The document discusses the rehabilitation process following total hip replacement surgery. It describes preoperative assessments and instructions including teaching exercises. Postoperative precautions are outlined to prevent dislocation, and phases of rehabilitation are described focusing initially on exercises, transfers, and gait training progressing to increased independence over 6-8 weeks. Common discharge criteria include independence with transfers, exercises, and stairs. Potential complications are also reviewed.

1. Physiotherapy for
HIP JOINT

2. Hip Arthritis
 The classic clinical test for hip arthritis is
internal rotation of the hip in flexion.
 With hip arthritis internal rotation will be
limited and painful.
 Differential diagnoses
 Radiographic examination includes an AP
and lateral views (modified frog-leg lateral
or Lauenstein) of the hip.

3. Conservative Mx
 Anti-inflammatories and analgesics
 A cane in the opposite hand helps to unload
the hip significantly
 cane should reach the top of the patient's
greater trochanter of the hip while wearing
shoes.
 Stretching and strengthening exercises

4. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

5. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

6. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

7. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

8. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

9. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

10. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

11. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

12. Exercises for the Arthritic Hip
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

13. Surgical Mx
 The mainstay of surgical treatment is total
hip replacement
http://uconnmsi.uchc.edu/clinical_services/orthopaedic/totaljoint/total_hip.html

14. Weight-bearing restrictions
Cemented
 as strong as it will ever
be 15 minutes after
insertion.
 allow immediate full
weight-bearing with a
cane or walker.
Non cemented
 Stability is usually
adequate by 6 weeks to
6 months
 toe-touch weight-
bearing for the first 6
weeks - to allow
weight-bearing as
tolerated immediately
after surgery.

15. Preoperative Session: Phase I Days 1-2
Generally includes an assessment of
 patient's strength (including upper extremity potential)
 ROM
 neurologic status
 vital Signs
 endurance, functional level, and safety awareness
 Any existing edema, contractures, and leg length discrepancies
In the evaluation of patient's home
 the status of stairways
 equipment needs
 safety adaptations (such as furniture and electrical cords)

16. Preoperative Instructions
GOALS:
 Educate patient regarding precautions with
transfers and movements,
 help patient become independent in
exercises for postoperative phases

17. Preoperative Instructions
Postoperative exercises can be taught at this
time.
These exercises may include the following:
 Ankle pumps
 Quadriceps sets
 Gluteal sets
 Active hip and knee flexion (heel slides)
 Isometric hip abduction
 Active hip abduction

18. Preoperative Instructions
 The danger of post operative dislocation is
largely a result of compromised integrity
of the hip's joint capsule caused by
surgical disruption.
 This information may assist in motivating
the patient to adhere to precautions and
the strengthening program.

19. Postoperative Precautions
 Straight-Ieg raises (SLR) and Side-leg-lifting
can produce very large loads on the hip and
should be avoided.
 vigorous isometric contractions of the hip
abductors should be practiced with caution
 protect the hip from large rotational forces for
6 weeks or more
 use a cane in the contralateral hand until the
limp stops. This helps prevent the
development of a Trendelenburg gait,

20. Postoperative Precautions
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

21. Postoperative Precautions
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

22. Postoperative Precautions
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver Extremity; pp 441-458

23. Post Operative Rehab.: Phase II a Days 1-2
GOALS:
 Prevent complications
 increase muscle contraction
 control of involved leg
 help patient sit for 30 minutes
 continuously reinforce THR precautions
Deep Vein Thrombosis
Pulmonary embolism
Infection
Anemia

24. Post Operative Rehab.: Phase II a Days 1-2
Maxey L, Magnusson. J. Rehabilitation for the postsurgical orthopedic patient. Mosby, Inc.; 2001. Chapter 10, Total Hip Replacement; pp 172-187

25. Gait Training Using walker
 Place the walker one step ahead of you
 Lean into it and pick up the operated leg,
bend the knee and step forward, planting
the heel down first
 Bring your good leg up to the front of the
operated leg
 Repeat the process

26. Post Operative Rehab.: Phase II b Days 3-7
GOALS:
 Promote transfers and gait independence
(using assistive devices as indicated)
 continuously reinforce THR precautions

