Hip replacement surgery is where the hip joint is replaced by an implant, either total replacement or hemi (half) replacement surgeries. Such operations are usually to relieve pain due to arthritis or to correct severe bone/joint damage as part of hip fracture treatment protocols. Our patients who undergo hip replacement surgery are usually following a fall, and landing on the buttocks, causing a bone fracture of the hip.
What Are The Indications For This Option?
It is usually used to treat damage such as osteoarthritis, rheumatoid arthritis, avascular necrosis, hip fractures, bone tumors, ankylosing spondylitis and juvenile rheumatoid arthritis. The surgical goal is pain relief and improve hip mobility and function. Often, we provide physiotherapy and occupational therapy consultations to patients prior to surgery, to ascertain and understand their mobility and functional level premorbidly, and to teach them exercises to strengthen them before surgery (this boost healing and discharge success rate).
Techniques Employed By Surgeons
There are a few techniques for hip replacement surgeries, and their main differences are the approach. They are: posterior (Moore), lateral (Hardinge or Liverpool), antero-lateral (Watson-Jones), anterior (Smith-Petersen) and greater trochanter osteotomy. If you’re wondering which is best, don’t. Leave that to the doctors; they are the specialists – they will evaluate the damage of the joint and bones, your lifestyle, their implant options and your financing options, and prescribe you what best suits you.
However, there is one approach that you can take note of, which is the Minimally invasive approach; which seeks to limit and reduce the amount of soft tissue damage to minimizing the size of the cuts and incisions. But, this may limit positioning, which in turn limits visualization and accuracy, which is not a very good trade-off, for mobility and functional results. As more research and development looks at this approach, more and more technology will be developed to aid and perhaps this approach will be a more viable approach later.
Risks And Complications Of Hip Replacements
The common risks and complications are: dislocation, loosening, impingement, infection, osteolysis, metal sensitivity, palsy, pain and death.
Physiotherapy For Patients With Hip Fractures
Following corrective surgery for hip fracture, patient almost always have resultant pain, decreased mobility, weakness and difficulty walking and moving around. Physiotherapy provides chest physiotherapy exercises, to ensure that the lungs and chest functions remains strong, to prevent any onset of chest infections which facilitates healing; and gradually, to improve the mobility of the patient by first teaching and doing with the patient bed exercises, to exercises out of bed, and gradually to walking with aids (if required) then to walking independently. In between, we will work with pain relief, range of motion exercises and strengthening exercises.
Occupational therapy implication, on the other hand, looks at functional, day to day tasks – they will ensure that when the patient discharges to go home, they will be able to perform activities such as wearing their own clothings (pants and underpants); that their homes will be safe and accessible (we might have to send our occupational therapy staff to do a home visit and recommend any changes required for a safe discharge); train caregivers to be competent in walking and doing activities with the patient.
Where to next?