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Total Hip Replacement

Original Editors - Annelies Beckers, and Vincent Everaert as part of the Vrije Universiteit Brussel's Evidence-based Practice project.


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Description

Hip prosthesis components
Hip prosthesis components

Total Hip Replacement (THR), or Total Hip Arthroplasty (THA), is a procedure that removes damaged bone and cartilage and replaces it with prosthetic components. THR is one of the most cost-effective and consistently successful orthopaedic surgeries. 

  • THR provides good outcomes for advanced degenerative ⠀⠀hip osteoarthritis⠀⠀patients pain relief, functional restoration, and improved quality of life.[1][2]

Clinically Relevant Anatomy

Total Hip Replacement X-ray
THR X-ray

The hip joint is regarded as one of the joints with the highest natural degree of stability[4]. The femoral head and acetabulum articulate to form this joint, which joins the axial skeleton to the lower extremities and aids the transmission of forces during everyday tasks[5].

This design allows the poly-axial movement seen at the hip. The head of the femur and the inside of the acetabulum are covered with a layer of hyaline cartilage.[6] Once this cartilage is worn away or damaged (usually by arthritis), the underlying bone is exposed, resulting in pain, stiffness and possibly shortening of the affected leg. By replacing these surfaces the aim is to reduce pain and stiffness to restore an active and pain-free life. The video link below explains Hip Osteoarthritis:

[7]

THR is mostly done electively.[8][9][10][11]

Anatomy of Muscles and Movements of the Hip Joints

Total hip replacement surgery can help restore gait function, which is essential for daily tasks[12], a thorough understanding of Hip joint anatomy can help to clarify the relationship between the muscles responsible for hip movements and stability following THR[13].

Key Muscles Involved in Hip Movement

The muscles responsible for hip movement are categorized based on the specific action performed. Hip flexion is primarily facilitated by the “psoas major, iliacus, pectineus, rectus femoris, and sartorius muscles”. In contrast, hip extension is driven by the “gluteus maximus and the hamstring group, which includes the semitendinosus, semimembranosus, and biceps femoris”. Abduction of the hip involves the “gluteus maximus, gluteus medius, gluteus minimus, and tensor fasciae latae”. For adduction, the primary muscles are the “adductor magnus, adductor longus, adductor brevis, gracilis, and pectineus”. Internal rotation of the hip is supported by the “gluteus medius, gluteus minimus, tensor fasciae latae, psoas major, and iliacus”, while external rotation is controlled by the “gluteus maximus, piriformis, obturator internus, gemellus superior and inferior, quadratus femoris, and obturator muscles”. Each of these muscle groups plays a crucial role in maintaining proper hip function and mobility.[14]


The video link below explains the motion at the hip joint and the muscles responsible:

[15]

Indications for Surgery

The most common indication for THA hip OA. Other indications include:[16]

Complications

Leg length discrepancy after Total Hip Replacement
Leg length discrepancy after THR

Complications following THR can be loosely divided into systemic and procedure-specific complications. Incidence of complications has improved over time, due to surgical and anaesthetic technique improvements, along with the better diagnosis and management of these complications.

The most common systemic complication is deep vein thrombosis. Infection is the most dreaded complication. Leg length discrepancy is a common cause of patient dissatisfaction[18]. For more see Total Hip Replacement Complications.

Contraindications for Surgery

THA is contraindicated in the following clinical scenarios:

Orthopaedic Assessment

An assessment by an orthopaedic surgeon consists of several components:

  • Medical history: general health and questions about the extent of hip pain and how it affects the ability to perform ADLs.
  • Hip examination
  • X-rays. Assess the extent of damage or deformity in the hip.
  • Other tests. Occasionally other tests, e.g., an MRI scan, may be needed to determine the condition of the bone and soft tissues of the hip.

