Important Guide on Physiotherapy After Hip Replacement

Hip replacement surgery, also known as total hip replacement, is a major surgical procedure that replaces the worn-out joint surfaces of your hip with prosthetic components. Hip replacements are often solutions for patients suffering from chronic hip pain and limitations caused by osteoarthritis, a degenerative joint disease that damages the cartilage cushioning the hip joint.

The ball and socket joint of the hips comprises two bones, namely:

• Femur (thighbone)
• Pelvis (made up of three bones - ilium, ischium, and pubis)

During the hip replacement procedure, your orthopaedic surgeon will remove the damaged ball (femoral head) and socket joint (acetabulum) of your hip and implant artificial components made of metal, ceramic, or plastic.

While hip replacement surgery offers significant pain relief and improved mobility, physical therapy after hip replacement is not optional. Just like physiotherapy for osteoarthritis of the hip, it is necessary for the recovery process and rehabilitation after hip joint replacement surgery.

Why Physiotherapy is Required After Hip Replacement Surgery

Physical therapy after hip surgery is both clinical- and cost-effective, especially for total hip replacement (THR) cases. The research found physiotherapy improved functional performance, hip muscle strength, pain management, and range of motion specifically in flexion (bending the hip).

Additionally, the study suggests physiotherapy provides a cost-effective solution from the UK's perspective. From the Singaporean perspective, a systematic review has shown promise for the cost-effectiveness of physiotherapy interventions following total knee and hip replacements.

Physical therapy providers in Singapore such as Phoenix Rehab offer similar benefits with physiotherapy after total hip replacement. Our qualified physiotherapists create a personalised treatment plan based on your specific needs and recovery goals, vital for the rehabilitation process. We also specialise in joint surgery such as hip fracture physiotherapy and hip impingement physiotherapy.

Let's dive deeper into why physiotherapy is crucial for recovery after hip replacement surgery.

Reduce Pain and Inflammation

Pain and inflammation are natural after surgery, but they shouldn't hinder your progress. Physiotherapists utilise manual therapy techniques like massage, joint mobilisation, and soft tissue mobilisation. These techniques target the surgical area and surrounding muscles, promoting pain relief and reducing stiffness.

Physiotherapists will also design a personalised exercise programme that complements manual therapy. These exercises focus on gentle movement and increasing circulation, allowing you to move more comfortably and participate in daily activities sooner.

Restore Muscle Strength and Joint Motion

The surgical procedure can weaken the muscles that support and stabilise your hip joint. Physiotherapy addresses this by incorporating targeted strengthening exercises for your hip muscles, extensors, abductors, and adductors (buttock and thigh muscles). A strong foundation of musculature is essential for proper joint motion and stability.

The programme will gradually progress, allowing you to regain your full range of motion in the hip joint. This newfound flexibility allows you to perform everyday activities with greater ease and confidence.

Improve Gait and Balance

Walking is a complex activity that requires precise coordination between multiple muscle groups. After surgery, your walking pattern (gait) may be altered due to pain or stiffness. Physiotherapists will guide you through gait re-education, ensuring proper weight distribution on your new hip. This not only improves walking efficiency but also reduces stress on the joint.

Additionally, physiotherapy incorporates balance training exercises. Improved balance helps prevent falls, a significant concern after hip replacement surgery.

Prevent Blood Clots

Following surgery, there's an increased risk of blood clots forming in the legs. Early mobilisation is key to preventing this complication. Physiotherapists will introduce safe and gentle exercises soon after surgery to promote good circulation in your legs. These exercises, along with proper positioning and compression stockings, can significantly reduce the risk of blood clots, allowing you to focus on your recovery without this additional worry.

Functional Restoration

The ultimate goal of physiotherapy is to empower you to regain your independence in performing everyday activities (daily living activities) such as:

• Walking
• Climbing stairs
• Getting dressed
• Bathing
• Preparing meals

Through a combination of manual therapy, targeted exercises, gait training, and balance work, physiotherapy equips you with the skills and confidence to get back to your normal activities without assistance.

