Total Hip Replacement

A total hip replacement refers to an orthopaedic surgery to replace the head of the femur and the acetabulum of the pelvis with a prosthetic joint. These are the ball and socket of the hip joint. Typically made out of metal, ceramic and plastic.

Less invasive surgery to a total hip replacement is resurfacing the hip, less of the bone is removed and from the femur and pelvis. The Birmingham hip resurfacing is the most widely used technique. This alternative only replaces the surface of the femoral head and the surface of the acetabulum. This can be a good option and a popular choice with younger patients to preserve as much natural skeletal bone to allow for future operations which may be needed as prosthetics have a limited life span.

Trauma

A fractured femur or acetabulum can sometimes be treated with pins and plates to hold the bones together to heal. However, if there is low bone density, as in the case of osteoporosis or osteopenia, and if there is an increased risk of poor healing a total hip replacement may be recommended.

Osteoarthritis

The most common cause of elective total hip replacement surgery is the degeneration of the joint, leading to pain and restricted range of movement. If the quality of life and activity levels are reduced due to this, and if physical therapy does not significantly improve these, then a total hip replacement surgery can be a good option to consider.

Congenital Hip Dysplasia/Perthes Disease

Certain congenital conditions affect the formation of the hip joint in childhood and adolescence. Poor structure and shape can result in early degeneration of the hip and early onset osteoarthritis. Therefore, these individuals are likely candidates for a total hip replacement.

Total Hip Replacement Surgery

A total hip replacement is a major surgery and the decision to undergo this procedure should not be taken lightly. However, it has a relatively quick recovery time, as surgical procedures and prosthetics have advanced, and physical therapy protocols have become more refined. This is especially true for a healthy, fit and strong individual.

Elective surgery is always better than emergency surgery. The patient can be physically prepared in the months preceding the operation, and they can be psychologically prepared for what to expect post-surgery. Of course, depending on the reason for surgery this is not always possible.

Physical therapy Pre-Operative

Often referred to as prehab, this is the physical training that is undertaken before surgery. This will include strengthening work for muscles around the hip which will help recovery, as well as learning the exercises and movements that might be unfamiliar, that will be part of your post-operative rehabilitation.

Physical therapy Post-Operative

Post-operative physio follows strict protocols to ensure the surgery has the best opportunity to be successful. There are common limitations to the ranges of movement of the hip as well as activities that are evidence-based and should be followed closely. There are also specific limitations and restrictions that a surgeon might impose to reflect the specifics of the surgery procedure and the individual’s anatomy and risks.

Many people are surprised with how quickly they are expected to get out of bed and start walking. The hip joint is a very stable joint and weight-bearing in a standing position is very safe and the best way to start strengthening and returning to functional activities.

Additional specific exercises will be given and directed by your physical therapist, focused on mobility and strengthening:

Mobility – Active range of movement of the hip to gain the full mobility of your new joint.
Strengthening – This will include weight-bearing exercises such as squats, ascending and descending steps, and balance exercises. And resistance exercises using resistance bands or weights, which can target specific muscles, such as your gluteal muscles, hip flexors and adductors.

Additional low-impact exercise such as walking and cycling can be gradually introduced and progressed depending on your response. Other exercises including using a cross trainer, and swimming or hydrotherapy, can also be helpful for your recovery. But should be done under the instruction of your physical therapist.

Restrictions a Total Hip Replacement

A total hip replacement is an effective surgery when it is needed. However, a prosthetic hip joint is not the same as the original hip. If the original hip is damaged, worn, painful and with restricted mobility, a replacement will feel much better and most individuals are extremely happy with the outcomes after surgery. However, there are some restrictions to ensure the prosthetic joint is preserved for as long as possible.

High-impact exercise, while not completely off the table, should be limited. A sensible limit to the volume, intensity and choice of exercise should be discussed with your physical therapist and surgeon. Your age, strength and fitness will impact the guidelines that you will be set.

Mobility will be strictly restricted for the first 6 weeks. The restriction of hip movement is no more than 90º flexion, 0º adduction, and 0º internal rotation. Beyond these positions, and with combinations of these positions, there is an increase in the risk of dislocation. After the first 6 weeks, the risk of dislocation is significantly less as strength has improved, but extremes and combinations of these positions should be cautiously used.

Photo of man walking with crutches

Total Hip Replacement Surgery Outcomes

A total hip replacement is a resoundingly positive and successful surgery for the vast majority of individuals who need it. Poor outcomes are related to individual factors such as (Rolfson et al, 2009 & Hofstede et al, 2016):

High body weight
Poor strength
Poor general health
Low bone density
Reason for surgery and presurgery radiography findings
High levels of anxiety and/or depression
Poor adherence to post-operative advice and physical therapy
Surgeon experience and technique

Revision Surgery

As with any prosthetic joint, a total hip replacement has a limit to its life span. In 58% of individuals, a total hip replacement will last for 25 years (Evans et al, 2019) but it can last longer for some people. This has significantly improved over the past few years and the materials used have advanced.

Most cases of revision surgery are due to the age of the replacement joint. This is why the individual’s age will be a factor in the decision-making process before doing the initial surgery. In the minority of cases the body may reject the implant, or the implant can become infected, these are both cases when the implant will need to be removed and a revision replacement done. Surgeon experience is a key factor in the outcomes of revisions and more complex cases.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments.