Hip Replacement & Rehabilitation

3D medical image of hip bone where pain is located in hip replacement surgery

This month’s article is focused on Hip Replacement and Rehabilitation. As many as a third of the people we see in our practice have had a total hip replacement. Having a hip replacement appears to be one of the more successful replacement surgeries. And people generally return to their activities of daily living quicker than with many of the other joint replacement surgeries. This has been more evident since the latest evolution in replacement surgery. Which has seen some surgeons changing techniques from the old posterior (or direct lateral) method, to an anterior method.

Basic Anatomy

The hip joint is a major weight-bearing joint. It is placed under a significant amount of stress during any weight-bearing movement. It is what is known as a ball and socket joint. The head of the femur (ball) sits snugly in the acetabulum (socket). These surfaces are covered with a layer of articular cartilage, which allows the bones to move smoothly over each other. This type of joint allows for movement in all planes i.e. flexion, extension, abduction, adduction external and internal rotation, as well as circumduction.

Experiencing Pain in the Hip Joint

As we age, this articular surface can become damaged due to general wear and tear. In some people, this damage will result in pain and limited mobility. The pain is often experienced in the groin area. And you may notice an altered gait pattern including limping or walking “duck foot”. Sometimes, one is able to get the pain/inflammation under control with medications, physiotherapy and strengthening exercises. However, pain can starts to interfere with daily living. For example, increasing when walking or affecting one’s sleep. And when medications and other therapies are no longer having any effect, it may be time to consider having a joint replacement.

Hip Replacement Methods

Once the decision has been made to have a hip replacement, one needs to decide on which method the surgeon will be performing. Knowing which method the surgeon is going to perform will help one to prepare adequately before the surgery and have a better idea of what to expect from the healing time. There are pros and cons to each method. And each individual, along with their GP/surgeon, must decide which is best for their condition. It is important to note that not all surgeons perform the newer anterior method.

As mentioned earlier, there has been a new method developed, which has has seen some surgeons changing techniques from the old posterior or direct lateral method, to an anterior method. The older posterior method, although not as invasive as the direct lateral method, held a higher risk of post-operative dislocation. The direct lateral method allowed for the best exposure of the hip joint, however, the surgeon needs to cut through muscles to get to the joint, which can result in a longer recovery time. In this “new” anterior method, the surgeon is able to perform the surgery without having to cut through any of the muscles, which often results in faster healing time.

Pre-Operative Exercise Program

Whichever method is chosen, starting an exercise program before the surgery is highly beneficial. The stronger and fitter one is before surgery, the easier it is to get up and going after the surgery. Performing simple strength and mobility exercises is key, however, it is important not to overdo it. Getting a full assessment prior to surgery will allow one to identify muscle strengths and weaknesses as well as any tightness and postural compensations that may have occurred. From this, a program to correct the imbalances can be designed specifically for each individual’s needs. The emphasis during this strengthening phase, must be on correct exercise technique and ensuring the correct muscles are engaging to perform the exercise. Having the basics in place before surgery will allow one to move quicker through the rehab program post-surgery as the exercises will be familiar and the correct techniques already learned.

Biokineticist and Article Author Nicole Fish at Fish and field Biokinetics, Sandton

Nicole Fish

Biokineticist at Fish & Field Biokineticists

Nicole holds a BA HMS (Stellenbosch), BA Hons Biokinetics (RAU) and BA Hons Sport Science (RAU). She is passionate about aquatic therapy and is trained in Advanced International Aquatic Therapy Techniques and International Orthopaedic Aquatic Techniques. Nicole also takes a special interest in those in need of geriatric movement medicine.

If you are unsure where to start with your exercise program, why not get in touch with us at Fish and Field, we can assist you with the right program for you.

Credit

Image by kjpargeter on Freepik

References

A New Future For Hip Replacements | Medical & Surgical Equipment Supplier (specmed.co.za)

Anterior or Posterior Hip Replacement Surgery: Which is Better? (peerwell.co)

Anterior vs. Posterior Hip Replacement Surgeries (arthritis-health.com)

Hip joint: Bones, movements, muscles | Kenhub

Hip replacement – Mayo Clinic

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