Total Hip

Replacement
Rehabilitation

Abdullah Osama
PT,MSc,DOMTP
Total Hip Replacement(THR)

VS.

Total Hip Arthroplasty(THA)

 Treatment Options: Non-operative
Activity Modification •
Weight Loss •
Cane/walker •
Physical Therapy •
Medications: •
NSAIDs –
COX-2 Inhibitors –
Nutritional supplements –
Injections: •
Corticosteroid –
Viscosupplementation –
 Background
• Total joint replacement is one
of the most commonly
performed and successful
operations in orthopaedics as
defined by clinical outcomes
and implant survivorship*
 TJA Volume Estimates
Primary and Revision TJA Procedures Performed in the US

2500000
Projections*
2000000
Number of Procedures

1500000 Primary TJA

Revision TJA
1000000

500000

0
2000 2005 2010 2015 2020 2025 2030

Year
 Goals of Joint Replacement Surgery
• Relieve pain!!!

• Restore function,
mobility
Pre-Op. Assessment
Pre-Op. Assessment
General muscular condition
Pre-Op. Assessment
General joints conditions
Pre-Op. Assessment
Posture
Pre-Op. Assessment
Gait analysis
Pre-Op. Assessment
ADL (independency )
Pre-Op. Assessment
Psychological
Patient Education Makes
a Big Difference
Training the patient
on Post Op.
Exercises
and Gait
don’t worry about

- Swelling
- Numbness
- Bruises
- Heaviness
- Clicking
WHAT DO YOU EXPECT AFTER
TOTAL HIP SURGERY ??!!
Improved walking,
independent walking, possibility of hiking,
Complete pain relief, relief of pain with stair
climbing,
Return of mobility into the Hip joint
Improved wellbeing, return of good mood
Improved recreation activities
Improved stair climbing,
Improved activities of daily life.
DO NOT OVER EXPECT!!!
Satisfaction Depends on
Satisfaction Depends on

Severity of
preoperative pain
and stiffness.
Satisfaction Depends on

Outcome of the
operation
Satisfaction Depends on

Pre-Op. expectations
Decision of THR??
Decision of TKR??

Specialized Orthopedic Surgeon

( Arthroplasty Surgeon )
Decision of THR??

Anesthetist.
Decision of THR??

Hospital
(Operation room, Nursing , . )
Decision of THR??

Physiotherapy
THA Implants
 Pre
Operative
Planning
 Implant Choice
Cemented Vs. non Cemented
Cemented:
•Elderly (>65)
•Low demand
•Better early fixation
•? late loosening
 Implant Choice
Cemented Vs. non Cemented
Cementless:
•Younger
•More active
•Protected weight-
bearing first 6 weeks
•? Better long-term
fixation
 Implant Material

Cross linked, highly cross • Lower rate of wear • Higher density

Linked, HCL e V E • Wider ROM • Smoother
Higher rate of wear • Metallic debris in blood • More resistance to
Aseptic loosening • loosening scratching
• squeak
• cracking
Posterior
Approach

Better
Exposure

Sciatic
nerve
injury ??!!
 Posterior
Approach

• gluteus maximus innervated by inferior gluteal

nerve
• muscle split is stopped when first nerve branch to
upper part of muscle is encountered
 Lateral
Approach

More common
has lower rate of total hip prosthetic dislocations
Abductors injury ?!!
 Lateral
Approach

• splits gluteus medius distal to innervation (superior gluteal nerve)

• vastus lateralis is also split lateral to innervation (femoral nerve)
 Technique: Total Hip Replacement
• Femoral neck resection
 Technique: Total Hip Replacement
 Insertion of
• Acetabular reaming acetabular
component
 Technique: Total Hip Replacement
• Reaming/broaching of  Insertion of
femoral component femoral component
 Technique: Total Hip Replacement
• Femoral head impaction  Final implant
 a left sided Trendelenberg gait resulting from left sided gluteus
medius weakness. Left-sided abductor muscle weakness is most likely
found in the setting of a left total hip arthroplasty performed through
a lateral approach, of the options listed.

Abductor weakness will lead to an apparent leg length

discrepancy with the left side feeling longer to the patient.

Maloney and Keeney note that most leg length discrepancies

that are less than 1 centimeter are well tolerated by the patient.
However, they also discuss that patient dissatisfaction with leg-length
discrepancies after THA is the most common reason for litigation
against orthopaedic surgeon.

Clark et al present a Level 5 review describing the differences

between true and apparent leg length discrepancies. Increasing
femoral neck length and not fully seating the femoral stem will lead to
a true leg lengthening on the operative side
What to Expect: Weeks 0 – 3
Follow suggestions to keep your pain under control in the
early days after surgery. This reduces your chance of long
term pain and helps you to move more freely. Get enough
sleep and maintain regular bowel movements. In the first 3
weeks, exercises focus on hip movement and gradually
increasing your standing and walking.

Goals: By the end of week 3

• Move your leg in and out of bed by yourself (start with a
strap)
• Move on and off a raised chair, bed and toilet without help
• Walk at home using a walker, cane or crutches
• Use the stairs safely with cane or crutches