According to a report by the Centers for Disease Control and Prevention (CDC), approximately 1.5 million Americans are living with a total hip replacement (THR) as of 2019. This number is expected to increase as the population ages and the demand for joint replacement surgery continues to rise. In fact, THR is one of the most commonly performed joint replacement surgeries in the United States, with over 300,000 procedures performed each year. The majority of THR recipients are over the age of 65, although the surgery may be recommended for younger patients with certain conditions or injuries.
What is Total Hip Replacement?
Total hip replacement, also known as hip arthroplasty, is a surgical procedure in which the damaged or worn out parts of the hip joint are replaced with artificial components. The hip joint is a ball-and-socket joint that connects the thigh bone (femur) to the pelvis. It allows us to move our legs in a variety of directions, including forward, backward, and sideways.
Total hip replacement is typically recommended for people who have severe hip pain and stiffness that affects their daily activities and quality of life, and who have not found relief through non-surgical treatments such as medication, physical therapy, or assistive devices.
During the surgery, the damaged parts of the hip joint are removed and replaced with artificial components made of metal, plastic, or ceramic materials. The ball component is typically made of metal or ceramic and is attached to the top of the thigh bone, while the socket component is made of a plastic or metal cup that is inserted into the hip bone. The new components are designed to fit together and move smoothly, allowing for improved hip function and reduced pain.
Total hip replacement surgery is typically performed under general anesthesia and requires a hospital stay of several days. Following the surgery, patients will undergo physical therapy and rehabilitation to regain strength and mobility in the affected hip. With proper care and rehabilitation, most patients can expect to return to their normal activities and experience improved mobility and reduced pain.
Causes of Total Hip Replacement (THR)
The most common reason for total hip replacement (THR) is osteoarthritis, a degenerative joint disease that causes the cartilage cushioning the joint to wear away over time, leading to pain, stiffness, and decreased mobility. Other common causes of THR include:
Rheumatoid arthritis: An autoimmune disorder that causes inflammation in the joints, leading to
pain, stiffness, and eventually joint damage.
Avascular necrosis: A condition where the blood supply to the hip joint is disrupted, leading to bone death and joint damage.
Hip fracture: A break in the hip bone that can cause severe pain and mobility issues, especially in older adults.
Congenital hip dysplasia: A condition where the hip joint is improperly formed, leading to abnormal wear and tear and eventual joint damage.
Trauma: Severe injuries to the hip joint, such as dislocations or fractures, may require total hip replacement surgery to restore function and reduce pain.
In addition to these common causes, there are several other conditions or injuries that may lead to the need for total hip replacement surgery. Your doctor can help determine if THR is the right treatment option for your specific situation.
Fall and hip replacement
A fall can be a common cause of hip fractures, which may require hip replacement surgery to restore function and relieve pain. Hip fractures are especially common in older adults who may have weakened bones due to osteoporosis or other conditions.
If a person has a hip replacement and then falls, the implant may be damaged or dislocated. In some cases, a fall may also cause a new fracture or damage to the surrounding bone or tissue.
To help prevent falls after hip replacement surgery, it is important to follow your doctor's post-operative instructions carefully, including any weight-bearing restrictions, use of assistive devices such as crutches or a walker, and rehabilitation exercises. You may also need to make changes to your home environment, such as removing tripping hazards, installing grab bars or handrails, and using non-slip mats in the bathroom.
If you do experience a fall after hip replacement surgery, it is important to seek medical attention right away, even if you don't experience any immediate pain or discomfort. Your doctor can examine you and perform tests to check for any damage or displacement of the implant, and provide treatment if necessary.
After total hip replacement (THR) surgery, it is important to take certain precautions to prevent complications and ensure a successful recovery. Here are some common precautions that patients may be advised to follow:
Weight-bearing restrictions: Depending on the type of surgery and the surgeon's preference, you may be advised to avoid putting weight on the affected leg for a certain period of time. This may involve using crutches, a walker, or other assistive devices.
