Protocol for physio post Total Hip Replacement (THR)

[lesleyfx]

Protocol for physio post Total Hip Replacement (THR)

Hi, I had a Right THR, uncemented, lateral approach on the 13th March. At 3 days post-op I was discharged from hospital AND from physio. Yes I was given 3 physio exercises to continue myself at home... but no further input and the Othopaedic Surgeons (OS) follow-up appointment not until 9 weeks post-op.

Why? From surfing relevant forums it seem most patient's have ongoing physio input and exercises are assessed and altered to better suit the patient. I can't get to speak to my OS either (his PA is way to good at side-stepping any questions).

• I feel like I've been abandoned ! I'm having problems with:
• leg length discrepency,
• unlevel pelvis,
• back-pain,
• tightness behind my knee and in my groin.

I feel I need assessment and help but GP says wait for OS appointment in 4 weeks time (I'm nearly 5 weeks post-op now).

Is my experience normal or unusual? Is there anything I can do to help myself?

Thanks, Lesley

Similar Threads:

• Total hip replacement clinical evaluation
• Total shoulder replacement protocol
• Mini Total Hip Replacement
• rheumatoid arthritis ,recovery,total hip replacement,knee replacement
• Total Hip Replacement

[arkesh_physio]

Hi
thanx charlize & jwilso for the informn..

[charlize29]

Hi Arkesh_physio,

No problem with that, but I have found this article which everyone was discussing about :

Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial.
• Hesse S,
• Werner C,
• Seibel H,
• von Frankenberg S,
• Kappel EM,
• Kirker S,
• Kading M.
Department of Neurological Rehabilitation, Klinik Berlin, Kladower Damm 223, D-14089 Berlin, Germany. [email protected]
OBJECTIVE: To compare treadmill training with partial body-weight support (TT-BWS) and conventional physical therapy (PT) in ambulatory patients with hip arthroplasty. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Eighty patients with a fully loadable implant who could walk independently with crutches after unilateral total hip arthroplasty were randomized to receive either TT-BWS (treatment group) or conventional PT (controls), for 10 working days. INTERVENTIONS: Each patient received 45 minutes of individualized PT, either treadmill training plus PT in the experimental or PT alone in the control group. MAIN OUTCOME MEASURES: The Harris score, recorded by blind assessors, served as the primary outcome measure. Secondary outcome measures were the hip extension deficit, gait velocity, gait symmetry, affected hip abductor power; hip abductor amplitude of electromyographic activation; and the interval from surgery to abandoning crutches. RESULTS: At the end of training, the treatment group's Harris score was 13.6 points higher (P<.0001) than the control group's score. Further, hip extension deficit was 6.8 degrees less (P<.0001), gait symmetry was 10% greater (P=.001), affected hip abductor was stronger (Medical Research Council grades 4.24 vs 3.73; P<.0001), and the amplitude of gluteus medius activity was 41.5% greater (P=.001) than those measures for controls. Gait velocity did not differ in the 2 groups. These significant differences in favor of the treatment group persisted at 3 and 12 months. The treatment group abandoned crutches sooner than the control group (3 vs 8wk). In the treatment group, 39 patients finished treatment, 35 appeared at 3, and 26 at 12 months for follow-up. In the control group, the corresponding numbers were 40, 35, and 24 patients, respectively. CONCLUSION: TT-BWS is more effective than conventional PT at restoring symmetrical independent walking after hip replacement.
PMID: 14669181 [PubMed - indexed for MEDLINE]

[charlize29]

Well, it depends on you guys whether you want to incorporate treadmill training after THR. Goodluck!!!

[physiobob]

I also think that using treadmill in gait training of patients with THR is a barbaric approach regarding the patient safety point of view.

As it was mentioned the poster did give reference to beginning slowly, perhaps more like walking pace and only if they feel safe. I have used treadmill training for years for patients after hip replacement. In fact because we have an unweighting system over the treadmill we can being this work when they are still partial weight bearing (PWB), expecially with cemented prostheses as these are their most strong really at day 1 after surgery. The beauty of this approach is you can perform sidewards and backwards walking in safety.