Total hip replacements is a common procedure today. The number of these surgeries done in Canada keep going up year over year. In 2017-2018 a total of 59,000 hip replacement surgeries was conducted and this was a 17.4% increase over the previous 5 years. It is estimated that 50% of the population over 50 years will develop osteoarthritis over their lifetime. Although most won’t need joint replacement surgeries there is a small percentage of people that will.
Ideally, a typical joint replacement lasts for 10-15 years depending upon the type of loads being placed on it. For this reason, most surgeons try and defer doing joint replacement surgeries for years unless its absolutely necessary.
In my practice, I have seen functional improvements in individuals with mobility and strengthening protocols. Many studies have shown that conservative options such as physiotherapy, aquatic therapy etc. improves functional strength and improves quality of life. Thus averting the need for surgery and in some cases deferring the need for surgery temporarily.
Pre Surgery To-Do’s:
In case you are someone who has been scheduled for a hip replacement surgery. You may need to focus on the following:
1. Loosing weight: If you are overweight, you might want to discuss with your health professional on ways to help you lose a few pounds before surgery. This will not only put less stress on the new joint but will also help you move better.
2. Exercises: In the months leading to the surgery, we tend to use our legs less due to pain. This in turn weakens our muscles. It is therefore very important that you stretch areas that are tight and work on gaining as much strength in muscles that support you to stand and walk before surgery. Talk to your physiotherapist about exercises that you can do pre surgery. Aquatic/pool therapy is another option that can be beneficial pre surgery.
3. In-Home adjustments: If you sleep on the second floor, consider shifting your sleeping arrangement to the first floor for the first few weeks post surgery. Getting a toilet seat lift, shower chair, installing grab bars in the bathroom etc are some ways you can make you home ready before surgery. If you live by yourself, consider placing objects at shoulder level or waist level in the kitchen so that you don’t have to stop low or be on your tip toes. Move your furniture around so that you will be able to maneuver around with a walker or cane easily without tripping. Declutter your home and floors so that you don’t trip and fall.
4. Arranging aids: Walking aids like walkers, canes, long handle shoe horns, reachers etc will help you be less dependent on your care givers.
5. Have a designated driver: You will not be allowed to drive for weeks following THR surgery, so having a someone to drive you from the hospital to your home.
Post: Surgery (At home):
1. Take your pain meds on time as prescribed by your surgeon.
2. Watch out for red flags like signs of infection(fever > 100 degrees F, shaking chills, Increased redness, tenderness around the wound, growing pain both at rest and movement, leaking from wound, blood clot in legs(increased swelling in the legs, severe pain in calf or leg area) and in very rare cases shortness of breath, pain in chest with coughing. The last one might be a sign of the pulmonary embolism where a blood clot from the leg travels to the lungs and it can be life threatening.
3. Do your exercises every 3-4 hours as tolerated.
4. Motion is lotion: You need to move as much as you can. Use walking aids to help you ambulate safely.
5. Apply ice pack every 3-4 hours either pre or post exercises- whichever gives you most relief.
If you are someone who has hip pain, consider meeting your trustworthy physiotherapist and discussing life style changes and exercises that can help you improve quality of life and function. Physiotherapist use a range of modalities that include Shockwave therapy, dry needling, soft tissue release techniques, electric stimulation to help with symptom management and most importantly assess and identify weak links and muscles in your legs. Working on fixing these weak chains should help improve your pain and function.
Read our blog on hip pain- causes and non surgical management. Not all hip pan requires surgery.
This article is written by AJ Varghese. AJ is a physiotherapist and co-owner of Theramax Rehab Centre with years of experience treating hip and knee replacement patients.