The diagnosis of patients requiring THR is mostly symptom-based. Pain, loss of range of motion and functional impairments are mostly considered.[20]

Prosthesis

Stainless steel and ultra high molecular weight polythene Total Hip Replacement
Stainless steel and ultra-high molecular weight polyethene THR

When performing a THR, the ball is removed, the socket reshaped, and the artificial implant is positioned in the bone. The implant may be held in the bone by tightly wedging it in place or cementing it into position. The type of fixation used depends on the patient's bone health and the design of the implant. Contemporary THR techniques have evolved into press-fit femoral and acetabular components, and many variations exist.[21] The basic components are:

  1. Bearing surfaces are the surfaces which articulate in the prosthetic joint. The femoral head and the acetabular liner can be used in different combinations. These will give different appearances on radiographs depending on the configuration. Many options are available e.g., Metal-on-polyethylene, Ceramic-on-polyethylene, Ceramic-on-ceramic, Metal-on-metal.[1]
  2. Femoral component or stem: this refers to the prosthesis which is implanted into the femur. They can be described by length, taper, and the presence of a collar. Attached to the femoral component are the neck and head which in most prostheses can be altered in size to create a stable joint[22].
  3. Prosthesis fixation: Femoral stem fixation can be either cemented or non-cemented (biological) fixation[22]. Prevalence of fixation technique: increasing trend towards cementless fixation; 93% of THA in United States in 2012 were cementless[23]

Surgical Approaches

Posterior hip approach illustration
Posterior hip approach

Any number of approaches can be used for the THA procedure. The three most common approaches are:

  1. Posterior (PA): A most common surgical approach for THR. The major advantage of this approach is the avoidance of the hip abductors. Performed with a patient lying on their side and a surgical incision made along the outside of the hip.[24]
  2. Direct Anterior (DA): This surgical procedure has been increasing over the past decade. This approach is performed with a patient lying on their back, and a surgical incision is made coming down the front of the thigh (between the tensor fascia lata and sartorius on the superficial end, and the gluteus medius and rectus femoris on the deep side). There are several potential advantages of the direct anterior approach. The two most prominent are a low dislocation risk and early postoperative recovery.[24]Perception is that DAA results in less tissue damage, however, this lacks support in the literature.[25]
  3. Direct lateral (Hardinge) or anterolateral: Often considered to be a balance between the AP and PA. The person is positioned on their side, and the surgical incision is placed directly down the outside of the hip. The advantage is a balance of having a versatile incision that can be used to correct deformities and insert specialised implants with lower dislocation rates following surgery than what is observed with posterior approaches. Disadvantage: superior gluteal nerve dissection may result in nerve injury, leading to postoperative Trendelenburg gait, characterized by compensatory movements to address hip abductor weakness. [24]
MAKOplasty® THR is powered by an Interactive Robotic Arm.

Additionally

  1. Robotic Arm Assisted THR: Assists with THR surgery, helping in the accurate positioning of the implants which correlates with improved function and lifespan of the THR. Can be used in all current surgical approaches to the hip (AP, PA and lateral).
  2. Minimally invasive surgery is becoming popular all around the world, due to the quicker recovery rates and reduced postoperative pain. Long-term follow-up and comparison studies are still needed in this field.[26]

View this 3-minute video and learn about the different approaches to hip replacement surgery and the advantages of each method.

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[27]

Physiotherapy Management

Plenty of questions remain concerning the most effective rehabilitation management of patients following a THA. This uncertainty exists as a comparison of the effectiveness and harms of interventions is difficult due to the diverse programs, frequently inadequate intervention description, and an extensive variety of outcomes reported across research. What is needed are well-conducted studies that address both the effectiveness and harms of interventions using randomised controlled trials.[28]

Discuss Hip precautions before surgery.

  1. PA avoid flexion past 90 degrees; extreme internal rotation; and adduction past the body's midline.
  2. The anterolateral approach avoids extension; extreme external rotation; and adduction past the body's midline.
  3. AP avoid: bridging; extension; extreme external rotation; adduction past body's midline[23]

Hip precautions have traditionally been used within the management of total hip arthroplasty to reduce the risk of dislocations [29]. This is particularly needed to provide safe boundaries for movement when patients are keen to “push” those boundaries soon after surgery or have other risk factors such as abductor deficiency with a history of previous dislocations, loose soft tissues, patients with neuromuscular and cognitive disorders[30]. However, their use is increasingly controversial due to their association with a slower return to activities, an absence in the rise of dislocation rates when precautions are not used, and a lack of evidence to support their use [31][30].

