Total Hip Replacement
Original Editors - Annelies Beckers, Vincent Everaert
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Definition/Description[edit | edit source]
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Epidemiology /Etiology[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Examination[edit | edit source]
The task of a physical therapist consists before the operation of investigating the muscular state (force, volume), ROM and the circulatory state of the injured as well as the healthy limb [1] . This gives an idea of the preoperative state of the patient.
The general physical and psychological state of the patient should also be taken care of.
For example explaining the surgical technique and the therapeutic monitoring after surgery can help lowering the patient’s anxiety. Explaining how to use a rollator or walk on crutches properly can also make the patient more self-confident when entering the postoperative stage of the therapy[1].
Medical Management
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Many surgical approaches for THR are described but we can resume them to anterior, lateral and posterior approach. These approaches determine the amount of soft tissue damaged. Many surgeons are changing from a posterior approach to a more anterior one. Cadaveric studies show that this type of approach is less invasive and damaging for muscles, capsules, ligaments and nerves[2][3]. Other studies have shown a better rehabilitation time and functional outcome[4]. Because of the lowered risk of dislocation compared to a posterior approach[5], early mobilizations as well as full weight bearing exercises according to tolerance are made possible in the first postoperative days[4].
The articulating couples (head and cup) used by surgeons are made of metal-on-polyethylene (PE), ceramic-on-PE, metal-on-metal and ceramic-on-ceramic[6]. Important components of prosthesis are friction-coefficient, survival, stability against dislocation and fixation in bone tissue[7][8]. In some cases there can be formation of osteonecrosis due to erosion of the two components rubbing against each other[9].
Physical Therapy Management
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The main factors defining the therapy management are the surgical approach and the general state of the patient. Whether the patient desires to gain physical fitness or wishes to recover for recreational activity should also be taken into account when establishing the rehabilitation program.
The posterior approach implies that precautions should be taken against dislocation when exercises combining flexion, endorotation and adduction are given. For example, cycling with elevated saddle and low resistance keeps the articulation in a reasonable range of motion and induces bearable joint load[10]. For the anterior approach it is the combination of extension, exorotation and abduction although the probability of dislocation is less great than for the posterior approachv.
The treatment after a total hip arthroplasty (without other complications) includes the non-exhaustive set of items listed below[1][11]. The given order is not fixed but shows a progressive contribution of the patient in the therapy. It should start as soon as possible according to the patient’s tolerance and medical recommendations.
First postoperative day:
• Static contraction of the M. Quadriceps in order to have a muscular and circulatory effect.
• Flexion/extension/rotation of feet and toes to prevent edema
• Education of muscular relaxation
• Upper limb exercises to stimulate the cardiac function
• Maintenance of the non-operated leg: attention should be paid to the range of motion in order to preserve controlled mobilization on the operated hip.
Bed exercise following total hip replacement does not seem to have an effect on the quality of life[12] but remains none of the less important (edema, cardiac function, etc.)[13]. It also allows an assessment of the physical and psychological condition of the patient right after surgery.
First postoperative week:
• Active/passive mobilizations to gain ROM
• Progressive resistance exercises
• Progressive weight bearing exercises according to tolerance
• Equilibrium exercises including walking with crutches/2 canes/1 cane.
Early exercises including full weight bearing exercises have shown different positive effects on the recovery of patients after THA (faster recovery[14], gain in walking ability[15]). Physical activity is also good for quality of bone tissue[9]. It improves the fixation of the prosthesis and decreases the incidence of early loosening. Once again the amount of activity is linked to the general state of the patient. Certain specific sport movements have a higher risk of injury for unskilled individuals.
1-12 postoperative month:
• Gain of initial ROM, muscular force (stabilization), and control (proprioception).
• Endurance
• Flexibility
• Equilibrium on one foot
• Speed, precision, neurological coordination
• Functional exercises
Physical therapy quickly maximizes the patient’s function which is associated with a greater probability of earlier discharge, which is in turn associated with a lower total cost of care[16].
Key Research[edit | edit source]
- Minns Lowe C. J. et al. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials. BMC Musculoskeletal Disorders 2009; 10 (98)
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 Raymond Sohier, Kinesitherapie de la hanche ; La Hestre : Sohier, 1974
- ↑ Van Oldenrijk J. et al., Soft tissue damage after minimally invasive THA. Acta orthopaedica 2010; 81 (6): 696-702
- ↑ Zhang X. et al. Anterolateral muscle sparing approach total hip arthroplasty: an anatomic and clinical study. Chinese Medecine Journal 2008; 121 (15):1358-1363
- ↑ 4.0 4.1 Röttinger H. Minimally invasise anterolateral approach for total hip replacement.,Operative Orthopädie und Traumatologie (4)
- ↑ Sköldenberg O. et al. Reduced dislocation rate after hip arthroplasty for femoral neck fractures when changing posterolateral to anterolateral approach. Acta Orthopaedica 2010; 81 (5): 583-587
- ↑ http://orthopedics.about.com/od/hipkneereplacement/a/implants.htm
- ↑ Bader R. et al. Differences between the wear couples metal-on-polyethylene and ceramic-on-ceramic in the stability of dislocation of total hip replacement. Journal of materials science: materials in medicine 2004; 15:711-718
- ↑ Garcia-Rey E. et al. Alumina-on-alumina total hip arthroplasty in young patients. Clinical Orthopaedics and Related Research; 467 (9):2281-2289
- ↑ 9.0 9.1 Mahendra G. et al. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthopaedica 2009; 80 (6): 653-659.
- ↑ Kuster M. Exercise recommendations after total joint replacement. Sports medecine 2002 ;32(7) : 433-445
- ↑ Suetta C. et al. Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse 2004; 97: 1954-1961
- ↑ Smith T. et al. Bed exercises following total hip replacement : a randomised controlled trial. Physiotherapy 2008; 94: 286-291
- ↑ Perhonen M. et al. Cardiac atrophy after bed rest and spaceflight. Journal of Applied Physiology 2001; 91: 645-653
- ↑ Ström H. et al. Unrestricted weight bearing and intensive physiotherapy after uncemented total hip arthroplasty. Scandinavian Journal of Surgery 2006; 95: 55-60
- ↑ Kishida Y. et al. Full weight-bearing after cementless total hip arthroplasty. International Orthopaedics 2001; 25: 25-28
- ↑ Freburger J. An analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty. Physical therapy 2000; 80 (5): 448-458
