Range of Motion following Hip Replacement

hip pain

The range of motion and strengthening of the hip following total hip replacement must be instructed to the patient. The hip joint moves in many planes which differs it from the knee. The hip joint moves up and down (flexion/extension), in and  out (abduction/adduction) and rotation (internal and external rotation).

total hip diagramThe muscle that allows the hip to leg lift is the quadriceps. to bend is the ilio-psoas, to extend  hip backwards is the gluteal muscle, to bring leg out and in are the abductor/adductor group  and finally to rotate are the smaller internal/eternal rotators. When the hip joint is replaced it also acts as a ball and socket joint.

Initial Physical Therapy

With the start of physical therapy the patient must expect pain and stiffness in the joint. You might be using a walker or crutches to ease the discomfort of weight bearing. In time weight bearing becomes easier and less painful.

The physical therapist knows the limitation of motion of the total hip replacement and should definitely convey them to you on first visit. There are certain motions to avoid dislocating the hip in the early goings.

The involved leg should not cross the mid line, the hip should not go beyond 90 degrees of flexion and internal rotation must be avoided. During this phase set a goal to ambulate 100 yards and start going up and down steps.

Starting Exercises

THR crutchesTo start toning up the quadriceps and gluteal musculature the physical therapist will demonstrate quad and gluteal sets. With patient supine hip and knee flexion(only to 90 degrees hip flexion) will be performed. If the patient has difficulty performing these the therapist can introduce a sliding board or powder board to cut down the friction.

In supine position the patient will start active hip abduction/adduction. It must be stressed in these exercises not to rotate the leg internally which is very common here. Knee extension for the knee joint and quadriceps strengthening is performed by placing a wedge under the knee to create a 30-45 degree angle. The patient then extends the knee into a holding pattern. Also important in the early stages is range of motion of the ankle to prevent calf atrophy and ankle stiffness. To help ease the pain of these exercise the therapist can apply a mild heat to the hip followed by ice application after the exercises.

Precautions

abduction THRThe total hip patient must use chairs with arm supports so you can use your arms to slide into the chair and avoid bending the hip too much. Patients can speak to a physical therapist or home care provider to purchase or rent a total hip chair.

The patient should never sit on the floor, low stools or low toilet seat. Modified toilet seats are definitely available and I highly recommend. Reaching to put on your shoes or socks must be avoided. Use a reacher and wear slip on shoes. Always keep an eye on your patella while performing range of motion exercises as an indicator if you are internally rotating. Many patients sleep with a wedge or pillow between the knees so as to avoid the leg crossing the mid line.

Long Term

The success of total hip replacement depends on your consistency and dedication to following the guidelines of your surgeon and physical therapist. Performing your strengthening and range of motion exercises is extremely important to getting back to normal functioning.

The majority of patients with total hip replacement  can resume nornal activities and live pain free in the hip region.