable it to flex, extend, rotate and move side to side, these are too numerous to name here but the most important and easy to locate ones are the glutes which are the buttock muscles. A vital substance inside of the joint and in between the ball and socket is cartilage which acts as a shock absorber and reduces friction in the joint. When we are younger this cartilage is smooth and looks like an ice rink, however as we age this becomes worn and pitted and can become inflamed and painful. As the cartilage becomes pitted and thinner more load is passed onto the bones of the joint often causing the bone to grow little spurs called osteophytes. This general process is called osteoarthritis and can be a source of substantial pain for many people.
Hip replacements tend to happen for one of two reasons: firstly the joint and cartilage inside has become worn out (arthritis) and the patient is now having a lot of pain and difficulty walking or the patient has broken their hip from a fall and now needs the joint replacing. The majority of patients who fall and break their hip will be elderly females, (over the age of 70), this is because post menopause many women will experience a drop in bone density due to changes in hormonal levels. This drop in bone density is called osteoporosis and results in the bones becoming more fragile and thus can cause a fractured hip if an elderly female falls on it. To reduce the risks of osteoporosis everyone should be getting enough exercise each week (especially weight bearing exercise such as walking), for more information about exercise for older persons have a look at our blog. Furthermore if you suspect you or someone you know is at risk of osteoporosis then you should contact your GP to discuss how to manage things.
So, what should you expect after your hip operation? Well hopefully you will have been given a pack of information detailing what will happen during your stay in hospital so we won't go over this initial period in much detail. However I think it is fair to say that you should obviously expect to be sore following the procedure - this is after all a large operation. It is important that you get up and are mobilising as soon as possible post operation (obviously only with the assistance of hospital staff!). You will likely be using a frame initially but depending on how well you were prior to the operation this should be reduced to crutches over the next week or so. You should see a physiotherapist on the ward daily who will help you with mobility and give you exercises to do. On average most patients will stay approximately 3-5 days in hospital and then will be discharged home where ideally they will see a community physiotherapist or attend out patient clinics.
A key factor post total hip replacement to be aware of are the movement restrictions for your operated leg, these will be discussed with you by the physiotherapist in hospital and are there to reduce the risk of dislocation as the area heals. Firstly you must not bend your hip more than 90 degrees, secondly your must not twist your hip and finally you must not cross your operated leg over your midline. These are generally in place for at least 6 weeks and your surgeon will decide when these can be removed.
Physiotherapy will form a key component of your recovery process and this is where a community physiotherapy service such as ours can really help you get the best possible result and return you to full mobility. The initial weeks are a key time for your recovery and ideally you will see a physiotherapist multiple times per week in this period to enhance your strength, mobility and fine tune your exercises. Physiotherapy in this period will include taking you through an exercise program step by step and discussing any issues, working on your gait and walking, reducing your dependence on your walking aids and pushing you to work hard each session. As you begin to recover after the first couple of weeks, physiotherapy will still be vital but you will need to see your physiotherapist less often as you will be able to complete the exercises independently and your physiotherapist will only need to see you in order to progress your exercises and review progress. It is vital that you keep up with the physiotherapy as part of your overall recovery and several studies have recently shown that even 1 year after a hip operation many patients are still having difficulties with walking and have reduced strength.
Our home visit physiotherapy service offers patients who have had a hip replacement an ideal way to access regular physiotherapy without the need to visit an outpatient clinic which can be exhausting if not impossible in the early days. Our physiotherapists will be able to visit you daily at home, if needed, and will be able to assist you through the recovery process to gain the best possible outcome. If you have had your operation with the NHS (as most people do) you should receive some community and outpatient physiotherapy however due to resource constraints it is unlikely that you will receive the optimal amount and this is where our community physiotherapy service can step in and supplement things and maximise your chances of a good recovery.
Due to the complexity of the problems that hip replacement patients face, the need to strictly observe any protocols from the surgeon and the lengthy assessment process; treatment sessions are 1 hour for all sessions including follow ups. It is our experience that this extended period of time allows for a much greater benefit and response to therapy and is especially beneficial for patients who are in significant pain and benefit from a slower and more progressive approach to rehab.