Total hip replacement, also known as arthroplasty, is a common surgery often done when severe arthritis or a hip fracture makes it difficult to manage with less invasive treatments. The main goal of this procedure is to reduce pain, improve movement in the joints, and help people regain their ability to perform everyday activities like walking, standing, climbing stairs, or even running. After surgery, physical therapists play a key role in helping patients strengthen their muscles and restore movement so they can reach their full potential.
There are two main types of hip replacement surgeries, total hip replacement and partial hip replacement. In a total hip replacement or arthroplasty, both the ball and socket of the hip joint are replaced with artificial parts. This surgery is commonly performed to address conditions like osteoarthritis, rheumatoid arthritis, traumatic arthritis, ankylosing spondylitis, avascular necrosis (which is the loss of bone tissue), certain hip fractures, as well as benign and malignant tumors.
Partial hip replacement, also known as hemiarthroplasty, only replaces the ball of the hip joint, as the socket remains strong and doesn’t require replacement. This procedure is typically done when damage is limited to the femoral, or thigh, portion of the hip joint. Hemiarthroplasty is most often performed on elderly, frail patients with fractures involving the ball or neck of the femur.
The leading cause of chronic hip pain and disability is arthritis, with the most common forms being osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.
Osteoarthritis is a wear-and-tear condition that typically develops with age, often affecting those over 50, especially individuals with a family history of the disease. In osteoarthritis, the cartilage that cushions the hip joint wears down, causing the bones to rub against each other, leading to pain and stiffness. This type of arthritis can also be triggered or worsened by slight irregularities in how the hip formed during childhood.
Rheumatoid arthritis, on the other hand, is an autoimmune condition where the synovial membrane, which lines the joint, becomes inflamed and thickened. This ongoing inflammation can damage the cartilage and cause pain and stiffness. It is the most common form of inflammatory arthritis.
Posttraumatic arthritis occurs after a significant injury to the hip, such as a fracture. Over time, damage to the cartilage from the injury can result in pain and stiffness in the joint.
Osteonecrosis, sometimes called avascular necrosis, happens when an injury like a hip dislocation or fracture restricts blood flow to the femoral head. Without sufficient blood supply, the bone’s surface may collapse, leading to arthritis. Certain diseases can also cause this condition.
In some cases, hip issues in childhood, even if treated successfully, may lead to arthritis later in life. This is because the hip may not develop normally, affecting the joint’s surfaces and eventually leading to arthritis.
Total hip replacement is often recommended for individuals suffering from chronic hip pain and severe joint damage that significantly impacts their daily activities and quality of life. One of the primary reasons for this surgery is severe arthritis, such as osteoarthritis, rheumatoid arthritis, or posttraumatic arthritis. These conditions can cause the hip joint to deteriorate over time, resulting in ongoing pain, stiffness, and limited mobility that cannot be effectively managed through non-surgical treatments.
Hip fractures are another common reason for total hip replacement, especially in older adults. Major injuries to the hip can lead to damage that does not heal properly, requiring joint replacement to restore function and alleviate pain. When hip pain and stiffness become unmanageable, preventing basic activities like walking, standing, or climbing stairs, and other treatments have failed, total hip replacement offers a solution to improve mobility and enhance the individual’s quality of life.
A total hip replacement offers significant benefits, particularly in reducing pain and enhancing your overall quality of life. This procedure can dramatically improve your range of motion, making it easier to walk, run, or engage in daily activities that may have become difficult due to hip pain. Restoring your mobility often allows you to regain a sense of independence and return to aspects of life that you may have missed out on.
However, surgery is not always the immediate or only solution. It’s important to consult with an orthopedic professional who can guide you through nonsurgical treatment options. These alternatives might help alleviate your symptoms, potentially delaying or even avoiding the need for surgery altogether.
In a total hip replacement, the damaged bone and cartilage in the hip joint are surgically removed and replaced with prosthetic components. This procedure begins with the removal of the damaged femoral head, which is the rounded top of the thigh bone. In its place, a metal stem is inserted into the hollow center of the femur. This stem is either cemented into place or press-fitted so that it securely anchors into the bone.
A metal or ceramic ball is then attached to the top of the stem, taking the place of the removed femoral head. This new ball will function as the top of the thigh bone, allowing for smooth movement within the hip joint. The cartilage surface within the hip socket, or acetabulum, is also removed and replaced with a metal socket. Depending on the specific case, screws or cement may be used to hold the socket securely in position.
To ensure a smooth, frictionless movement between the new ball and socket, a spacer made from plastic, ceramic, or metal is inserted between the two. This spacer, also called a liner, provides a gliding surface, allowing the hip joint to move freely without pain or discomfort.
A physical therapist plays a crucial role both before and after hip replacement surgery, providing support to ensure a smoother recovery and better outcomes. Before surgery, your physical therapist will help prepare you for the upcoming procedure by educating you about what to expect and guiding you through exercises designed to condition your body. This prehabilitation includes flexibility and strengthening exercises for the lower extremities to enhance your strength and mobility, which can aid in your recovery after surgery.
Following your surgery, a physical therapist will visit you to begin your postoperative treatment. Depending on the specifics of your surgery, you may be required to limit the amount of weight you place on your surgical leg, which could range from a light toe touch to as much weight as you can comfortably tolerate. Your physical therapist will instruct you on how to correctly bear weight on your affected leg and may recommend using assistive devices such as a walker or crutches to reduce discomfort while you gradually regain your strength and mobility.
Regular exercise is essential for regaining strength and mobility in your hip and for ensuring a full recovery after total hip replacement surgery. To support your progress, your orthopedic surgeon and physical therapist may advise incorporating exercise into your routine for 20 to 30 minutes a day, or even 2 to 3 times a day during the initial stages of recovery. They may also recommend specific exercises to help improve your mobility and facilitate your return to daily activities.
Ankle Pumps: Gently move your foot up and down, repeating every 5 to 10 minutes. You can do this during TV commercials. Start right after surgery and keep it up until you’re fully recovered.
Ankle Rotations: Rotate your ankle inward and then outward, 5 times in each direction. Spend about 3 minutes on this exercise and do it 3 to 4 times a day.
Straight Leg Raises: Tighten your thigh muscle with your knee straight, lift your leg a few inches, hold for 5 to 10 seconds, then lower it. Repeat until your thigh feels tired. This should take about 2 minutes.
Standing Hip Extensions: Slowly lift your operated leg backward while keeping your back straight. Hold for 2 to 3 counts, then lower your foot. Repeat 10 times, taking about 2 minutes, and do this 3 to 4 times a day.
Standing Hip Abduction: With your hip, knee, and foot facing forward, lift your leg out to the side while keeping it straight. Slowly lower your leg back to the floor. Repeat 10 times, taking about 2 minutes, and do this 3 to 4 times a day.
For more information about physical therapy for total hip replacement in Long Island, contact Hicksville Physical Therapy today.
