Physiotherapy after a hip replacement in London and Essex
Thursday 4th January 2024
Gemma B
Physiotherapy after a hip replacement in London and Essex
When is a hip replacement indicated?
A hip replacement is normally recommended when a person has severe joint pain, restricted movement and reduced function. Common reasons the hip can get worn out or damaged include osteoarthritis, rheumatoid arthritis, avascular necrosis and trauma, such as a neck of femur fracture. Normally, prior to a hip replacement a variety of conservative measures are trialled such as exercise, pain medication and assisted devices. A steroid injection is sometimes trialled, which may also be used as an assessment to confirm that the pain is coming from the joint itself.
Who is offered surgery?
The decision to offer a hip replacement will be made on a case-by-case basis. A team of professionals normally work together to determine factors such as the impact on a person's quality of life, severity of symptoms and overall health. X-rays can help to evaluate the condition of the cartilage. Some people may also have a MRI or CT scan.
Physiotherapy prior to hip replacement
Preoperative rehabilitation plays a crucial role in preparing for the procedure and optimising postoperative outcomes. You may be seen by a Physiotherapist to guide you through specific exercises and give you tailored advice. If your pain is caused by arthritis, you are over 45 and had pain for over 3 months, a free application called "ESCAPE-pain" may be recommended to you.
What does the surgery involve?
Before the surgery, you will undergo a thorough assessment of your overall health and appropriateness for surgery. Your surgeon will discuss the risks, benefits and expected outcomes.
Hip surgery is normally performed under general anaesthesia, this is to make you feel comfortable. Occasionally, regional anaesthetic is used instead, such as a spinal or epidural block.
Once you are under anaesthetic, an incision will be made over the joint. The damaged bone and joint surfaces are removed, including the femoral head (Ball-shaped top of the thigh bone) and damaged acetabulum (Socket). Typically, a metal stem is inserted into the thigh bone and a ball is attached to the top. The damaged acetabulum is replaced with an artificial socket component. This replicates the shape and function of the individual's healthy hip. The surgeon will then close the incision, normally with sutures or staples.
Following the surgery, you will be taken to a recovery area where you will be closely monitored. Pain management, wound care and Physiotherapy will start on the ward in the hospital.
What is hip resurfacing?
Hip resurfacing involves reshaping the damaged hip joint surface with a metal prosthesis, which preserves more of an individual's own bone. It is normally offered to younger, active individuals.
Recovery
Hospital:
A multidisciplinary team will help manage pain, monitor health, give you tips on how to regain independence and help you exercise. You will also be given guidance on how to get in and out of bed, use walking aids and how to walk up and down the stairs.
Home:
You must continue to follow the guidance you were given on medication, wound care and exercise. Swelling, stiffness and discomfort is normal during this period. Your surgeon will follow you up to monitor your progress, assess healing and make further recommendations on your treatment plan.
A Physiotherapist may support you at home by tweaking the exercises, as well as working on joint and soft tissue mobility. The Physiotherapist may also recommend exercising in water. The number of sessions needed is dependent on your range and function to start with and the speed of your progress.
The healing process takes time, and the post-operative rehabilitation is tough and should not be underestimated.
Risks following surgery
The likelihood of experiencing complications varies from person to person. The vast majority of hip operations occur without any problems and your surgeon can provide you with further information on how likely these are to happen to you. Here are some potential complications that can occur:
· A fracture in the bone around the hip replacement during or after the operation.
· Infections can develop in the surgical site. This can be superficial or deep. Certain health conditions and malnutrition may increase your risk of developing an infection.
· Blood clots may form in the veins of the leg after surgery. Exercise, medications and compression stockings may be used to reduce this risk.
· The implant may dislocate, which may need revision surgery.
· Damage to the nerves or blood supply during the surgery may lead to sensation changes.
· Although surgery is intended to alleviate pain, occasionally people end up with persistent pain.
· Differences in leg length.
Post-Operative physiotherapy
An individual's specific goals and timeframes will vary. However, as a general guide, this is what can be expected.
Early Postoperative Exercises: Gentle exercises which help maintain range, prevent clots and improve mobility will be started in the hospital setting.
Walking: You may have been walking with an altered walking pattern prior to the operation, also the bottom muscles may be weaker, and you may be in pain. Therefore, it is important that you use the recommended walking aids and apply any tips given by your healthcare team.
Strengthening: These exercises are essential and will improve balance, stability and function. The surgeon may create an incision through the bottom muscle to access the hip so this can be particularly weak.
Range of motion: Gentle stretching and joint mobilisations may be used to increase flexibility. Cycling is a very good activity to help with this.
Functional activities: Exercises may mimic daily tasks such as sit to stand. Depending on your goals, return to sports exercises may be added further down the line.
Scar management: You should start massaging your scars when your wounds are healed or after your stitches are removed. A water-based cream should be used, it is helpful to use the pads of your fingers to massage the scar and tissue around the scar.
Booking an appointment
If you would like to find out more about Estuary Physios hip replacements service, please get in touch with us today and speak with one of our clinicians. https://www.estuaryphysio.com/book-now
Helpful resources:
NHS - Hip Replacement
Versus Arthritis - Hip Replacement
NJR Centre - Hip Replacement
Other conditions we treat:
We understand that our clients often have a range of medical conditions. Our therapists have a broad range of backgrounds. For example, an altered gait pattern may lead to back pain. We have specialist musculoskeletal therapists who can work alongside an Orthopaedic Physiotherapist to get the best results. Here are some other conditions we treat here at Estuary Physio:
Back, neck and joint pain
Medical Review
The information on this page has been reviewed for accuracy by Barry Ford BSc MCSP, Physiotherapist