What to Expect During Physiotherapy Rehabilitation

Physiotherapy isn't something that starts after you've fully recovered from hip replacement surgery. Similar to physiotherapy for labral tear hip, this process is necessary for the healing process from the very beginning.

Physical therapy rehabilitation typically begins in the hospital shortly after surgery. Bed exercises like ankle pumps and leg slides will be introduced to improve circulation and prevent stiffness.

In some cases, your orthopaedic surgeon may recommend pre-operative physiotherapy exercises. Prehabilitation focuses on strengthening the muscles around your hip joint in the weeks leading up to surgery. These exercises can significantly improve your surgical outcome and make the post-surgical physiotherapy process smoother and more manageable.

As you progress, your physiotherapist will gradually introduce more challenging exercises, including:

Straight Leg Raises

Straight leg raises directly target the quadriceps muscles on the front of your thigh, which are essential for extending your hip joint. Strong quadriceps are key for activities like walking, climbing stairs, and standing from a seated position. To perform this exercise:

1. Lie on your back.
2. Slowly raise your operated leg.
3. Keep that leg straight.
4. Hold for a few seconds and lower back down.

Hip Abduction

This exercise targets the gluteus medius muscles, located on the outer side of your hip. These muscles play a role in stabilising your hip joint and preventing unwanted inward rolling during movement. Weakness in the gluteus medius can contribute to limping and gait abnormalities. Strengthening these muscles through hip abduction exercises enhances hip stability and proper mechanics, leading to a smoother and more efficient walking pattern. To do this:

• Lie on your side
• Lift your operated leg upwards away from your other leg with your toes pointing forward.
• Hold for a few seconds and lower back down.

Short Leg Stands

This might seem like a simple exercise, but they pack a powerful punch when it comes to regaining balance and confidence after surgery. Balancing on your operated leg challenges your core muscles and proprioception (your body's awareness of its position in space). As you progress in these exercises, gradually increasing the standing time and reducing support, you'll retrain your body for balance and stability. You can do this exercise with support or something to hold for balance.

These are just a few examples of the exercises you might encounter during physiotherapy rehabilitation. Your physiotherapist will design a personalised program that incorporates a variety of exercises tailored to your specific needs and recovery goals.

Tips for When You Get Home

Following discharge from the hospital, physiotherapy continues at home. Here are some tips to ensure a smooth recovery:

• Use a walking aid: Your physiotherapist may recommend a walker or crutches for support during the first few weeks.
• Practice safe exercises: Perform your prescribed exercises regularly on a firm surface, initially under the supervision of a physiotherapist or caregiver.
• Maintain good posture: Stand tall with your shoulders back and avoid slouching. This promotes proper alignment and protects your new hip.
• Use a raised toilet seat: This can make sitting and standing from a seated position easier.
• Apply ice packs: Ice therapy can help reduce pain and swelling after exercises.
• Listen to your body: Don't push yourself too hard. Rest when you feel tired and seek advice from your physiotherapist if you experience any pain or discomfort.

What Not to Do After Hip Replacement

Here are some activities to avoid during your initial recovery:

• Crossing your legs: This can put undue stress on your new hip joint.
• Bending at the waist: Bend from your knees and hips when picking up objects.
• Twisting: Avoid twisting motions that can strain your hip joint.
• Climbing stairs without a handrail: Use the handrail for support when navigating stairs.
• Operating a vehicle: Wait for your doctor's approval before getting behind the wheel again.

Conclusion

Hip replacement surgery can significantly improve your quality of life by reducing pain and increasing mobility. However, a successful recovery hinges on comprehensive physiotherapy rehabilitation. By following your physiotherapist's guidance and diligently performing your exercises, you can regain strength, improve hip motion, and return to your normal activities with confidence. Physiotherapy is an investment in your long-term health and well-being after hip replacement surgery.