Total hip replacement
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Transcript of Total hip replacement
TOTAL HIP REPLACEMENT Physiotherapy Management
Irene Toh Principal Physiotherapist Department of Physiotherapy
COMMON CAUSES
Arthritis Osteoarthritis
Inflammatory arthritis
Avascular Necrosis (AVN)
Childhood hip joint malformations
GOALS OF EARLY THR REHABILITATION
Independent bed mobility and safe transfer
Independent ambulation with walking aids
Restore functional hip motion and strength
Educate patient on hip precautions
COMPLICATIONS POST THR
Dislocation – greater risk right after surgery
Loosening of implant
Deep venous thrombosis (DVT)
Infection of wound and implant
POST OPERATIVE DAY (POD) 1
Optimise respiratory and circulatory functions – chest therapy, ankle pumps and TEDs stockings
Start hip/knee exercises Assisted hip ROM (flexion below 90deg and
abduction about 20deg)
Static gluteals, quads
Inner range quads
Hip abduction pillow (PRN)
Bed mobility encouraged
POD 2
Bed mobility and transfer practice (bed to
chair and chair to bed)
Ambulate (check with surgeon, post xray)
Self assisted hip exercise – flexion (below
90deg) and abduction
Strengthening ex – knee extension/inner
range quads, bridging (for posterior
approach THR), assisted straight leg raise
POD 3
Progress hip ROM and strengthening
exercises
Progress walking distance and walking
aids
Correct gait pattern
Ambulate stairs (if patient steady on level
ground)
POD 4 ONWARDS
Progress ambulation
Review walking aids
Stairs practice
Progress hip/knee exercises
Home exercise program
DO’S
Sleep with pillow between legs
Sit on high chair
Turn in an arc and slowly
Continue to use walking aids until good
balance and strength is achieved
Continue home exercise program
DISCHARGE CRITERIA
Safe bed mobility and transfer
Safe ambulation
Community hospital referral as necessary
or
Outpatient physiotherapy
OUTPATIENT PHYSIOTHERAPY
Continue to improve hip and knee strength
Progress gait to without aids
Correct gait pattern
Return to functional activities /work