The total hip replacement has evolved into a standard procedure to relieve hip pain and impairment due to hip arthritis offering some of the highest improvements in quality of life of any medical procedure. The majority of surgeries are performed for older patients and many people get a great outcome from hip replacement surgery however, many don’t reach their maximum potential due to the absence of rehabilitation follow-up in the post-operative phase.
An osteoarthritic hip joint likely to cause some degree of discomfort and impairment for at least one year prior to the patient’s the operation. The time of discomfort can result in significant changes to the hip’s tissues that can impact the postoperative phase. Inflammation and pain can cause us to use our joints less often, which means we are unable to push them to the limits of their motion and reduces gradually the joint’s motion. The process of adaptive shortening takes place in the ligaments of the hip, because the ligaments shrink due in response to the realization that the joint isn’t getting the full range anymore as a result of the daily routine.
If a hip joint isn’t utilized in the way it should be or in its full range, the muscles that power it will lose their strength. The hip joint is built to support weight and be able to move around, which requires a high level of strength that are supplied by the biggest muscles within the body, the gluteal muscles. The ability to walk, run and to get up from an office chair or climb stairs, and then go uphill is made easier by the strength of the gluteal muscles, to a large extent. If the muscles become weaker, it could limit a person’s independence in a significant way.
The hip abductors are a small muscle group in the gluteal muscles are crucial in regulating the side-to front pelvic girdle’s stability during gait, and weakness of these muscles affecting walking. While standing on one foot while walking, we keep on the other side our pelvis to prevent it from dropping , which makes transferring the leg that is moving more difficult. Abductor muscle in the hips accomplish this and when they’re weak, we experience instability while walking. We tend to lean toward the weaker side, which causes us to tilt our body towards the opposite side to get back in the balance. This is known as the Positive Trendelenberg sign.
The unnatural Trendelberg gait exerts unnatural force on the hips and demands an inclination of one side in order to keep the balance each time. The unnatural gait that results does not improve the abductors of the hip and correct the issue. In the case of hip pain, we do not extend our hips to the fullest extent, so the gait cycle becomes shorter because the hip extensor muscles are unable to achieve full mobility and strength. A limitation in hip joint mobility along with muscle insufficiency makes mobility more challenging and could cause the results of the operation less than satisfactory without rehabilitation.
Patients usually have issues with balance and coordination before having their joint replacement procedure There is a slight improvement when the hip’s function shifts closer to normal after the joint is replaced and the operation of the joint has been back to normal. Other issues are usually related to the sense of joint positioning sense, an essential ability that is lacking and can cause balance issues and make falls more likely.
A physiotherapist will assess the patient’s ability to use their hips and hips to carry out their everyday tasks, and look at the weaknesses in the joint, so they can plan their rehabilitation. The gait of the patient is the first step to be assessed, before following by examining the moves of the hip as well as the knee to identify any issues caused by stiff joints. An unnatural gait could be routine and the physiotherapist will examine and modify the gait pattern to normal.
Excessive range of motion is not recommended when it comes to hip replacements due the possibility of dislocation. The strength of the muscles surrounding it will be evaluated, as well as the patient’s balance reaction as well as joint position awareness. Once the evaluation is completed the physiotherapist will offer the patient a program that includes joint mobility, strengthening and gait and balance correction. Many patients with hip arthroplasty fail to not achieve their full potential because of a absence of rehabilitation after the surgery.