Recovering from a total hip replacement

Have an upcoming total hip replacement? This is the blog for you! Learn all about the reasons for total hip replacements, the procedure and recovery.

Total hip replacement is a very common surgery in older adults. It involves replacing any damaged bone (i.e. arthritic bone) with metal or plastic material. Total hip replacement is commonly performed when the hip is suffering from degenerative changes, i.e. from osteoarthritis that is causing a significant impact on function and daily activities.

What structures are replaced in a Total hip replacement?
In the majority of surgeries, the outer surface of the head of the femur and the hip socket in the pelvis are replaced with the prosthesis material (metal or plastic). Most typically the head of the femur is replaced by metal material that is held in place by a rod going into the femur. Additionally, the hip socket surface is typically replaced by a metal socket, with additional material to sit in between these two structures to allow for smooth movement of the hip joint.

Reasons for a Total hip replacement:
Total hip replacement is performed when degenerative changes occur in the hip that affect quality of life. Pain and stiffness accompany degenerative conditions such as osteoarthritis. In some cases, pain may be so severe that prolonged standing, walking and other daily activities become affected. Alternatively, stiffness can result in a reduction in hip range of motion, which can limit activities such as bike riding, surfing, and walking up hills or stairs. It is important to note that not everyone who has osteoarthritis will require a total hip replacement. The effects osteoarthritis has on quality of life vary greatly between individuals. Some may have severe osteoarthritis and have significant pain and stiffness accompanying this, while others may have the same level of osteoarthritis on scans but with fewer symptoms.

Pre-surgical preparations:
The best thing to do to ensure good results from a total hip replacement is to participate in a pre-surgical rehabilitation program. The stronger your lower limb muscles are surrounding the hip, and the more range of motion you have, the better your surgical outcomes will be. It is a great idea to see a physiotherapist to create an exercise program tailored to your needs and function. This can then be modified and built on after surgery.

Another really important thing to do prior to surgery is to make sure your home or the place you will be staying after surgery is well set up to accommodate your needs. Depending on levels of function after surgery, equipment such as a raised toilet seat, a shower chair, and a higher seated chair may be required for a short time. Being prepared with this equipment before your surgery will allow for a smooth transition back home.

The hospital will provide you with all other pre-surgical information to be performed in the days leading up to the surgery.

Recovery in hospital:
The surgery itself takes approximately 2 hours to be completed. The day of, or the day after surgery physiotherapy staff will get you up moving, and walking. This may seem daunting at first however you will have the support of a gait aid, such as a frame, and the physiotherapist. During your time at the hospital, the staff will progress you to using crutches to provide support, ensure you feel comfortable on stairs, and give you basic exercises to improve your hip range of motion. Any movements that are not recommended to you by the surgeon will also be outlined.

Post-surgical rehabilitation:
Once you are out of the hospital it is vital for your recovery to be seeing a physiotherapist to continue on your rehabilitation and care. There are several main goals of rehabilitation post-surgery and that is to regain as much range of motion as possible in the first few weeks, return your walking gait to normal, and then strengthen throughout the lower limb to improve function and return you to your activities.

If you are still using any gait aid that you didn’t use before surgery your physiotherapist will help to normalize your gait and remove the use of aids as able. This will be done by giving you cues to change your gait if necessary and wean off any aids, i.e. decrease from two crutches to one, and then none. Range of motion will continue to be progressed through exercises involving moving the hip joint. Additionally, strengthening work will be commenced. This will continue to progress over several months and can be completed at home or in the gym. Equipment such as resistance bands and weights can be utilized throughout the strength program. Ensuring that the muscles surrounding the hip is strong after surgery will allow for the best surgical outcomes and function. The final goal after surgery is to return you to any sports or activities that you enjoy. Initially, activities may have to be modified whilst building up tolerance.

A question many people have surrounding a total hip replacement is what will my function be like after? This is a very valid question, but often hard to give a clear answer to. It depends on numerous factors such as function before and improvements post-surgery through exercise. In some cases, return to high activity is possible, as seen through tennis player Andy Murray who returned to elite-level tennis after having a very similar surgery (hip resurfacing).

Total hip replacement surgery is a very common and successful surgery. If you are awaiting surgery, or have had surgery, it is a great idea to get in touch with our physiotherapists so we can optimise your recovery and outcomes.