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Why physiotherapy after a hip replacement is non-negotiable

Your hip is a ball and socket joint that allows the upper leg to move front to back and side to side. The hip joint is made of two parts, the acetabulum (the socket) and femur (the ball). Your hip is the largest weight bearing joint in the body, surrounded by plenty of ligaments, muscles and nerves that perform a variety of critical movements.

The head of the femur and the inside of the acetabulum are covered with a layer of cartilage that can be worn away or damaged (usually by arthritis). Once this has happened and the underlying bone is exposed, you’re going to find yourself suffering pain, stiffness and in some cases even shortening of the affected leg. Unfortunately, with so many moving parts and the pressure of day to day life, the hip is a common joint to have replaced for a variety of reasons.

This is known as a total hip arthroplasty or replacement.

What is a total hip replacement?

With total hip replacements, both damaged surfaces of the hip joint are replaced with prosthetic substitutes. Firstly, the head of the femur is replaced with a prosthetic head on a shaft, and the joint surface of the acetabulum is lined with a bowl shaped synthetic joint surface.

Hip replacements are usually only performed on people who have severe osteoarthritis that is making daily activities difficult and is failing to respond to other treatments.

Following surgery, the muscles and soft tissues around the hip are weaker and unable to stabilise the hip as usual and recovery can be long and intense.

What are the common reasons for needing a hip replacement?

  • Hip Osteoarthritis

A “wear and tear” type of arthritis that occurs when the cartilage cushioning the bones of the hip wears away, causing the bones to rub against each other, causing hip pain and stiffness.

  • Rheumatoid Arthritis

An autoimmune disease that can thicken and inflame the synovial membrane leading to chronic inflammation that can damage the cartilage; causing pain and stiffness.

  • Post-traumatic Arthritis

This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.

  • Avascular Necrosis

An injury to the hip, such as a dislocation or fracture, that has limited the blood supply to the femoral head. This condition can cause the surface of the bone to collapse, causing hip arthritis. Ouch.

Looking after hip replacements post-surgery

In the days following surgery it is important to continue managing swelling once you’ve been discharged from hospital. Excessive swelling will delay healing, causing more pain and limiting the completion of exercises to aid recovery.

Some swelling is expected but large amounts that involve the whole leg may indicate that more rest is required. Resting is ideally performed lying flat in bed and can be assisted by applying ice packs for up to 20 minutes at a time. It is not uncommon to require a rest in bed between meals.

Concerns with swelling following discharge should be discussed with your GP, physio and medical team.

Why is physiotherapy important for hip replacement recovery?

Physiotherapy is recommended after every joint surgery as soon as you are able. Early postoperative rehabilitation after a total hip replacement is instrumental in restoring mobility, strength, flexibility and reducing pain.[1] Your risk of suffering a hip dislocation is heightened during the first few months after surgery while the tissues are healing. Rehabilitation post-hip replacement usually begins immediately after your surgery but the whole rehabilitation period for a hip replacement can take between 3 to 6 months, in some cases lasting longer depending on your progress.

The aim of post-operative rehabilitation is to address functional performance and to improve strength and range of motion and it has been established that patients can achieve significant pain and function improvements through a targeted strengthening programme following total hip replacement.[2]

Your physio will start with a full body and situation assessment that includes:

  • Subjective history
  • Range of motion
  • Muscle power
  • Circulation
  • Mobility and function

On top of that, physiotherapy increases the patient’s knowledge of their condition and offers a chance to learn about the exercises and precautions that are necessary during hospitalization and after discharge.[3]

What to expect after your Hip Replacement

You will have to make adjustments to your day to day life in order to avoid particular positions and movements that could put extra pressure on your hip, causing further injury.

Most patients are able to be pain-free while walking, hiking, bending, stair & ladder climbing, kneeling, crawling and are eventually able to return to low-impact sports such as golf, swimming, cycling, social tennis, and most gym exercises. Best to stay away from some of the more flexibility heavy movements in Yoga though, as these can place you at risk of suffering a dislocation.

[1] Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Archives of physical medicine and rehabilitation 2009;90(10):1652-7.

