Debilitating hip pain can come in the form of osteoarthritis, rheumatoid arthritis or trauma such as a fracture. When the amount of pain limits functional ability, an orthopedic surgeon may recommend a total hip replacement. Typically the surgeon will use a posterolateral approach when performing a hip replacement. This leaves the hip abductors and extensors, the muscles that pull the hip out to the side and backwards respectively, very weak. Physical therapy is important following this surgical procedure to strengthen the surrounding hip muscles and restore gait to a normal pattern.
The Surgery
With the posterolateral approach, surgeons make an incision through the gluteal muscles, and this direct trauma is what causes weakness. The gluteal muscles bring the hip out to the side and backwards, and these movements become the primary focus of rehabilitation. Although still uncommon, an anterior surgical approach is sometimes uses because of the limited complications and faster recovery. A small incision is made to the front of the hip and does not disrupt the gluteal muscles, thus maintaining hip stability. There is also less risk for dislocation and fewer movement restrictions.
Early Hip Abduction
Hip abduction is movement of the hip out to the side away from the body. In early rehabilitation following a total hip replacement, you perform hip abduction strengthening lying supine. Keeping the heel on the bed, slide the affected leg out to the side and back to the center. If your heel has a difficult time sliding on the bed, place your foot inside a plastic grocery sack. Most initial exercises are performed for 20 repetitions.
Advanced Hip Abduction
Several weeks after surgery, the physical therapist issues standing strengthening exercises. To perform standing hip abduction, hold onto a kitchen countertop or back of the couch and kick the affected leg out to the side while keeping your toes facing forward. Kick the leg out as far as possible without compromising trunk posture. It is easy to add a standing hip extension exercise while in this position. Kick the affected leg behind you while keeping the knee straight. Do not lean your trunk forward while performing this exercise. Both of these exercises are ideally performed for 20 repetitions. If your form is compromised due to weakness, decrease the number of repetitions to maintain correct form.
Importance of Walking
Walking is one of the best activities to do following a hip replacement because it naturally strengthens the gluteal muscles. It is common to have a Trendelenburg gait after surgery, which is a trunk lean towards the side of the operated leg. This is improved through strengthening exercises for the hip abductors and extensors as well as a walking program. A physical therapist can guide you in an appropriate walking program based on your post-surgery recovery.
References
- "Journal of Orthopaedic Surgery"; Total Hip Arthroplasty: The Relationship between Posterolateral Reconstruction, Abductor Muscle Strength, and Femoral Offset; T. Yamaguchi et al.; 2004
- St John's Health Center; The Anterior Approach for Total Hip Arthoplasty: Background and Operative Technique; Dr. Joel Matta; August 2005
- American Academy of Orthopedic Surgeons; Total Hip Replacement; April 2009
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