Pre-operative

One-on-one preoperative physical therapy session protocol is effective at reducing the number of postoperative PT visits and time for readiness to discharge from PT. It plays an important role towards improving preoperative quality of life (people can wait many months for surgery and experience further deterioration in health-related quality of life during long waits).[32]See also Physical Activity Pre and Post-Surgery

Pre-operative assessment and treatment session

  • Helps to develop a patient-specific rehabilitation programme to follow post-operative, considering assessment findings e.g., Does the patient desire to reuptake golf?
  • Benefits: decreased length of stay[33]; decreased anxiety levels[34]; improved self-confidence[35]; established a relationship of trust between the physiotherapist and patient.
  • A combination of verbal explanations and written pamphlets is the best method for health education.[34] Important to incorporate this into the pre-operative physiotherapy management of patients before total hip replacements (linked to better post-operative adherence).[34]

Pre-op Assessment

  • Subjective history
  • Range of motion
  • Muscle power
  • Circulation
  • Mobility and function[35]

Pre-op Treatment

  • Education and advice: Patient information booklet; Precautions and contraindications; Rehabilitation process; Goals & expectations; Functional/ADL adaptions; Safety principles
  • Encourage them to stop smoking if applicable.
  • Discharge planning
  • Teach: Bed exercises; Transfers in and out of bed (within precautions)
  • Gait re-education with mobility assistive device (crutches vs walkers)
  • Stair climbing

Post-operative

Starting the day of surgery leads to a decreased length of stay, reduces pain and improves function.

  • Aim of post-operative rehabilitation: address the functional needs of the patient (e.g. start mobilizing) and to improve mobility, strength, flexibility and reduce pain.[10] . This starts as an assisted process, but the aim is to get the patient as functional as possible before discharge.
  • As a result of the underlying pre-operative pathology, patients may present with muscle atrophy and loss of strength, particularly in the gluteus medius and quadriceps muscles. The result of the loss of strength is that the elderly are less independent.[8]
  • Surgery will correct the joint problems but associated muscle weakness that was present before the surgery will remain and require post-operative rehabilitation (research has shown hip abductor weakness after surgery is a major risk associated with joint instability and prosthetic loosening).[9] Patients can achieve significant improvements through a targeted strengthening programme following total hip replacement.[36] Motor Imagery training, is a useful adjunct therapy tool as it improves both specific and general adaptations that were related to patients’ physical capabilities when added in a corollary to routine physical therapy.[37]
  • No specific general hip replacement protocol is currently in use, as small elements of the rehabilitation process are surgeon-specific. For example, in some enhanced recovery after surgery protocols, patients are mobilised out of bed within the first 6 hours post-surgery. Other settings may only start mobilizing patients out of bed on day 1 or 2 post-surgery. Accelerated rehabilitation programmes and early mobilization have been shown to give patients more confidence in their post-operative mobilization and activities of daily living, as well as being more comfortable with earlier discharge.[38]

Evidence

Physiotherapy: can improve strength and gait speed after total hip replacement and help prevent complications such as subluxation and thromboembolic disease; increases the patient’s mobility and offers education about the exercises and precautions that are necessary during hospitalization and after discharge.[39]; 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[40]

  • Bed exercise following a total hip replacement is important for the effects on oedema, cardiac function and improving range of motion and muscle strength[41].
  • Early weight bearing and physical activity have benefits for the quality of bone tissue[42], improving the fixation of the prosthesis and decreasing the incidence of early loosening. The amount of activity is patient-specific, and clinical reasoning should be used to make adaptions where needed. Certain specific sports movements have a higher risk of injury for unskilled individuals and should be incorporated later in the rehabilitation process under the supervision of a physiotherapist.

Suggested protocol in the absence of complications: Surgeon preference should be taken into account, as well as any other factors that might hinder the following of the protocol. Adaptions should be made to make it more patient-specific.[35][43]

Day 0 of Surgery

Initiating early mobilization and rehabilitation on the day of surgery following THR can minimize post-operative problems, aid early recovery and shorten the length of stay in the hospital.[44] Also, Enhanced Recovery After Surgery (ERAS) or Fast Track protocols since its introduction into post-operative management of THR have proven to be effective in improving patient recovery as well as reducing healthcare costs.[45] The existing recommendations from NICE guidelines indicate that rehabilitation after hip replacement should commence at the earliest opportunity; however, postoperative complications such as nausea, hypotension, pain, delirium, and confusion may hinder the initiation of early mobilization.[46]A thorough assessment is required before mobilization of the patient on day zero following THR:

