PT Tip of the Month
What is total hip arthroplasty?
Total hip arthroplasty (THA), aka total hip replacement, is a surgical procedure in which the ball and socket hip joint is replaced. The socket (acetabulum) is replaced with a new liner made of plastic, ceramic, or metal. The ball of the upper thigh bone (femur) is also replaced using a metal or ceramic prosthesis. There are two types of THA procedures: cement and cementless. In a cemented procedure, the artificial prosthetic pieces are implanted into healthy parts of the existing bones and affixed with a bone cement. The cementless procedure allows for bone to become intertwined within the prosthesis, and is often used in younger, more active patients.
THA is typically done when:
- There is severe pain unalleviated by anti-inflammatory drugs or non-surgical options
- There is evidence of severe osteoarthritis or injury to the hip joint to the point that interferes with a person's mobility and overall function (i.e. work, recreational activities, everyday life)
Before your doctor will recommend a THA, conservative management via physical therapy will be suggested. Many times, a physical therapy regimen consisting of a combination of LE and core strengthening, regular walking program, increasing knee joint ROM, and manual therapy will be sufficient to relieve pain and restore a person to prior functional levels.
Pre-operative physical therapy
A large, prospective study found that pre-THA pain and function were the best predictors of these variables six months post-THA. Patients with poorer pre-op physical function have decreased functional abilities and increased pain post-op two years following lower limb joint replacement surgery. Another study found that patients who required assistance with functional mobility and activities of daily living pre-op were significantly more likely to require assistance with these same tasks one year after their THA compared to patients who were independent with these tasks pre-op. There is some evidence to demonstrate that an exercise program pre-op has some benefit on decreasing pain and improving levels of self-reported disability. There is also some evidence to indicate that pre-op exercise results in faster functional recovery after surgery. However, the types of exercise programs and outcome measures vary extensively, so it is difficult to determine exactly what pre-op exercise regimen is best to maximize post-op results.
Post-operative physical therapy
Depending on the hospital, either on post-op day 1 or 2 in acute care, you will work with a physical therapist to get out of bed, transfer, walk using an assistive device, negotiate stairs, and perform strengthening and range of motion exercises. Although there are many different approaches to performing a THA, the most common is the posterior approach, where the hip is accessed through an incision through the posterior hip muscles. Thus, your physical therapist will instruct you in all the above mentioned activities without breaking your hip precautions: no hip flexion past 90 degrees, no hip adduction (crossing midline), and no hip internal rotation. Depending on your progress during your acute care stay, you can be expected to continue your physical therapy either with home physical therapy or on an outpatient basis, such as at Beantown Physio. Here, we will work with you to continue managing your pain and edema levels, increasing LE strength and ROM, preventing secondary contractures, increasing your balance and weight-bearing tolerance, and improving your functional mobility while weaning you off using your assistive device.
If you are experiencing signs and symptoms of osteoarthritis or will be undergoing a total hip replacement procedure and would like to be scheduled for a physical therapy evaluation, please contact 617-232-PAIN (7246) for our Brookline office and 617-325-PAIN (7246) for our West Roxbury office.
Ackerman HN and Bennell KL. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Aust J Physiother. 2004;50:25-30.
Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D et al. Outcomes of total hip and knee replacement: pre-operative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42:1722–1728.
Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Belisle P et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002;46:3327–3330.
Gilbey HJ, Ackland TR, Wang AW, Morton AR, Trouchet T, Tapper J. Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res. 2003;408:193–200.
Wang AW, Gilbey HJ, Ackland TR. Perioperative exercise programmes improve early return of ambulatory function after total hip arthroplasty: a randomized, controlled trial. Am J Phys Med Rehabil. 2002;81:801–806.
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