A total hip replacement (THR) is a common orthopaedic surgical procedure. It is generally necessary when a hip is diagnosed with osteoarthritis by X-ray or MRI and the individual experiences persistent pain. The client will probably complain of pain in the groin radiating down the anterior aspect of the thigh sometimes also effecting the knee especially when weight bearing & gait. They also present with limited movement of the hip with rotation abduction & adduction.THR can also be performed following trauma to the hip resulting in fracture to the neck of femur or also with congenital hip formation.
Reason for THR:
- Pain relief
- Improved function & hip movement
- Improved quality of life
Ideally it is preferable to assess a client pre operatively to gage their hip range of movement and general physical ability, however this may not always be possible.
Pre operatively the client could be taught posture, basic pelvic tilts, spinal curls, breathing and ankle mobility in sitting or lying.
Before the client is discharged from hospital – normally within 48 hours of surgery – a physiotherapist will ensure that they can walk with a walking aid and climb the stairs. They will also be given basic lower limb circulatory & breathing exercises to prevent clots, as well as quadriceps, abductor and gluteal exercises. Your client should have a booklet outlining these exercises for you to clarify the aims of rehab for the next 6 – 8 weeks post surgery. At 6 weeks the client will be reassessed by the orthopaedic team to determine if the scar and hip movement is healing sufficiently.
There are several movements the individual will initially be told to avoidto prevent dislocation of the new joint these are:
- Hip flexion above 90 degrees
- Leg adduction
- Hip rotation
The aims of the pilates teacher is to continue to follow the rehabilitation guidelines by gradually progressing these movements to strengthen not only the operative leg but to create balance in the bodies function.
- Strengthen hip abductors & extensors, quads.
- Balance & agility
- Gently increase hip flexion
- Disassociate hip & lumbar movement
- Create balance in lower limbs
- Improve posture & gait
The hip will continue to improve over 6 -9 months after surgery but recovery is also dependent on the clients medical history, age etc.