  • Check the Postoperative instructions and note the Estimated Blood Loss (EBLs) as this could have an impact on patient early mobilization.
  • Ensure the Hb is within the acceptable range as per post-op instructions.
  • Check Blood Pressure, Heart Rate, Oxygen saturation, Respiratory Rate, Temperature and Level of consciousness.
  • Check if an x-ray is required to determine the weight-bearing status before mobilization.
  • Follow hip precautions based on the procedure or surgical approach.
  • Assess the patient's hip wound and dressing.
  • Pay attention to any changes in skin colour and swelling.
  • Notify the surgical team if there is substantial bleeding.
  • Continuously monitor for symptoms of pulmonary embolism, deep vein thrombosis, or any peripheral nerve impairment. If any neurological issues are detected, inform the physician immediately.
  • Be vigilant for signs of hip dislocation, such as uncontrolled pain, noticeable leg length differences, or the leg appearing rotated in comparison to the unaffected side.
  • Always ensure the level of pain is assessed before intervention using appropriate outcome measures such as Numerical Pain Rating Scale(NPRS) or Visual Analogue Scale (VAS)

Day 1 Post-Surgery

  • Education and advice
  • Education on muscular relaxation
  • Revision of precautions and contraindications (provided that the patient had a pre-operative session with the physiotherapist, otherwise full education will be done as mentioned in the pre-operative section).
  • Bed exercises:
    • Circulation drills
    • Upper limb exercises to stimulate cardiac function
    • Maintenance of the non-operated leg: attention should be paid to the range of motion to preserve controlled mobilisation on the operated hip
    • Isometric quadriceps (progressing to concentric VMO) and gluteal contractions
    • Active-assisted (progressing to active) heel slides, hip abduction/adduction
  • Bed mobilisation using unilateral bridging on the unaffected leg
  • Getting in and out of bed (see here)
  • Getting on and off a chair with arms (see here)
  • Sit to stand with a mobility assistive device (preferably a device giving more support like a walking frame or rollator)
  • Gait re-education with mobility assistive device as tolerated (weight-bearing status as determined by the surgeon)
  • Sitting out in the chair for a maximum of 1 hour
  • Positioning when transferred back to bed

Day 2 Post-Surgery

  • Bed exercises as described above, progressing repetitions and decreasing assistance given to the patient.
  • Progression of distance mobilised and/or mobility assistive device.
  • Incorporate balance exercises if needed.
  • Sitting in chair

Day 3 Post-Surgery

single leg bridge illustration
single leg bridge

Bed exercises as described above, progressing repetitions and decreasing assistance given to the patient.

  • Progression of distance mobilised and/or mobility assistive device.
  • Stair climbing (at least 3, or as per home requirements)
  • Sitting in chair
  • Revision of precautions, contraindications and functional adaptions
  • Give 6-week progressive resistive strengthening home exercise to the patient; this can include stationary cycling, as long as the patient stays within the precautions (especially posterior approach surgery)

After 3 days clients are usually discharged home if they meet the discharge criteria. The physiotherapist and nurse help to transfer to a car whilst maintaining hip precautions. As the majority of patients lack understanding about the activities they can do following THR surgery, discharge education about pre-discharge pain management, movement, ADL, and support requirements should be provided to the clients. A recent RCT showed that video-assisted discharge program and education booklets given to the patient and their relatives after THR on activities of daily living, functionality, and patient satisfaction found that video-assisted discharge program along with physiotherapy reduced pain perception and kinesiophobia, improved hip function, and increase patient satisfaction. Further research is needed to assess the long-term outcomes of video-assisted discharge education in THR patients.[47]

Discharge Home Criteria:
  • independent ambulation with an assistive device
  • independent transfers
  • independent ADLs
  • stairs with supervision
  • appropriate home assistance (spouse, family, visiting nurses)[23]

Home Planning

crutch gait swing phase illustration
crutch gait swing phase

Several modifications to make the home easier to navigate. The following items help with daily activities:

  • Securely fastened safety bars or handrails in the shower or bath.
  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (allows knees to remain lower than hips), a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoehorn
  • A reacher allowing grasping of objects without excessive bending of your hips
  • Firm pillows for chairs, sofas, and cars enable the client to sit with their knees lower than their hips.
  • Removal of all loose carpets and electrical cords from the areas walked in the home[23]

This 7-minute video presents post-operative exercises after a total hip replacement for weeks 1-4.

