REHABILITATION AFTER HIP SURGERY

1. REHABILITATION AFTER HIP SURGERY TOTAL HIP ARTHROPLASTY ORIF OF THE HIP Russ Ridenhour, OTR, CHT

2. Terminology THA=Total Hip Arthroplasty ORIF= Open Reduction Internal Fixation Arthroplasty=Joint replacement Acetabulum=Cup portion of hip joint NWB=Non Weight Bearing PWB=Partial Weight Bearing TTWB=Toe Touch Weight Bearing TDWB=Touch Down Weight Bearing

3. Anatomy of the hip The joint is deep & stable Acetabulum has fibrocartligenous labrum to enhance the depth of the cup & enhance stability Capsule is reinforced anteriorly by Y shaped ligament of Bigelow

4. Why a THA ? Arthritis has eroded hip joint Other hip damage which results in pain & limited function

5. Other complications S/P THA Loosening of components This is related to skill of surgeon activity level of pt quality of bone stock Pts should limit activities which put impact on hip (especially running) Infections in hip can be caused by introduction of bacteria during surgery

6. dental work toe nail infection UTI bacterial pneumonia bacterial endocarditis Signs of hip infection superficial discharge that persists febrile Hip infections can rarely be eradicated without removal of prosthesis In the younger population (<50) incidence of failure within 5 years is 57% Chandler, et. al.

7. Post op dislocations 2.1% incidence Dee, Stillwell, Mango More frequent after revision surgery mortality 20% Embolic disease - 50% Use of intermittent calf/foot compression device & garment can decrease incidence Incidence of fatal pulmonary embolism s/p hip surgery, 1-2% Sciatic nerve palsy

8. Total Hip Precautions No hip flexion > 70-900 No bending down to the ground No hip adduction past midline Avoid hyperextension in anterior approach Avoid IR/ER

9. Precautions Cont. In non-cemented femoral component, prosthesis must remain relatively motionless to allow bone ingrowth. Most surgeons recommend PWB for 2-3 months Others believe weight will place good stress on the prosthesis & hasten ingrowth What should you do if physician will not give you WB precautions document be conservative keep calling

10. Why do we observe hip precautions ? The hip joint is removed during surgery The ligaments are removed to allow head of femur to be removed from the acetabulum After surgery, the joint is very unstable until the capsule can regrow Flexion and adduction tend to dislocate the joint

11. THINGS FOR PATIENTS TO AVOID Low chairs & couches Low toilets Mat tables Washing their foot without an assistive device Putting on sock/shoe without an assistive device Loose rugs

12. Equipment Needs With THA Trapeze in room Adduction wedge Leg lifter Reacher Dressing stick Long handled shoe horn Sock aide 3-in-1 commode or elevated commode Long handled sponge Tub bench Grab bars in bathroom Elastic shoe laces

13. Rehab of the Hip ORIF

14. The incidence of hip fractures in the U.S. is 98 per 100,000 Women make up 80% Usually occurs in 70-80 year olds

15. Hip fractures are the most frequent cause of traumatic death after age 75 Mortality rate after hip fracture 20%

16. There are 2 types of femur fractures... Intracapsular - fx of neck of femur heals slowly (poor blood supply) Extracapsular - fx of trochanter heals rapidly (good blood supply)

18. WHAT IS AN ORIF OPEN REDUCTION AND INTERNAL FIXATION OF A BONE TREATMENT AFTER AN UNSTABLE BONE FRACTURE THIS INCLUDES: SCREWS PLATES ROD

19. ORIF- REHAB GOALS Get the patient up out of bed and moving (the fracture is painful, but the pt must get moving) pain is usually a symptom of stress on fx Begin functional activities Prevent DVTs Prevent inactivity

20. Contraindications with an ORIF Weight bearing is limited to avoid excessive force on the fracture Use caution when standing or walking

21. Can a hip dislocate after an ORIF? Yes, but... It’s not likely (My hip could dislocate right now too I suppose. There is always a chance). Joint is stable Bone repair is weak They can flex, adduct, (just no WB)

22. Why are there weight bearing restrictions after an ORIF ? The fractured bone is being held together by a rod, screw or plate Any healing bone must remain still to heal properly The bone will shift if too much weight is placed on the extremity. This will delay or prevent healing. The surgeon is the best person to estimate how much force their repair can withstand

23. Many pts violate their WB precautions because they lack strength in UE’s and non-involved LE to balance. Test WB by putting your hand or foot under involved LE. Always position your body on pt’s involved side so you can lean into them if they start to fall. Good exs to develop UE strength: WC propulsion WC pushups

24. ORIF- POST-OP EXERCISES Hip, knee and Ankle AROM Gluteal & Quad Sets Early protected ambulation with crutches/walker Active resisted ex’s of non-involved extremities & trunk ADL retraining

25. Equipment Needs With ORIF Walker or crutches 3-in-1 commode or elevated commode ? Tub bench Grab bars in bathroom