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PHYSICAL THERAPY

Buchberger: What to expect after total hip replacement, part one

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Happy Senior Woman Patient in Hospital Bed

The total hip replacement (total hip arthroplasty) is becoming as routine as any arthroscopic surgery. Patients suffering from degenerated hips are improving their quality of life every day through the scientific advancements of total hip replacement surgery. Despite the routine nature of a total hip replacement, many patients with arthritic hips are still apprehensive when they are told that they need one. Some of this apprehension is driven from a lack of information regarding risks, outcomes and the path from surgery to recovery. Hopefully, this two-part article will answer some common questions about the process of having a total hip replacement.

Since the first attempt at hip replacement surgery was performed in 1821, hip replacement surgery has advanced to become one of the safest procedures performed today, with over 350,000 surgeries per year in the United States. According to the Cleveland clinic, approximately 96% of the patients who have a total hip replacement experience a significant reduction in pain and are able to return to recreational activities such as golf and walking. According to a 2017 study published in The Lancet, 4.4% of hip replacement patients needed revision at 10 years, and 15% at 20 years. This would mean about 85% of hip replacements are lasting longer than 20 years. The most common age group having hip replacements is the 60- to 80-year-old age group, with the average being about 70 years old. Men and women have an equal opportunity of needing a hip replacement.

The most important thing to remember is that every case is different! Even if you have had your own opposite hip replaced, both hips may not fare the same. Some cases recover quickly, some take longer. There is no exact time frame. It may take an entire year before the hip feels “normal” again.

The traditional procedure starts out with a 10-12-inch incision. In the minimally invasive procedure, the incision is 3-6 inches. This then requires the surgeon to split or detach the muscles from the hip, allowing for adequate visualization. The arthritic femoral head (ball) is removed and the metal stem is inserted into the hollow of the femur (thigh bone). A metal or ceramic ball is connected to the upper part of the stem. The surgeon removes the damaged cartilage surface of the acetabulum (socket) and inserts a metal socket. Screws or cement may be used to secure the socket. A plastic, ceramic or metal spacer is placed between the new ball and the socket, providing a smooth, gliding surface.

The early post-operative stage (zero to seven days) is extremely important for several reasons. The first is to get the new hip moving. Early movement will improve your outcome and help prevent blood clots. Keeping your wound clean and dry will help reduce the chance of developing an infection as the incision heals. Most surgeons will apply a transparent adhesive waterproof film on the incision to keep it protected. Even though you will experience some early post-operative pain, performing the prescribed exercises is critical to not only the recovery process, it will also extend the longevity of your new hip.

Dr. Dale Buchberger

Dr. Dale Buchberger

You will use a wheeled walker initially to help with walking and balance as you get used to your new hip. This does not mean you need to use it forever! You will be up and walking as soon as possible when you come out of anesthesia. You will be able to put as much weight as you tolerate on that leg and you are encouraged to do so, with as much of a “normal” gait pattern as possible. Once you get stronger and your walking improves, you can wean off the walker to a cane, and then to no assistive device at all. Another important part of the early post-op period is to wean off pain medications as soon as possible, as the side effects can actually hinder recovery when taken for a long period of time (i.e. drowsiness, constipation, etc.). The most effective way to do this is to only take pain medications at night to assist with sleep.

Your hip motion will be restricted while the staples and post-operative dressing are in place. Not all surgeons use staples; some use surgical adhesive. If staples are used, once they are removed (about two weeks post-op), your range of motion should improve. Steri-Strips are commonly applied at this time to keep the incision closed as it heals. Sometimes these can be restricting, depending on how much glue is used, but they should fall off on their own within a week. Do not attempt to pull them off unless they are loosened enough. As the edges begin to curl, you can trim them down if desired so they don’t catch on your clothing.

Next month, we will address what is involved in the physical therapy aspect of having a total hip replacement. Special thanks to Carolyn Collier, PTA, for her significant contribution to this series.

Dr. Dale Buchberger is a licensed chiropractor, physical therapist and certified strength and conditioning specialist diplomate of the American Chiropractic Board of Sports Physicians with 33 years of clinical sports injury experience. He can be contacted at (315) 515-3117, activeptsolutions.com or shouldermadesimple.com.

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