Download Total Hip Replacement Protocol

Total Hip Replacement (THR)
Post-operative Physiotherapy/Hydrotherapy
Pre-operative guidelines
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Restore Hip range of movement as follows: Flexion 90°, abduction 40°, extension 10-15°
Strengthen the Quads, hamstrings and glutes to promote recovery.
Gait re-education
Educate Patient on post-op compliance to ensure the best functional outcome
Home advice:
 avoid bending your hip more than 90° (a right angle) during any activity
 avoid twisting your hip
 do not swivel on the ball of your foot
 when you turn around, take small steps
 do not apply pressure to the wound in the early stages (so try to avoid lying on
your side)
 do not cross your legs over each other
 do not force the hip or do anything that makes your hip feel uncomfortable
 avoid low chairs and toilet seats (raised toilet seats are available)
Precautions/Contraindications:
Will depend upon type of surgical approach: If anterior approach, contraindicated motions are
simultaneous hip extension and external rotation. For lateral approach, motions to be avoided are
simultaneous hip flexion/adduction and internal rotation. For posterolateral approach,
contraindicated motions are simultaneous hip flexion/adduction and internal rotation.
Phase 1: (Post Op Days 1-7)
Frequency: 1-2 times per week
Duration: 6-12 weeks depending on physiotherapy findings
Goals:
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To complete a full assessment in clinic including goals i.e.: returning to work and hobbies to
promote specificity of rehab.
To ensure sufficient pain management.
To ensure that patient is free from DVT or infection.
Demonstrate safe and independent transfers from the bed to chair.
Demonstrate safe and independent ambulation with assistive devise.
To demonstrate safe use of stairs to mimic their home environment.
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To attain the following ranges of movement by day 7: Flexion 90°, Abduction 25° and
Extension 5°
To demonstrate a safe home exercise program.
To orientate to pool and treadmill program and given information pack.
To address secondary problems at the knee, lumbar spine and ankle to promote realignment of the musculoskeletal system.
* All Post Op programmes have been carefully formulated to facilitate and promote the normality
of tissue to repair throughout the stages of healing:
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Inflammatory phase – Essential component of healing. Starts in first few hours post injury
and peaks at 1-3 days, gradually resolving after 2 weeks.
Proliferation phase – Production of scar (collagen) material. Rapid onset of 24-48 hours and
peaks at around 2-3 weeks post injury. (The more vascular the tissue the shorter the time it
takes to reach its peak). This phase continues for several months post trauma.
Remodelling Phase- Results in an organised quality and functional scar which will behave in
a similar way. Starts around 1-2 weeks and continues for several months.
Water component (1-2 weeks)
Underwater Treadmill
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Water level at 1000- 1200m to reduce weight bearing by 50%-75%
Walking slowly encouraging a normal gait. Re-education phase, i.e. heel to toe
To increase speed of belt to encourage larger stride lengths and full knee extension/ VMO
activation.
Walking slowly with knees to 90° to encourage mobility in hips and knees.
Hydrotherapy Pool (Limit ROM dependent upon surgical approach)
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Walking forward and backwards
Marching/clap unders
Walking heel to buttocks
Walking lunges in comfortable range
Kickboard hip flexion/extension (not exceeding 90°)
Step lunges
Step ups
Semi squats in pain-free range
Knee flexion/extension with buoyancy aid to promote further range
Cycling legs under water
Hip abduction exercises (straight plane)
Single leg balance with eyes open/closed
Core stability exercises
Hamstring/hip flexor/ gastrocnemius stretches in open area/bench/steps
Cryotherapy
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15 mins cryotherapy to be done at the end of each session.
Land component
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Strengthening exercises for Quads/Hamstrings/Glutes/Core
Stretching exercises for Quads/Hamstrings/Glutes/Core
Scar massage
Ice for reducing swelling
Hands on Physio including SSTM’s, PNF, Joint mobilisations, Taping, Acupuncture,
Electrotherapy and Muscle Stimulation.
Post-operative 2-4 weeks
GOALS
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Reduce pain and swelling
Restore mobility to Flexion 90°, Abduction 20°-30° and Extension 5°
Independent with transfers
Weight bearing as tolerated with appropriate assistive devices (weight bearing status
determined by physician)
Demonstrates good understanding of Total Hip Arthroplasty Precautions
Fair/good recruitment of gluteus medius
Water component (2-4 weeks)
Underwater Treadmill
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Reduce water level at 900-1000m to increase weight bearing
To increase speed of belt to encourage increase stride length.
Hydrotherapy Pool
REPEAT OTHER EXERCISES FROM WEEK 1-2
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Sit to stand with weight (don’t exceed 90° hip flexion)
Lunge with weight
Single leg squat
Step ups with weight
Cryotherapy
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15 mins cryotherapy to be done at the end of each session.
Land Based
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Continue with mobilisations techniques
Stationary bike
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Manual stretching
Balance and Proprioception exercises.
Encourage home exercises – Add stair Quad stretch and Partial squats
Hands on Physio including SSTM’s, PNF, Joint mobilisations, Taping, Acupuncture,
Electrotherapy and Muscle Stimulation.
Post-Op Weeks 5-6
Goals
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Minimal effusion
Hip active range of movement as follows: Flexion 90°, abduction 40°, extension 10-15°
No incisional adherence/hypersensitivity
Normal reciprocal stair negotiation with/without rail
Meet Self- management criteria at the end of this phase
Water Component
Underwater Treadmill
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Reduce water level at 600-900 to increase weight bearing depending on progress
To increase speed of belt to encourage increase stride length
To start jogging and incorporating interval training for CV fitness and plyometrics
Hydrotherapy Pool
REPEAT OTHER EXERCISES FROM WEEK 2-4
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Walking Lunges with weight or medicine ball with rotations
Kickboarding exercises with hip flexion/extension (don’t exceed 90° hip flexion)
Lateral Lunges with weight (be guided by surgeons protocol, surgical approach dependent)
Heel to butt
Increase height of step ups
Increase depth of step downs
Single leg squats
Challenge balance
Land Based
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Continue strengthening program: Leg Press, Leg extensions, Leg Curls, Shoulder Bridge,
Lateral step ups, Step Downs,
Continue Balance/Proprioception exercises: Rocker board, Walking Lunges
Cardiovascular exercises: Treadmill walking with an incline and increasing resistance on
stationary bike.
Hands on Physio including SSTM’s, PNF, Joint mobilisations, Taping, Acupuncture,
Electrotherapy and Muscle Stimulation.
Post op weeks 7-8
Goals
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Meet self-management criteria
Precautions/contraindications:
Dependent upon surgical approach and/or physician
Land/Water Components:
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Continue with treatment as indicated in post-operative weeks 5-6
Begin sports specific exercises if appropriate with consideration of precautions set by
surgeon.
Continue with home exercise program progression
Continue with swim/swim program dependent upon physician recommendations and
physiotherapy re-evaluation
Orient patient to program and equipment selection at a local health club
Discharge Criteria
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Symmetrical knee/ankle active range of movement
Hip active range of movement as follows: Flexion 90°, abduction 40°, extension 10-15°
No scar sensitivity
Normal gait pattern
4/5 to 5/5 glute and quad strength
A good understanding and performance of their home exercise program
Failure to Progress
Failure to Comply
See attachment for illustrations of exercises