27. Post Operative Rehab.: Phase II b, Days 3-7
Maxey L, Magnusson. J. Rehabilitation for the postsurgical orthopedic patient. Mosby, Inc.; 2001. Chapter 10, Total Hip Replacement; pp 172-187

28. Transfers Independence
Getting into Bed
 Sit on the edge of the bed
with both feet on ground
 Scoot your hips backwards as
you keep your weight on
your hands
 Lower yourself onto your
forearms
 Slide your legs onto the bed;
keep your operated leg
straight
 Once in bed, keep your toes
pointed up
Getting out of Bed
 Slide your legs toward the
edge of the bed; keep your
operated leg straight
 Push yourself up to your
forearms and onto your
hands
 Slide your legs so that your
heels are over the edge of
the bed
 Scoot your hips forward until
both feet are on the ground

29. Gait Training Using crutches
 Place the crutches one step ahead of
 Place weight on the good leg and
 bring the operated leg up between the crutches
 Bring good leg up beyond the crutches
 advance to a two-point gait pattern.
 This means move the crutches and operated leg at
the same time, and then move good leg beyond the
crutches
 while standing, the crutches should always be kept
in front of and slightly out to the side to prevent
from falling.

30.  Transition from crutches to crutches to a
single-point cane usually occurs 3 to 4
weeks after surgery.

31. Stair Climbing
Going Upstairs
 Put one hand on the
banister and carry the
crutch under the other
arm
 Put your weight
through your arms and
step up with good leg
 Then step up with
operated leg
 Then the crutch
Coming Downstairs
 Place the crutch
under one arm and
the opposite hand on
the banister
 Start down the stairs
with the crutches
first
 Then operated leg
 Then good leg

32. Post Operative Rehab.: Phase III, Days 3-7
GOALS:
 Increase patient independence with gait
and transfers (community appropriate)
 evaluate safety of home
 plan return of patient to work or previous
activities as indicated

33. Post Operative Rehab.: Phase III Days 3-7
Maxey L, Magnusson. J. Rehabilitation for the postsurgical orthopedic patient. Mosby, Inc.; 2001. Chapter 10, Total Hip Replacement; pp 172-187

34. Common discharge criteria for THR
 The patient is able to demonstrate and state the
THR precautions.
 The patient is able to demonstrate independence
with transfers.
 The patient is able to demonstrate independence
with the exercise program.
 The patient is able to demonstrate independence
with gait on level surfaces to 100 feet.
 The patient is able to demonstrate independence
on stairs.

35. Signs of complications
 Thigh pain with walking that clears quickly with sitting down, possibly indicating
intermittent claudication.
 A positive Trendelenburg sign that does not resolve with treatment, possibly caused by
damage to gluteal innervation
 Severe rubor and swelling at the surgical site with accompanying fever, possibly
indicating a wound infection
 Unexplained swelling of the limb that does not dissipate with elevation, possibly
indicating thrombo embolic disease
 General systemic effects, possibly indicating an allergy to the implant materials (rare),
postoperative anemia, pulmonary embolus, or other medical complications
 Persistent, severe pain, unexplained limb shortening or extreme rotation, or pain with
rotation of the limb possibly resulting from dislocation of the prosthesis, heterotopic
ossification, or a fracture of the adjacent bone or reflex sympathetic dystrophy

36. Reference
1. Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd
Edition. Mosby, Inc.; 2003. Chapter 6, The Arthritic Louver
Extremity; pp 441-458
2. Maxey L, Magnusson. J. Rehabilitation for the postsurgical
orthopedic patient. Mosby, Inc.; 2001. Chapter 10, Total Hip
Replacement; pp 172-187
3. Shankman GA. Fundamental Orthopedic Management for the Physical
Therapist Assistant. 2nd Edition. Mosby, Inc.; 2004. Chapter 20,
Orthopedic Management of the Hip and Pelvis; pp 335-358
4. http://uconnmsi.uchc.edu/clinical_services/orthopaedic/totaljoint/
total_hip.html
5. http://www.massgeneral.org/ortho/patienteducation/pt-ed-
hiprehab.pdf
6. Kisner C, Colby LA. Therapeutic Exercise Foundations and
Techniques. 5th Edition. F. A. Davis Company, 2007. Chapter 20, The
Hip, pp 643-685