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What is a total hip replacement?

A total hip replacement is a surgical procedure wherein a part of the hip is removed and replaced using an artificial part.

Who needs a total hip replacement?

It is a surgical procedure. Therefore, it should be the last resort, after exhausting all conservative management such as: 

  • walking aids

  • pain killers

  • lifestyle modifications, 

Or if the individual suffers:

  • osteoporosis, 

  • pain, 

  • significant arthritic changes, 

  • hip fracture, 

  • extreme stiffness, 

  • lifestyle limitations.

Who should not have a total hip replacement?

Those who have:

  • joint infections, 

  • other systemic infection or sepsis, 

  • neurological pain, 

  • bones in normal condition. 

 

If other conditions are present: 

  • When an individual cannot tolerate general anaesthesia, such as in those with a poor heart, 

  • general poor health, 

  • failed extensor mechanism in the knee, 

  • significant peripheral vascular disease.

What are the benefits of a total hip replacement?

  • Improved range of motion, 

  • Reduced pain, 

  • Improved functional abilities, 

  • Improved quality of life.

 

What functions can be improved after a total hip replacement?

  • Transfers such as sit-to-stand,

  • Bed transfers, 

  • Toilet transfers, 

  • Getting in and out of a car, 

  • Improved mobility and reduced use of walking aids, 

  • Ability to go up and down stairs, 

  • Mobility without pain, both indoors and outdoors, 

  • Ability to engage in enjoyable activities. 

 

How long does a total hip replacement last?

Most clinicians tend to agree that a total knee replacement will last for 10 to 15 years. However, it is possible to experience no issues for 30 years or more. The key to maintaining a replaced knee is leading an active lifestyle. 

What precautions do I need to take following a hip replacement?

Unlike other post-surgery precautions, which are likely to be temporary, hip replacement precautions are for life. All precautions are to be taken daily.

  • Do not flex or bend your hip more than 90 degrees. 

  • Do not medially rotate or rotate your lower limbs inwards. 

  • Do not twist your hip while turning back, but turn by taking small steps. 

  • Do not cross your legs over each other.

  • Avoid low chairs and low toilets. 

  • Avoid falls.

  • Avoid forcing your hip, which can make your hip uncomfortable.

 

 

What are the cons of having a hip replacement?

  • The main con is limb-length inequality. Usually, the inequality will normalise within six months. Patients should be cautious and remember to check this after six months. If limb-length inequality is still present, correctional shoes may be necessary.

Other cons include the following: 

  • blood clot, 

  • infection, 

  • dislocation, 

  • nerve damage, 

  • fracture,

  • falls: Remove all rugs and mats from the floor. Always be cautious while changing clothes. Have the lights on in the hallway and toilets, particularly during the night. Use walking aids when rising from sleep to use the toilet at night.

  • infection: Avoid long periods of inactivity. Do not overdo the exercises, and slowly wean from painkillers.

What does total hip replacement rehabilitation consist of?

THR rehabilitation consists of: 

  • pre-operative care, 

  • post-operative care, 

  • long-term maintenance.

 

Pre Operative: It is good practice to: 

  • learn how to apply ice to the surgical site, 

  • learn the post-surgery exercises,

  • gain knowledge on 

  • pain, 

  • stiffness, 

  • swelling and its management.

 

Post Operative: It is crucial that this is approached wholeheartedly, with maximum effort. Do not be deterred by:

  • pain, 

  • stiffness,

  • swelling. 

Physiotherapy starts on Day 1. The physiotherapist will begin with:

  • exercises, 

  • mobility using frame, 

  • cryotherapy for pain. 

Between Days 3 and 5, a patient should be able to: 

  • get in and out of bed independently, 

  • sit to stand from bed/chair independently, 

  • progress in mobility from frame to elbow crutches

  • mobilise with one or two elbow crutches independently, 

  • navigate stairs with physiotherapy technique, 

  • get in and out of a car, 

  • be discharged from hospital and return home.

 

Long term maintenance: After coming home, the following are recommended:

  • home exercises, 

  • slowly starting outdoor mobility, 

  • gradually increasing the distance every day. 

A physiotherapist will review the exercises and increase the intensity to a mutually agreed level.

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