A Physio's perspective: Thinking of a Hip Replacement? Consider Physiotherapy beforehand
With Phase 3 underway this week in Ontario, many Markham residents will be more willing to get their elective surgeries again. That's great news if you have been suffering from hip pain! As a Physiotherapist who has worked in Markham Stouffville Hospital's Fracture Clinic for the past few years, I want to go over why active physio before (pre--op) and after surgery (post-op) lead to superior outcomes. Click here for a COVID-19 update for my clinic.
What is a hip replacement?
Total Hip Arthroplasty (THA) or hip replacement is a surgery that does exactly what it says - it replaces your hip joint. Your hip joint is a ball and socket joint where the ball represents the top of your thigh bone (femur) and the socket represents the bottom/side part of your pelvis (acetabulum). The surgery typically replaces the hip joint with artificial parts (protheses) and is done by an Orthopaedic Surgeon. Yes, you will become 'Ironman' (or 'Ironwoman')!
Do I need a hip replacement?
Most patients choose to get a hip replacement if their hip joint deteriorates to the point of dysfunction and pain. The most common causes include osteoarthritis, inflammatory arthritis, paediatric hip disorders, avascular necrosis, and trauma. A common clinical symptom of hip osteoarthritis is groin pain. Many Doctors will try conservative treatment strategies before proceeding with surgery. These strategies are typically Physiotherapy, medications, exercise, and weight loss.
How can I prepare for my hip surgery?
There is good evidence that taking some steps pre-op can lead to better outcomes. 'Preoperative optimization' often includes quitting smoking, chronic disease management (such as diabetes), weight loss, deep vein thrombosis risk assessment, and addressing any other health conditions you have. Not only can these steps improve outcomes, they are also designed to help avoid complications post-op.
Seeing a Physiotherapist before your operation is a great idea for the following reasons:
Practice exercises that you need to do after surgery
Optimize physical conditioning
Pain management
Seeing a Physiotherapist before your operation is a great idea.
What are the types of Hip Replacement Surgeries?
There are a few different types of Hip Replacement surgeries. Most of them differ in terms of incision site (where the incision is made). Many Surgeons are now choosing surgeries that are 'minimally invasive'. Some of the Orthopaedic Surgeons at Markham Stouffville Hospital choose the Direct Anterior Approach (DAA). This usually allows for the quickest recovery time and least amount of restrictions after surgery. In fact, you will have no restrictions post-op (usually).
How long do Hip Replacements last?
Total hips typically last for at least 10-15 years. With technological advances these days and a good rehabilitation program pre and post-operation, most patients should be getting more than 10-15 years out of their new hip.
What are some potential complications after Hip Replacement Surgery?
Some rare complications post-op for Total Hip Arthoplasty can include:
Infection
Blood clots
Joint stiffening
Loosening of the joint implant
Change in leg length
Dislocation of the artificial hip joint
Your Physiotherapist should be aware and trained in looking for these complications. They are extremely rare and can be avoided with proper perioperative care. Physiotherapy can help with optimizing your surgery so that these complications do not happen.
References:
Bernstein DN, Liu TC, Winegar AL, et al. Evaluation of a Preoperative Optimization Protocol for Primary Hip and Knee Arthroplasty Patients. J Arthroplasty 2018; 33:3642.
Moyer R, Ikert K, Long K, Marsh J. The Value of Preoperative Exercise and Education for Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2017; 5:e2.
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