Avoiding certain movements: You may be advised to avoid crossing your legs, bending your hip beyond a certain angle, or twisting your hip in certain directions to avoid dislocation of the implant.
Sitting and standing: When sitting, you may be advised to use a firm, high chair with armrests and avoid sitting for long periods of time. When standing, you may be advised to use a stable surface, such as a countertop or chair, to support yourself while standing on one leg.
Wound care: It is important to keep the surgical incision clean and dry to prevent infection. Your doctor may provide specific instructions for wound care.
Medications: You may be prescribed pain medications, blood thinners, or antibiotics to prevent infection after surgery. It is important to take these medications as directed and notify your doctor of any side effects.
Physical therapy: You may be advised to participate in physical therapy to help restore strength and mobility in the affected hip joint. It is important to follow your physical therapist's instructions and attend all scheduled appointments. It is important to discuss any specific precautions or instructions with your doctor or physical therapist to ensure a safe and successful recovery after total hip replacement surgery.
Posterior approach THR precautions
The posterior approach to total hip replacement (THR) is one of the most commonly used surgical techniques. After surgery, patients who have undergone a posterior approach THR may be advised to take certain precautions to ensure a successful recovery and prevent complications. Here are some of the most common precautions:
Avoid crossing your legs: Crossing your legs can increase the risk of dislocation of the hip joint, which is a common complication after THR surgery. Therefore, it is important to avoid crossing your legs at the knees or ankles.
Avoid bending your hip beyond 90 degrees: Bending your hip beyond a 90-degree angle can also increase the risk of dislocation. Therefore, you may be advised to avoid activities that require deep bending, such as squatting or sitting in low chairs.
Use a pillow between your legs when sleeping: Placing a pillow between your legs while sleeping can help prevent your hip from rotating outward and reduce the risk of dislocation.
Use an elevated toilet seat: You may be advised to use an elevated toilet seat to avoid deep bending of the hip joint during toileting.
Use assistive devices: You may be advised to use crutches or a walker to assist with walking and prevent falls during the early stages of recovery.
Follow your physical therapy plan: You may be advised to participate in physical therapy to help restore strength and mobility in the affected hip joint. It is important to follow your physical therapist's instructions and attend all scheduled appointments.
It is important to discuss any specific precautions or instructions with your doctor or physical therapist to ensure a safe and successful recovery after a posterior approach THR.
Anterior approach THR precautions
The anterior approach to total hip replacement (THR) is a surgical technique that involves accessing the hip joint from the front of the body, rather than from the side or back. After surgery, patients who have undergone an anterior approach THR may be advised to take certain precautions to ensure a successful recovery and prevent complications. Here are some of the most common precautions:
Avoid hip extension: During the early stages of recovery, you may be advised to avoid activities that involve hip extension, such as walking up stairs or getting in and out of a car with one leg at a time.
Avoid hip flexion beyond 90 degrees: You may be advised to avoid activities that require deep bending of the hip joint, such as squatting, sitting in low chairs, or crossing your legs.
Use a pillow between your legs when sleeping: Placing a pillow between your legs while sleeping can help prevent your hip from rotating outward and reduce the risk of dislocation.
Use an elevated toilet seat: You may be advised to use an elevated toilet seat to avoid deep bending of the hip joint during toileting.
Use assistive devices: You may be advised to use crutches or a walker to assist with walking and prevent falls during the early stages of recovery.
Follow your physical therapy plan: You may be advised to participate in physical therapy to help restore strength and mobility in the affected hip joint. It is important to follow your physical therapist's instructions and attend all scheduled appointments.
It is important to discuss any specific precautions or instructions with your doctor or physical therapist to ensure a safe and successful recovery after an anterior approach THR.
How to prepare for joint replacement?
