Hip Replacement Pre-Op exercises

[Pamela Maunsell]

Hi
I've been advised to do some exercises to strengthen my hip and maintain (gain?) flexibility before my THR. I've trawled through the net and different sties recommend ones (or perhaps they're calling them different names!)
Here is the list: -

Straight leg lifts

Knee flexion and extension

Gluteal squeeze

Quadriceps strengthening

Heel slides

Hip Abduction and Adduction: Lying down on Back

Side-lying Hip Abduction and Adduction

Terminal Knee Extension: Short Arc Quads

Knee Extension: Long Arc Quads


Which do you recommend?
I'm also swimming twice a week and trying to use the static bike.
Many thanks

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[gcoe]

Hi Pamela

In theory this should be a really good thing to do. I presume you are having a THR for osteoarthritis? Such a programme will make rehabilitation of your artificial joint go easier, and get you back on your feet quicker.

Building up the muscles around the hip and knee as you have listed is a great idea. However the way to go about is not just to give you a list of exs but to use the principle of progressive resistance training (usually using weight machines in a gym is the most efficient) - that is you are working against resistance to the point that the muscle fatigues after 8-12 repetitions so that you are optimising the strengthening effect of the exercise. The resistance also needs to be adjusted over time so that it is increased as you get stronger. With a diseased joint you usually need to start gently at lower intensity.

So in practice I would get a programme from a physio rather working off a list of exercises, as they can assess what you can manage and tailor a programme for you.

[Pamela Maunsell]

Thanks for the response but as I'm pretty well bone on bone I don't really feel up to visiting a gym and doing weights. I thought a few exercises at home might help. For some reason the NHS seems reluctant to prescribe physio hence my trawling the net.

[gcoe]

That is a pity that the physios at the NHS won't provide some help. In fact that is quite poor practice. Progressive resistance training and getting fit does improve outcomes after surgery so not providing this support is a false economy.

In light of that and that you don't want to go to a gym, (which I fully understand) have a look at this page:

Knee Replacement - Patient Education Guide

It has some of the exercises you listed. With the:

• Terminal Knee Extension: Short Arc Quads and
• Terminal Knee Extension: Short Arc Quads

both these exercises can be made more effective if you add a weight to go around your ankle. Weights can be improvised by putting unopened food cans of plastic drinking bottles filled with sand or pebbles in a pair of socks and tying you’re the socks together and hanging over your ankle like a saddle with even weights on either side. A good starting point would be so that you can complete 15 repetitions of the exercise in succession and by the time you get to the 15th the muscle is getting tired and the weight feels like it is getting heavier. If the exercise is sore to do from the start or causes pain later then just take it easy and slowly work up to greater resistance. Give your body time to get used to the exercise. If you get creaking and cracking on the movement that in itself is not problematic as long as it isn't painful or brings on pain later. Sometimes the exercises will never be comfortable during the exercise but it shouldn’t be overly painful and the pain should settle quickly. As your legs get used to the exercise you can increase the weight so that you can lift only 8-12 repetitions. This is ideal for strengthening.

Another exercise you could do is standing up from a chair and sitting down again. Do the exercise slowly (no sudden movement so you can't use inertia) and practice really sticking your bottom back as you sit down. You can start on quite a high chair and increase the effort over time by using a lower chair or couch.

With strengthening exercises just introduce one at a time, so your joints and muscles can get used to them. Ideally you want to work up at that level where you are working quite hard. You should only exercise every second day. This gives the muscles time to recuperate after the exercise and actually gives you a better result than exercising every day. But you do have to build up to exercising quite hard.

Another thing to consider is building up your general endurance. This can get you really fit without overstressing the arthritic joint and is also a good medium for improving the endurance of the knee muscles. Do you like the water and can you swim? This is where a warm pool would be good particularly if it is disability access. In the pool you can do resisted walking and (even jogging if it feels ok). Even better would be to join a hydrotherapy group is such a things exists. If you do like the water this can be more fun way of exercising.

By the way if you are aiming to really get fit just make sure you have a "warrant of fitness" from your Dr to exercise. This is important if you are over 65 and particularly if you have any heart problems, high cholesterol, depression, hypertension, obesity, diabetes etc.

Have you approached your Arthritis Society?