[2] Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, McMeeken J, Westh R. A targeted home-and center-based exercise program for people after total hip replacement: a randomized clinical trial. Archives of physical medicine and rehabilitation 2008;89(8):1442-7.

[3] Coulter CL, Scarvell JM, Neeman TM, Smith PN. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. Journal of physiotherapy. 2013;59(4):219-26.

surgery

Do I need physiotherapy after a shoulder reconstruction? Emphatically, yes!

The shoulder is a complex joint, one that physiotherapists have spent decades studying and getting their diagnoses and treatment down to a fine art. It’s a good thing too, because shoulder injuries are amongst the most common suffered by Aussies, especially those on the Northern Beaches. Something about all that sun, surf and sand mixed with plenty of beach volleyball and other sports that are stressful on the shoulder joint makes shoulder injuries far too common.

One of the common knock-on effects of all these shoulder injuries is the number of shoulder reconstructions that are performed each year. Most shoulder injuries such as dislocations and fractures can be treated without surgery and with a solid dose of physiotherapy, but some injuries are a little more complex and require the surgeon’s scalpel to sort out once and for all.

The anatomy of the shoulder

The shoulder joint is made up of: the arm bone (the humerus), the collarbone (the clavicle) and the shoulder blade (the scapula). These connect to the glenoid, which is a ball-like shaped object that then connects with the socket of the scapula at the upper end of the humerus. When you injure your shoulder it is likely that one of these bones will be injured or that there will be damage to the surrounding ligaments or rotator cuff.

What is a shoulder reconstruction?

If your injury is a bit of a doozy, or your ligaments have been torn (remember that ligaments can’t heal themselves like other parts of the body) it’s likely that you’ll need some surgery.

A shoulder reconstruction involves repairing the torn or stretched ligaments so that they are able to hold your shoulder joint in place properly. During shoulder reconstruction surgery the torn ligaments will be stitched back to the shoulder socket with special anchors and your over stretched ligaments will be tightened back to new.

Shoulder reconstruction can usually be performed by keyhole microsurgery, but some patients may need an open surgical procedure which involves a larger incision over the shoulder to perform the repair. You’ll look a bit chopped up, but chicks dig scars right?

What can I expect after shoulder surgery?

Pain – It’s normal to have some pain and discomfort after shoulder surgery; they have been chopping around in your body after all. However, it is important to not be a hero and let someone know about your pain so it can be treated and managed. Your pain shouldn’t be that bad you are unable to cough, breathe deeply and do your exercises without hitting the roof. A bit of ice never went astray either.

Decreased movement – Your arm is probably going to be in a sling for at least 4-6 weeks so you better get used to it sooner rather than later. That sling is going to stop your shoulder dislocating again while it is recovering and it’ll also stop you from getting your arm in a painful position.

Blocked bowels – Anaesthetic is fantastic for putting you to sleep and stopping super sharp scalpels from hurting, but it’s not as great for a regular bowel. Most people come out of general anaesthetic a bit blocked up, so along with everything else, make sure you take any medication the hospital gives you and eat a high fibre diet.

How does physiotherapy help recovery from a shoulder reconstruction?

Your shoulder and most of your arm are going to be immobilized for well over a month, so it means they’re going to lose a bit of function and feel awfully tight and difficult to move after surgery. Shoulder injuries are also among the most common to re-injure so your musculoskeletal physiotherapist is critical for helping alleviate your current pain and movement woes while also helping to avoid further injury down the track.

Physio plays a critical role after surgery; it will affect how quickly you get back to your work, sport and the things you love. Regular exercises and mobilisation is needed to restore motion and flexibility to the affected shoulder.

Strengthening your rotator cuff muscles is the best defence against further shoulder dislocation, subluxation, and instability and your physio will design a program with exercises that build up these muscles around the shoulder. Adequate warming-up before an activity and avoidance of high-contact sports may help prevent a recurrence of instability.

If you’ve got questions, if you’ve got a surgery coming up, or if you’ve already had shoulder surgery get in touch with us, don’t wait until the pain becomes severe or chronic, give The Beaches Sports Physio a call on (02) 8964 4086 or email us to book at info@thebeachessportsphysio.com.