Preparing for joint replacement surgery is an important step in ensuring a successful outcome. Here are some steps you can take to prepare for joint replacement:
Talk to your doctor: Speak to your doctor about your expectations and ask any questions you may have about the surgery. Your doctor will give you detailed information about the procedure, including the risks and benefits, and help you understand the recovery process.
Get healthy: Get into good physical condition before the surgery. Exercise regularly and eat a healthy diet to strengthen your muscles and prepare your body for the procedure. Quit smoking if you are a smoker, as it can slow down the healing process.
Arrange for help: Make arrangements for someone to help you after the surgery. You may need assistance with daily tasks such as cooking, cleaning, and getting dressed for a while.
Prepare your home: Make sure your home is safe and easy to navigate. Remove any tripping hazards, install grab bars in the bathroom, and ensure that your bed and other furniture are at a comfortable height.
Plan for recovery: Plan ahead for your recovery period. You may need to take time off work or make other arrangements for a few weeks after the surgery.
Attend preoperative classes: Many hospitals offer preoperative classes to help you prepare for the surgery. These classes can provide you with information on what to expect before, during, and after the surgery, as well as tips on how to manage pain and recover more quickly.
Follow instructions: Follow your doctor's instructions carefully. Your doctor may advise you to stop taking certain medications or supplements before the surgery, or to start doing specific exercises to help you prepare for the surgery.
Remember, preparing for joint replacement is an important step in ensuring a successful outcome. By taking the necessary steps to prepare, you can help minimize the risks and speed up your recovery.
Physical therapy Protocol after Total Hip Replacement(THR)
There are several different physical therapy protocols that may be used after total hip replacement (THR) surgery, and the most effective protocol for an individual patient may depend on a variety of factors, such as their age, overall health, and specific surgical procedure.
However, research has shown that a standardized physical therapy protocol that emphasizes early mobilization, functional training, and patient education can be effective in improving outcomes and reducing complications after THR surgery.
Here are some components of a commonly used physical therapy protocol for total hip replacement:
Early mobilization: Patients are typically encouraged to begin walking and performing gentle range of motion exercises as soon as possible after surgery to prevent stiffness and promote healing.
Functional training: Physical therapists may focus on training patients to perform activities of daily living, such as getting in and out of bed, sitting and standing, and walking on various surfaces and inclines.
Strengthening exercises: Strengthening exercises for the muscles surrounding the hip joint can help improve stability and reduce pain.
Balance and gait training: These exercises can help improve balance and reduce the risk of falls after surgery.
Pain management: Physical therapists may use various modalities, such as ice or heat therapy, electrical stimulation, or manual therapy techniques, to help manage pain and promote healing.
Patient education: Patients may receive education on proper positioning and movement techniques, as well as guidance on home exercises and activities to promote healing and prevent complications.
It is important to work closely with your physical therapist to develop an individualized treatment plan that takes into account your specific needs and goals after total hip replacement surgery.
Research has shown that exercise is an important part of rehabilitation after total hip replacement (THR) surgery, and can help improve strength, flexibility, and overall function. However, it is important to consult with your doctor or physical therapist before starting any exercise program, as each person's situation may be unique.
Here are some research-based exercises that may be recommended after total hip replacement surgery:
Range of motion exercises: These exercises help improve flexibility in the hip joint and may include heel slides, ankle pumps, and knee-to-chest stretches.
Strengthening exercises: These exercises help build strength in the muscles surrounding the hip joint, including the glutes, quads, and hamstrings. Examples may include leg lifts, bridges, and squats.
Balance exercises: These exercises can help improve balance and stability, reducing the risk of falls. Examples may include standing on one leg, heel-to-toe walking, and side steps.
Cardiovascular exercises: These exercises help improve cardiovascular health and overall fitness, and may include walking, cycling, or swimming.
It is important to start with gentle exercises and gradually increase intensity and duration over time. Your doctor or physical therapist can help you develop an individualized exercise program based on your specific needs and goals, and can monitor your progress to ensure safe and effective rehabilitation after THR surgery.