Total Hip Replacement (THR)
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A total hip replacement is an orthopaedic procedure that involves replacing the head of the femur and the acetabulum of the pelvis with artificial components.
These components replicate the ball and socket of the hip joint and are commonly crafted from metal, ceramic, or plastic. A less invasive alternative to total hip replacement is hip resurfacing, in which only a minimal amount of bone is removed from the femur and pelvis.
The Birmingham hip resurfacing method is the most prevalent of these techniques. Instead of replacing the entire joint, this method only replaces the surfaces of the femoral head and the acetabulum. Younger patients often favour it, as it conserves more of the natural bone, paving the way for potential future surgeries—essential considering the finite lifespan of prosthetics.
Reasons Why You Might Have a Total Hip Replacement?
Trauma
A fracture in the femur or acetabulum can often be addressed using pins and plates to stabilize the bones, aiding in their healing. However, in situations where there’s reduced bone density, such as with osteoporosis or osteopenia, the healing process may be compromised. In such cases, a total hip replacement might be the advisable course of action.
Osteoarthritis
The primary reason for elective total hip replacement surgery is joint degeneration, which results in pain and limited mobility. When this significantly impacts one’s quality of life and activity levels, and if physical therapy fails to offer notable improvements, a total hip replacement surgery becomes a viable option.
Congenital Hip Dysplasia/Perthes Disease
Certain congenital conditions affect the formation of the hip joint in childhood and adolescence. Poor structure and shape can result in early degeneration of the hip and early onset osteoarthritis. Therefore, these individuals are likely candidates for a total hip replacement.
Surgery
Opting for a total hip replacement is a significant medical decision, and one should give it profound consideration, evaluating the potential risks and benefits. This procedure, which involves replacing a damaged hip joint with an artificial one, has seen significant advancements.
The recovery trajectory has dramatically improved with the evolution of surgical techniques, state-of-the-art prosthetics, and more sophisticated post-operative physical therapy regimens. As a result, patients, especially those who maintain good health, physical fitness, and muscular strength, can anticipate a better recovery process.
From a medical standpoint, elective surgeries, those scheduled in advance rather than in an emergency, are typically more advantageous. Planning allows the patient ample time for thorough pre-operative assessments, optimising their physical condition, and undergoing necessary medical interventions to ensure the best surgical outcome.
Pre-Operative Physical therapy
Often referred to as prehab, this is the physical training undertaken before surgery. Pre-operative Physical Therapy can include strengthening exercises for muscles around the hip, which will help recovery, and learning the exercises and movements that might have been unfamiliar and will be part of your post-operative rehabilitation.
Post-operative physio follows strict protocols to ensure the surgery has the best opportunity to be successful. There are common limitations to the ranges of movement of the hip as well as activities that are evidence-based and should be followed closely.
There are also specific limitations and restrictions that a surgeon might impose to reflect the specifics of the surgery procedure and the individual’s anatomy and risks. Many people are surprised with how quickly they are expected to get out of bed and start walking.
The hip joint is very stable, and weight-bearing in a standing position is safe and the best way to start strengthening and returning to functional activities.
Main Focus Points
Additional specific exercises will be given and directed by your physical therapist, focused on mobility and strengthening:
- Mobility – Active range of hip movement to gain the full mobility of your new joint.
- Strengthening – This will include weight-bearing exercises such as squats, ascending and descending steps, and balance exercises. And resistance exercises use resistance bands or weights, targeting specific muscles, such as your gluteal muscles, hip flexors and adductors.
Additional low-impact exercises such as walking and cycling can be gradually introduced and progressed depending on your response. Other exercises, including using a cross trainer and swimming or hydrotherapy, can also be helpful for your recovery. But should be done under the instruction of your physical therapist.
Restrictions a Total Hip Replacement
A total hip replacement is an effective surgery when it is needed. However, a prosthetic hip joint is different from the original hip. If the original hip is damaged, worn, painful and with restricted mobility, a replacement will feel much better, and most individuals are pleased with the outcomes after surgery. However, there are some restrictions to ensure the prosthetic joint is preserved for as long as possible.
Mobility will be strictly restricted for the first 6 weeks. The restriction of hip movement is no more than 90º flexion, 0º adduction, and 0º internal rotation. Beyond these positions, and with combinations of these positions, there is an increase in the risk of dislocation. After the first 6 weeks, the risk of dislocation is significantly less as strength has improved, but extremes and combinations of these positions should be cautiously used.
High-impact exercise, while not entirely off the table, should be limited. A sensible limit to the volume, intensity and choice of exercise should be discussed with your physical therapist and surgeon. Your age, strength and fitness will impact the guidelines that you will be set.
Factors Influencing THR Surgery Outcomes
A total hip replacement is a resoundingly positive and successful surgery for the vast majority of individuals who need it. Poor outcomes are related to individual factors such as (Rolfson et al, 2009 & Hofstede et al, 2016):
- High body weight
- Poor strength
- Poor general health
- Low bone density
- Reason for surgery and presurgery radiography findings
- High levels of anxiety and/or depression
- Poor adherence to post-operative advice and physical therapy
- Surgeon experience and technique
Revision Surgery
As with any prosthetic joint, a total hip replacement is limited to its life span. In 58% of individuals, a total hip replacement will last 25 years (Evans et al, 2019), but it can last longer for some people. This has significantly improved over the past few years, and the materials used have advanced.
Most cases of revision surgery are due to the age of the replacement joint. This is why the individual’s age will be a factor in the decision-making process before the initial surgery. In the minority cases, the body may reject the implant, or the implant can become infected.
Both cases are when the implant must be removed and a revision replacement is done. Surgeon experience is a crucial factor in the outcomes of revisions and more complex cases.
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We are specialists in treating knee conditions such as a Total Hip Replacement, and you can see one of our Sports Injury Physios in our clinic in Fulham, South West London.
We offer Online Appointments for £70 and Face-to-Face appointments for £90 in our clinics.
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