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[48]

6 Weeks Post Surgery

  • Patients are normally followed up by an orthopaedic surgeon.
  • The surgeon determines if the patient is allowed the following:
    • Full range of motion at the hip
    • Full weight bearing without mobility assistive device
    • Driving

After 6 Weeks

  • Gain of initial ROM, stabilization, and proprioception
  • Endurance
  • Flexibility
  • Balance
  • Speed, precision, neurological coordination
  • Functional exercises

Return to sport

Low-impact exercises are preferred

  • Golf: handicap shows minimal change after THA; handicap shows increase after TKA
  • High-impact exercises increase revision rates in patients less than 55 years old.

Outcome Measures

Team Work

Total hip arthroplasty (THA) is one of the most reliable, reproducible, successful, and cost-effective procedures in all orthopaedics. The procedure requires coordination of care across various healthcare provider groups, including nurses, physical therapists, advanced practitioners and physician extenders, medical physicians, and orthopaedic surgeons.

Clinicians including the surgeon, nurse practitioner, and physiotherapist should work together to provide the patient and family with education regarding the procedure, expected issues, and guidance for aftercare.[1]

Virtual Clinic Visits

Virtual follow-up for hip and knee arthroplasty patients is an effective substitute for in-person clinic assessment, substantiated in a recent investigation including 1,749 patients seen in a virtual visit between January 2017 and December 2018.

  1. For the 1-year postoperative visit and routine scheduled follow-up visits, only 7.22% of the patients required a further in-person assessment.
  2. Is accepted by patients, has high patient satisfaction, and can reduce the cost to both health services and patients.[49]  

