Total Hip Arthroplasty Rehabilitation

Total Hip Precautions

These are instructions given to the patient to help minimize the risk of postoperative hip dislocation. Most hip dislocate posteriorly and occur in extreme hip flexion or flexion with adduction and internal rotation. Patient are usually instructed to not flex hip past 90 degrees, do not adduct past midline, or internally rotate the leg past neutral. This is most important during the first six weeks when soft tissues are still healing.

Post-operative Weight Bearing Status

Patients with cemented joint replacements can WBAT unless the operated procedure involved soft tissue repair or internal fixation of bone. Patients with cementless or ingrowth joint replacements are put on PWB or TTWB for 6 weeks to allow bony ingrowth to take place.

Post-operative Strength

Restoring strength around the hip is crucial after a THA. Frost (2006) showed that at 4 to 5 months post-surgery, THA subjects displayed reduced isometric hip flexion strength compared to aged matched controls. There was no significant difference in hip abduction or extension strength. There was also no significant difference when compared to the nonoperated leg. Bertocci et al (2004) also showed no difference between the operated and nonoperated legs in strength when measured isokinetically. The THA subjects did display reduced strength compared to healthy age-matched controls. Rossi et al (2006) demonstrated that hip extensor and flexor strength before surgery on the involved side was 39% and 29% lower, respectively, compared with the uninvolved side. Sixty days after surgery, strength of the hip extensors and flexors improved 50% and 27%, respectively, compared with before surgery.

Suetta (2008) showed that a 12-week program consisting of resistance training after unilateral THA was superior to electrical stimulation or standard rehabilitation at increasing strength, muscle fiber area, and muscle thickness. There was also a 35% increase in stair walking power. The other groups had no significant change in any of these parameters.

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