Total Hip Joint Replacement

Introduction

Total Hip Joint Replacement (THJR) also called Total Hip Arthroplasty (THA) is an orthopaedic surgical procedure. It involves replacing the hip joint’s ball and socket surfaces (the head of the femur which is the ball, and the articular surface of the acetabulum on the pelvis which is the socket) with a prosthetic implant that is designed to replicate the natural movement of the hip joint. THJR is usually done in response to an irreversible condition severely affecting the hip joint itself and aims to reduce an individual’s hip pain and improve their function.

Other less common types of hip joint replacements also exist such as Partial Hip Joint Replacements which are usually performed in response to proximal femur fractures; in this surgery only the head of the femur is replaced. Another type of hip joint replacement is the Reverse Total Hip Joint Replacement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reasons for THJR

It is often recommended to trial a period of physiotherapy first, however if conservative treatment is not effective, then surgery is usually recommended.

THJR is considered when an individual’s function and quality of life is severely impacted by the condition of their hip joint.

 

Some of these conditions include:

  • Osteoarthritis: the most common reason for joint replacements accounting for over 90% of joint replacements in NZ. This condition occurs naturally with age and involves the gradual breakdown of the smooth tissue that covers the hip joint surfaces, causing friction and pain during movement. Osteoarthritis can also develop in younger individuals after a traumatic injury to the hip joint; this is called post-traumatic arthritis.

  • Rheumatoid Arthritis: a condition where an individual’s immune system attacks the joint structures that reduce friction and offer protection to the joint. This type of arthritis is more common in smaller joints such as those in the hand but can occur in the hip.

  • Haemophilia: increased bleeding into joint spaces causes an increased pressure within the joint cavity which can lead to chronic swelling and deformity of the hip joint surfaces.

  • Severe hip injury: this can include fractures to the hip bones or trauma to the hip joint itself which can cause deformity and disrupt the alignment and natural movement of the hip joint. The structures that protect the hip joint are some of the strongest in the body while the joint itself is one of the most stable in the body, therefore large traumatic experiences are usually required to cause severe damage to the hip joint i.e. motor vehicle accidents.

 

 

Surgery – Patient preparation and protocol

A comprehensive guide to preparing for a THJR surgery and what to expect during hospital stay can be found here as provided by the Ministry of Health:


https://www.health.govt.nz/system/files/documents/pages/guide-hip-replacement-surgery.pdf

 

 

Post-surgery: Hospital stay

After the THJR surgery has been completed, a patient will be closely monitored by the medical team to keep fluids and oxygen in balance, administer medications, and to keep the surgical wound clean to prevent infection. An X-ray is also taken to ensure proper hip alignment post-surgery.

Physiotherapy is also highly recommended, as evidence has shown that early, simple mobilisation exercises can prevent post-surgical complications and speed up recovery time. This can be as early as day zero (the same day as the operation) up to day three post-operation. The time at which physiotherapy after THJR commences will depend on the presentation of the patient to determine when it is appropriate to do so. Discharge from hospital with crutches usually occurs on day three post-surgery once you have been assessed and deemed safe to go home.

 

Post-surgery: Side effects

After surgery, it is very common to experience side effects such as:

  • Pain, stiffness, and numbness around the operated hip.

  • Swelling at and around the operated hip.

  • Bruising around the operated hip, it is common for this to extend above and below the hip as well.

  • Disrupted sleep usually due to pain.

  • Reduced movement of the operated hip. Initially it will be difficult to move your leg/hip but as the pain and swelling decreases over time this will improve, especially with physiotherapy.

 

 

Expectations after discharge

After being discharged from the hospital it is highly recommended to continue with physiotherapy to improve mobility and function. Routine wound dressing maintenance will also be provided to prevent infection of the wound. Medications are also routinely given by GPs to help alleviate symptoms.

Rehabilitation after a THJR usually takes up to three months to resume more strenuous activities, however throughout those three months normal function is expected to continuously improve. Full recovery can take up to six months. If a patient is particularly active or takes part in high level sports, this process may take longer to decrease chances of reinjury upon gradual return to these activities.

It is important to keep active even after a three-month period as studies have shown that physiotherapy exercises can continue to be beneficial for up to a year post-surgery.

 

Movements to avoid post-surgery

Your hip joint replacement is most vulnerable within the 12-weeks following surgery. During this time, it is important to avoid these movements as they can cause dislocation of the hip joint replacement:

  • Bending your operated hip further than 90 degrees (i.e. sitting on a low chair).

  • Crossing your legs with your operated hip when lying down or sitting.

  • Twisting or turning the operated leg inwards.

 

As your hip heals these movements will become safer to perform but only after the 12-week healing period.

 

 

Symptoms to monitor post-surgery

Complications after surgery can arise in few cases. These often include the formation of blood clots around the implant (blood thinning medication is often given post-surgery) and infection of the surgical wound.

 

Be sure to look out for these symptoms once you are discharged home:

  • Shortness of breath

  • Fever or chills

  • Chest pain

  • Calf pain and/or swelling

  • Bleeding

  • Unusual discharge or odours from the dressing

  • Nausea or vomiting

Physiotherapy Rehabilitation

Physiotherapy after THJR surgery will often consist of:

  • Swelling management.

  • Activity modification to reduce aggravation and chances of reinjury.

  • Range of motion exercises to restore functional movement of the hip and leg.

  • Strengthening exercises for the entire lower limb – initially these exercises will start off as gentle and become progressively more challenging over time to ensure that adequate hip and leg strength for function is obtained.

  • Aerobic exercise to maintain fitness.

  • Balance and gait retraining to prevent falls as well as to correct any compensations during walking that may have been picked up earlier.

If warranted, specific return to sport/activity exercises will also be given which can extend the rehabilitation journey but is nonetheless necessary. This will be dependent on how active the patient is as well as what their rehabilitation goals are.

It is important to note that often after a hip replacement surgery full range of motion may not be restored, however, functional range of motion is usually regained through physiotherapy. This means that although there is a possibility you may not have as much movement of your hip prior to surgery, you will still be able to move your hip/leg as far as required for your everyday activities which is often one of the main goals for physiotherapy.

 

For more information, please call to book in, or book online, for professional advice and management from your physiotherapist.

 

 

References

https://www.health.govt.nz/system/files/documents/pages/guide-hip-replacement-surgery.pdf

https://www.physio-pedia.com/Total_Hip_Replacement

https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/#:~:text=In%20a%20total%20hip%20replacement,hollow%20center%20of%20the%20femur.

https://www.mayoclinic.org/tests-procedures/hip-replacement/about/pac-20385042

Do not assume the worst.
This information is here for your knowledge. 

Book in with one of our team members for a proper assessment.

We will help you with your journey to recovery.

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