References

  1. ↑ 1.0 1.1 1.2 1.3 Varacallo M, Luo TD, Johanson NA. Total Hip Arthroplasty Techniques. InStatPearls [Internet] 2020 Jul 8. StatPearls Publishing.Available from: https://www.statpearls.com/articlelibrary/viewarticle/22894/ (accessed 14.2.2021)
  2. ↑ Levine BR, Klein GR, Cesare PE. Surgical approaches in total hip arthroplasty: A review of the mini-incision and MIS literature. Bulletin of the NYU Hospital for Joint Diseases 2007;65(1):5-18.
  3. ↑ Iglesias SL, Gentile L, Mangupli MM, Pioli I, Nomides RE, Allende BL. Femoral neck fractures in the elderly: from risk factors to pronostic features for survival. Journal of Trauma and Critical Care. 2017;1(1).
  4. ↑ Tsutsumi M, Nimura A, Akita K. Clinical anatomy of the musculoskeletal system in the hip region. Anatomical Science International. 2022 Mar;97(2):157-64.
  5. ↑ Bowman KF, Fox J, Sekiya JK. A Clinically Relevant Review of Hip Biomechanics. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2010 Aug;26(8):1118–29.
  6. ↑ Meyers HM. Fractures of the hip. Chicago: Year of the book medical publishers Inc., 1985
  7. ↑ Hip osteoarthritis. Available from: https://youtube/FHASkrHWDMg?
  8. ↑ 8.0 8.1 Gremeaux V, Renault J, Pardon L, Deley G, Lepers R, Casillas JM. Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial. Archives of physical medicine and rehabilitation 2008;89(12):2265-73.
  9. ↑ 9.0 9.1 Jan MH, Hung JY, Lin JC, Wang SF, Liu TK, Tang PF. Effects of a home program on strength, walking speed, and function after total hip replacement. Archives of physical medicine and rehabilitation 2004 ;85(12):1943-51.
  10. ↑ 10.0 10.1 Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Archives of physical medicine and rehabilitation 2009;90(10):1652-7.
  11. ↑ Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Archives of physical medicine and rehabilitation 2009;90(5):745-55.
  12. ↑ Bahl JS, Nelson MJ, Taylor M, Solomon LB, Arnold JB, Thewlis D. Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis and Cartilage. 2018 Jul;26(7):847–63.
  13. ↑ Tsutsumi M, Nimura A, Akita K. Clinical anatomy of the musculoskeletal system in the hip region. Anatomical Science International. 2021 Oct 22;
  14. ↑ ResearchGate. Computational modelling techniques to determine patellofemoral joint loads. Available from: https://www.researchgate.net/figure/Muscles-responsible-for-movement-in-the-hip_tbl1_327593569 [accessed 13 Sept 2024].
  15. ↑ Anatomy of movement of the hip.Available from: https://www.youtube.com/watch?v=cq-iyFzHdPY
  16. ↑ Affatato S. Perspectives in total hip arthroplasty: Advances in biomaterials and their tribological interactions. London: Woodhead Publishing, 2014.
  17. ↑ Hsu H, Nallamothu SV. Hip Osteonecrosis.Available:https://www.ncbi.nlm.nih.gov/books/NBK499954/ (accessed 9.12.2022)
  18. ↑ Park C, Merchant I. Complications of total hip replacement. InTotal Hip Replacement-An Overview 2018 Nov 5. IntechOpen. Available:https://www.intechopen.com/chapters/61241 (accessed 8.12.2022)
  19. ↑ Varacallo M, Luo TD, Johanson NA. Total Hip Arthroplasty Techniques. InStatPearls [Internet] 2020 Jul 8. StatPearls Publishing.Available from:https://www.statpearls.com/articlelibrary/viewarticle/22894/ (accessed 14.2.2021)
  20. ↑ Crawford AJ, Hamblen DL. Outline of Orthopaedics , thirteenth edition, London: Churchill Livingstone, 2001
  21. ↑ Very well health What Type of Hip Replacement Implant Is Best? Available:https://www.verywellhealth.com/what-type-of-hip-replacement-implant-is-best-2549558#citation-2 (accessed 8.12.2022)
  22. ↑ 22.0 22.1 Radiopedia THR Available from:https://radiopaedia.org/articles/total-hip-arthroplasty (accessed 14.2.2021)
  23. ↑ 23.0 23.1 23.2 23.3 Ortho bullets THR Available from:https://www.orthobullets.com/recon/5003/tha-implant-fixation (accessed 14.2.2021)
  24. ↑ 24.0 24.1 24.2 Varacallo M, Luo TD, Johanson NA. Total hip arthroplasty techniques. InStatPearls [Internet] 2022 Sep 4. StatPearls Publishing.Available:https://www.ncbi.nlm.nih.gov/books/NBK507864/ (accessed 8.12.2022)
  25. ↑ Mead PA, Bugbee WD. Direct anterior approach to total hip arthroplasty improves the likelihood of return to previous recreational activities compared with posterior approach. JAAOS Global Research & Reviews. 2022 Jan;6(1).Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8735710/ (accessed 8.1.2024)
  26. ↑ Alecci V, Valente M, Crucil M, Minerva M, Pellegrino C, Sabbadini DD. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthopaed Traumatol 2011;12:123-129.
  27. ↑ John Hopkins Medical. Approaches to Hip Replacement Surgery | Dr. Savya Thakkar. Available from: https://www.youtube.com/watch?v=1cUu-vMcSkM [last accessed 8.12.2022]
