TOTAL HIP REPLACEMENT Physiotherapy Management

Irene Toh Principal Physiotherapist Department of Physiotherapy

COMMON CAUSES

Arthritis Osteoarthritis

Inflammatory arthritis

Avascular Necrosis (AVN)

Childhood hip joint malformations

GOALS OF EARLY THR REHABILITATION

Independent bed mobility and safe transfer

Independent ambulation with walking aids

Restore functional hip motion and strength

Educate patient on hip precautions

COMPLICATIONS POST THR

Dislocation – greater risk right after surgery

Loosening of implant

Deep venous thrombosis (DVT)

Infection of wound and implant

POST OPERATIVE DAY (POD) 1

Optimise respiratory and circulatory functions – chest therapy, ankle pumps and TEDs stockings

Start hip/knee exercises Assisted hip ROM (flexion below 90deg and

abduction about 20deg)

Static gluteals, quads

Inner range quads

Hip abduction pillow (PRN)

Bed mobility encouraged

POD 2

Bed mobility and transfer practice (bed to

chair and chair to bed)

Ambulate (check with surgeon, post xray)

Self assisted hip exercise – flexion (below

90deg) and abduction

Strengthening ex – knee extension/inner

range quads, bridging (for posterior

approach THR), assisted straight leg raise

BED MOBILITY

Lying down on bed

Getting up from bed

EXERCISES - HIP FLEXION

HIP ABDUCTION

INNER RANGE QUADS

BRIDGING (FOR POSTERIOR APPROACH

THR)

AMBULATION

WITH WALKING

FRAME

POD 3

Progress hip ROM and strengthening

exercises

Progress walking distance and walking

aids

Correct gait pattern

Ambulate stairs (if patient steady on level

ground)

RESISTED HIP ABDUCTION WITH

THERABAND

STANDING HIP EXERCISE

Hip extension Hip Abduction

AMBULATION

WITH

QUADSTICK

STAIRS

POD 4 ONWARDS

Progress ambulation

Review walking aids

Stairs practice

Progress hip/knee exercises

Home exercise program

DISCHARGE INSTRUCTIONS

Do’s and Don’ts

Home Exercise program

DON’TS

http://www.healthsystem.virginia.edu/internet/orthopaedics/corhipos.cfm

DO’S

Sleep with pillow between legs

Sit on high chair

Turn in an arc and slowly

Continue to use walking aids until good

balance and strength is achieved

Continue home exercise program

DISCHARGE CRITERIA

Safe bed mobility and transfer

Safe ambulation

Community hospital referral as necessary

or

Outpatient physiotherapy

OUTPATIENT PHYSIOTHERAPY

Continue to improve hip and knee strength

Progress gait to without aids

Correct gait pattern

Return to functional activities /work

EXERCISES WITH FREE WEIGHTS

EXERCISE WITH MACHINES

Hip abduction

Hip extension

Balance exercise on foam

EXERCISE USING THERABANDS

THE END

Thank you for listening!