Arthritis Care : Welcome to Arthritis Care

Have a look under the "in your area" section. You may find they can offer you something

[TheHipLady]

That is a pity that the physios at the NHS won't provide some help. In fact that is quite poor practice. Progressive resistance training and getting fit does improve outcomes after surgery so not providing this support is a false economy.

oh boy how I agree with you. I managed to get two sessions ( I suspect because they found out I worked for clinical governance in a neighbouring hospital).

Your suggestion to approach the Arthritis Society made me (once again ) realise I am in denial. My reaction was "What me? Why would I want to go to the Arthritis society?" err 'cos you've got arthritis foolish person!!!

Looks like the arthritic knee (traumatic arthritis) is going to beat the (osteo) arthritic hip to the operating table.

Ho hum life goes on.

I'm trying to find more about why exercising can delay joint replacement. Especially hip as I've heard that's more successful and there's some hope for my left hip -whereas my knee is knackered. Any suggestions where I can read up on it.

[gcoe]

Here are a few resources:

Role of Exercise in Arthritis Management

this site talks through the benefits of exercise and some overall advise or OA

There are now a number of high quality trials that show the benefits of exercise for OA hip and knee. In order to make sense of the findings of these trials a number of systematic reviews - TWo good ones are on Cochrane collaboration and if you like I can send you another a fairly recent review which reports on the long term effects of exercise. In this case there were demonstrable benefits short term but long term it was more difficult to sustain the benefits. However having "booster" exercise sessions after the initial exercise period had positive gains.

In terms of finding if exercise delays or avoids the need for surgery you have to dig a bit deeper but many of the trials do report on these outcomes. We have one large trial just being completed by my University - The MOA trial that looks at OA of the hip and knee and definitely looks at surgical need post treatment. the treatment consists of exercise, manual therapy (joint manipulation)or a combination of exercise with manual therapy. The results of the trial are not yet published but I hear all is going very well. Here is the protocol for the trial:

Trials | Full text | Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol

I tried to find some information on the underlying physiology of exercise - ie why it works. However I have run out of time but in earlier stages I do know beneficial changes in cartilage are noted. In your case as the arthritis is probably quite advanced (bone-on-bone) the benefits may be more limited in terms of rebuilding cartilage but building up the muscles and improving the biomechanics of the joint are probably big advantages you can enjoy.

[artemis1]

Thanks for the great resources.

I read these carefully and will try to promote this

Here are a few resources:

Role of Exercise in Arthritis Management

this site talks through the benefits of exercise and some overall advise or OA

There are now a number of high quality trials that show the benefits of exercise for OA hip and knee. In order to make sense of the findings of these trials a number of systematic reviews - TWo good ones are on Cochrane collaboration and if you like I can send you another a fairly recent review which reports on the long term effects of exercise. In this case there were demonstrable benefits short term but long term it was more difficult to sustain the benefits. However having "booster" exercise sessions after the initial exercise period had positive gains.

In terms of finding if exercise delays or avoids the need for surgery you have to dig a bit deeper but many of the trials do report on these outcomes. We have one large trial just being completed by my University - The MOA trial that looks at OA of the hip and knee and definitely looks at surgical need post treatment. the treatment consists of exercise, manual therapy (joint manipulation)or a combination of exercise with manual therapy. The results of the trial are not yet published but I hear all is going very well. Here is the protocol for the trial:

Trials | Full text | Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol

I tried to find some information on the underlying physiology of exercise - ie why it works. However I have run out of time but in earlier stages I do know beneficial changes in cartilage are noted. In your case as the arthritis is probably quite advanced (bone-on-bone) the benefits may be more limited in terms of rebuilding cartilage but building up the muscles and improving the biomechanics of the joint are probably big advantages you can enjoy.

[TheHipLady]

.. but building up the muscles and improving the biomechanics of the joint are probably big advantages you can enjoy.

Would the above then work to: -
a) prevent further deterioration of the joint
b) reduce symptoms - e.g. pain and limping
c) alter the course of the disease itself (if that's not just a) in different words)

Thanks for the great references - much appreciated

[gcoe]

Exercise is not a cure all. and if you have really advanced osteoarthritis you have to be realistic about what can be achieved. So whether a good programme of exercise will stop you limping or remove your pain - I couldn't promise that. But exercise will make the muscles around your joint stronger and the joint more mobile no matter what stage of the disease you are at you should be in a better state than if you don't exercise. For example you should find you can walk further with less pain. And re: surgery, the stronger and fitter you are prior to the surgery you are likely to have a better outcome.