Hey Team,

 

A hip replacement is a serious decision, and nobody decides on a whim. I mean… it is pretty traumatic overall to have your hip replaced. The hip ball is obliterated, and a prosthetic replacement is hammered into the exposed end. The cup of your hip is sanded away with a fancy high-powered Dremel tool to make way for a new titanium cup to be cemented to your bone. To go through this… a person has to be in severe pain! Yes… that is precisely it. People experience so much pain and disability that they are ready for a total hip replacement… they don't protest too much when proposing a replacement. Today we plan to review total hip replacements, who is most appropriate for them, and why the rehabilitation is much easier than a total knee replacement.  

 

MEET JOHN

 

Today I plan to paint the picture of a typical total hip replacement progression with my former patient John. John is a retired sixty-seven-year-old moderately active male who loves staying "busy." He has a compulsion and can never sit still. If he has any energy to squeeze out of his body… he wants to be doing something productive. Paint the fence, mow the grass, build a chicken coop, or whatever help his neighbor Patty might need. However, John started noticing low back pain with increased activity around the home. He found an association between standing or walking with increased duration and low back pain. His low back pain was not actually in his back but near his back behind his upper hip. John felt this pain resulting from "old age," He figured it would go away with more rest. John did rest but found with increased activity… his pain would always return. John started taking Motrin to help with his symptoms and found he could work longer before his pain presented. John continued with his Motrin and mild rest progression for months and soon found his pain in the hip became sharper and would start sooner than expected. What was more concerning… he was finding he was becoming more fatigued. Friends and neighbors began to notice the decrease in activity from not working outside as much, and his neighbor Patty was starting to become concerned. John slowly became a shell of himself: too tired most of the time, pain prevented most activities, and he began to avoid increased weight-bearing activity.  

 

TOTAL HIP REPLACEMENT: DOES IT HELP?

 

John continued to have more and more pain in the hip, and after waiting for an entire year, he mentioned the pain to his Primary Physician. After reviewing imaging studies, they discovered the hip was severely worn out. He was then referred to an orthopedic surgeon. John investigated the hip replacement procedures and knew it was time to decide. He could not live life to its fullest and needed help, so he proceeded with the total hip replacement. Within a month, the hip was replaced, and he was discharged home after a day in the hospital.  

 

The pain was intense, and he could not walk very well with his walker. John was limited with mobility in the house, and without his neighbor, Patty, he is not sure how he would have managed. As John continued with the basic exercises sent home from his orthopedic surgeon, he was eager to progress to more function in the hip. John wanted to get back to living life fully. John had his two-week follow-up with his surgeon, where he found he would NOT be receiving the standard bout of physical therapy after a total hip replacement. His surgeon informed him he would not need it and gave him a few exercises to perform… and to start walking more. John was confused because his friends had told him they received physical therapy after their hip replacement. Ultimately, John attempted to follow the exercises on the sheet and started to walk more.   

 

But what eventually occurred… John never regained full strength in the hip, lower leg, and the core muscles of the trunk. The lack of strength significantly impacted him, keeping him from returning to all his activities even a year later. The pain in his hip had greatly improved, but John found considerable fatigue when attempting to work outside. He assumed this was part of aging and there was nothing more people could do for him.  

 

A MORE FREQUENT SCENARIO

 

John describes a scenario I have seen become more frequent over the past ten years. What once was a standard part of the post-surgical progression is now being limited… the rehabilitation. Individuals like John are not given the option to begin physical therapy after their total hip replacement, and as a result, they never truly gain full function to the leg and caulk it up to "old age." But it does not have to be this way! John can return to full function in the legs, complete yard work without being overly tired, and return to a productive lifestyle without the consequence of pain.  

 

4 REASONS YOU NEED PHYSICAL THERAPY AFTER YOUR HIP REPLACEMENT

 

• Muscle Strength: A Hip replacement disrupts the bone of the hip and the surrounding muscles. A disruption to the muscle will naturally weaken these tissues and prevent full muscle activation. Furthermore, studies have shown individuals who regain their hip strength after a hip replacement have the best one, three, and five-year follow-up in function after a hip replacement.  

• Gait Training: Many individuals are in intense pain after a joint replacement. Also complicating the progression, narcotics are given to help with pain management. These two items will make walking more challenging. A proper fit for crutches or a walker is needed for safety and to start walking effectively. Improper fit will limit hip, knee, or back mobility and form contractures in these areas, thus limiting full function. Note: email or call me - I have a Youtube video on how to fit these properly. 

• Balance: Coordination and balance is often overlooked with a total hip replacement. A person may walk without an assistive device and return to most activities of daily living, but they cannot respond to a change of direction well. A bump or a toe caught on a rug will send this person to the ground. Falling is the number one reason for a nursing home visit in older individuals. Proper balance training under the supervision of an exercise professional is needed to restore full coordination.  

• Range of Motion: Hip range of motion in extension is often limited with a total hip replacement. Why? Because we tend to sit more and not stress the joint into hip extension. We will lose more mobility to the hip, thus preventing a full stride with walking—the result: is considerable fatigue during walking.  

 

Overall Team, what happened to John is becoming more frequent, so I needed to touch on this today. I am starting to see the consequence of individuals not being prescribed physical therapy after their total hip replacement one or two years post-surgery. Fatigue, pain in the hip, poor balance, or general strengthening after a fall are some reasons. A hip replacement is a serious decision usually made after considerable thought. I know if you are planning on a hip replacement-you need a well-trained physical therapist in this area. You deserve the right to make the most of your procedure and return to ALL of the activities you enjoy- not just SOME of them. Also, after your physical therapy is complete… a proper progression to a wellness program at a local training facility will give you the BEST opportunity to make the most of each day. Thanks again, Team, for reading these and reaching out. Please send me your questions by phone, email, or come by the office. Your questions are the best part of my day.

Keep Moving!

 

 

 

As we discussed earlier, problems with balance and gait can occur in patients with hip issues. If you would like to learn more about how to improve your balance…

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