Hip Replacement? Try Physiotherapy

                                                                                         

Human populations are ageing across the world, particularly in developed countries such as the USA, Europe and Japan, with some developing countries such as China set to follow them over the next decades. This will place a large burden on physiotherapy and medical services as countries struggle to cope with steadily increasing levels of osteoarthritis (OA), an age-related degenerative condition. OA is responsible for significant levels of medical expenditure, disability, pain and work loss and provision of services such as joint replacement will be a challenge.

Medical interventions can be rated on a scale which calculates the improvement in quality of life which results and here hip replacement comes out top of all treatments. The 1960s saw its development into a standard treatment for hip arthritis but the 21st century has seen the technique evolve into a complex and predictable approach to many hip conditions, with excellent fifteen year plus results. Once conservative treatments have been exhausted due to a worsening joint then joint replacement becomes the standard choice.

The surgeon removes the osteoarthritic joint surfaces and replaces them with new components which are made of steel alloy and ultra high density polyethylene. The ball of the hip is replaced by a metal ball and stem and inserted into pressurized cement in the femoral canal. The plastic socket is pushed into the cement in the prepared socket to complete replacement of the two surfaces. Using the two materials, very slippery plastic and highly polished metal, ensures very low joint friction and a long functional life under load.

Post-operative physiotherapy consists of reviewing the operation note and the medical observations, assessing the patient and instructing them in breathing and leg exercises. The physio assesses the sensibility and muscle power in the legs to exclude problems such as nerve injury, although an epidural can cause temporary loss of feeling and power in the lower body and delay mobilisation. The next physio job is to get the patient up out of the bed with an assistant, stand and walk them as appropriate with elbow crutches or a frame, taking account of the necessary precautions to avoid dislocation.

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.

A good gait pattern is important in restoring normal walking function, ranges of movement and muscle power and balance. Initial gait taught by physiotherapists is typically the "step to gait", the walking aids moving forward first followed by the operated leg and then the unaffected leg steps up to the other. This is a slow but stable gait pattern and good for the initial stages. Patients progress quickly to the "step through gait" where the unaffected leg moves past the operated one, and eventually to an advanced gait where the crutches are moved forward at the same time as the operated leg. This pattern is very close to normal walking with a pair of crutches attached.

Once they return for their follow up appointment at six weeks after operation patients have often achieved a good gait, reasonable hip strength and returned to some activities of daily living. The physio may advise a stick if they are unsteady, slow or older, and they can gradually regain their previous abilities provided they observe the precautions to prevent hip dislocation: Avoid hip flexion over 90 degrees by not sitting down in low seating, not sitting down or standing up too quickly, not bending over to the floor quickly and not crouching. Weight bearing on the leg and rotating the body weight is unwise. 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.

About the author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for Physiotherapists in Croydon or elsewhere in the UK.

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