  28. ↑ Konnyu KJ, Pinto D, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Balk EM, Thoma LM. Rehabilitation for Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil. 2023 Jan 1;102(1):11-18. doi: 10.1097/PHM.0000000000002007. Epub 2022 Mar 12. PMID: 35302955; PMCID: PMC9464790.Accessed 8.1.204 Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9464790/
  29. ↑ Coole C, Edwards C, Brewin C, Drummond A. What do clinicians think about hip precautions following total hip replacement? Br J Occup Ther. 2013;76:7:300-307.
  30. ↑ 30.0 30.1 Mandel RT, Bruce G, Moss R, Carrington RWJ, Gilbert AW. Hip precautions after primary total hip arthroplasty: a qualitative exploration of clinical reasoning. Disab Rehab. 2022;44:12:2842–2848
  31. ↑ Barnsley L, Leslie Barnsley L, Page R. Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review. Geriatr Orthop Surg Rehabil. 2015;6:3:230-235
  32. ↑ Soeters R, White PB, Murray-Weir M, Koltsov JC, Alexiades MM, Ranawat AS. Preoperative physical therapy education reduces time to meet functional milestones after total joint arthroplasty. Clinical orthopaedics and related research. 2018 Jan;476(1):40.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919221/ (accessed 89.12.2022)
  33. ↑ Crowe J,Henderson J. Pre-arthroplasty rehabilitation is effective in reducing length of hospital stay. Canadian Journal of Occupational Therapy 2003;70:88-96.
  34. ↑ 34.0 34.1 34.2 Barnes RY, Bodenstein, K, Human N. Raubenheimer J, Dawkins J, Seesink C, Jacobs J, van der Linde J, Venter R. Preoperative education in hip and knee arthroplasty patients in Bloemfontein. South African Journal of Physiotherapy 2018;74(1).
  35. ↑ 35.0 35.1 35.2 Raymond Sohier, Kinesitherapie de la hanche ; La Hestre : Sohier, 1974
  36. ↑ Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, McMeeken J, Westh R. A targeted home-and center-based exercise program for people after total hip replacement: a randomized clinical trial. Archives of physical medicine and rehabilitation 2008;89(8):1442-7.
  37. ↑ Paravlic AH, Pisot R, Marusic U. Specific and general adaptations following motor imagery practice focused on muscle strength in total knee arthroplasty rehabilitation: A randomized controlled trial. PloS one. 2019;14(8).
  38. ↑ 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.
  39. ↑ Coulter CL, Scarvell JM, Neeman TM, Smith PN. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. Journal of physiotherapy. 2013;59(4):219-26.
  40. ↑ 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.
  41. ↑ Perhonen MA, Franco F, Lane LD, Buckey JC, Blomqvist CG, Zerwekh JE, Peshock RM, Weatherall PT, Levine BD. Cardiac atrophy after bed rest and spaceflight. Journal of applied physiology 2001;91(2):645-53.
  42. ↑ Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties: relation to implant failure and pseudotumor formation. Acta orthopaedica 2009;80(6):653-9.
  43. ↑ Suetta C, Aagaard P, Rosted A, Jakobsen AK, Duus B, Kjaer M, Magnusson SP. Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse. Journal of Applied Physiology 2004;97(5):1954-61.
  44. ↑ Yabuno K, Sawada N, Kanazawa POSTOPERATIVE DAY ZERO PHYSICAL THERAPY CONTRIBUTES TO FASTER PHYSICAL RECOVERY AND COST EFFECTIVENESS FOR TOTAL HIP ARTHROPLASTY PATIENTS. Orthop Procs. 2019 Apr 1;101-B(SUPP_4):42-42.
  45. ↑ Di Martino A, Brunello M, Pederiva D, Schilardi F, Rossomando V, Cataldi P, et al. Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review. Clinics and Practice [Internet]. 2023 Jun 1;13(3):569–82. Available from: https://www.mdpi.com/2039-7283/13/3/52
  46. ↑ National Institute for Health and Care Excellence Final Joint replacement (primary): hip, knee and shoulder [P] Evidence review for inpatient hip and knee postoperative rehabilitation NICE guideline NG157 Intervention evidence review underpinning recommendation 1.10.1 in the NICE guideline [Internet]. 2020. Available from: https://www.nice.org.uk/guidance/ng157/evidence/p-inpatient-hip-and-knee-postoperative-rehabilitation-pdf-315756469339
  47. ↑ Cetinkaya Eren O, Buker N, Tonak HA, Urguden M. The effect of video-assisted discharge education after total hip replacement surgery: a randomized controlled study. Scientific Reports. 2022 Feb 23;12(1):1-9.
  48. ↑ HeartlandOrthospecial. Post-Operative Exercises Weeks 1-4 for Total Hip Replacement. Available from: https://www.youtube.com/watch?v=9eU8G038zFo[last accessed 24.3.2023]
  49. ↑ El Ashmawy AA, Dowson K, El-Bakoury A, Hosny HA, Yarlagadda R, Keenan J. Effectiveness, patient satisfaction, and cost reduction of virtual joint replacement clinic follow-up of hip and knee arthroplasty. The Journal of arthroplasty. 2021 Mar 1;36(3):816-22.Available:https://pubmed.ncbi.nlm.nih.gov/32893060/ (accessed 6.12.2022)


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