Sometimes osteoarthritis at the hip becomes disproportionate in our lives and our quality of life is diminished. The ultimate method for dealing with the situation is total hip replacement (THA). However, this operation is not advisable to all and requires important pre and post-operative care. The present text is therefore intended to explain the operation as such, but also to give advice on this procedure.

When osteoarthritis in the hip is such that it prevents you from doing your daily activities and creates an unbearable pain, it is possible that the doctor recommends the operation to replace your hip. It is obvious that this is not the preferred option, but it must be understood that osteoarthritis degrades the cartilage, then the bone. When the stage of osteoarthritis is too advanced it is one of the most effective solutions to give you a better function.

You will have a meeting in physiotherapy before the operation to be assessed and taught exercises that will be started the day after the surgery. Also, you will be shown how to be able to function at home by adhering to the contraindications to avoid dislocation. Among other things, to make transfers to bed and on a chair, how to go up and down stairs and discuss contraindications to respect without fail.

The surgery

The surgery aims to replace a part of the femur and the coxal bone that have been damaged due to osteoarthritis. There are several types of prostheses. The choice is made by your surgeon. He or she will take into consideration your level of activity and age to make his/her choice.

There are several possible ways to perform the surgery at the hip: cutting to the front muscles, on the side or posterolateral on the buttock. Again, the surgeon is the one who determines how to proceed, but the posterolateral approach is more frequently used.

After the surgery

After surgery, it is necessary to follow all the surgeon’s recommendations and to do physiotherapy to be able to return to normal function. You will have to follow some specific contraindications to prevent dislocation of the hip  since the soft tissues have been weakened during surgery.

Contraindications

Sitting positions

When sitting, it is important not to raise the thigh or bend the trunk forward beyond 90 ° for about 6 weeks. It is forbidden to cross the legs or to stick the knees keeping the feet apart.

Sleeping positions

It is recommended to sleep on the operated side or on the back with a pillow between the legs to avoid doing contraindicated motions. It is forbidden to sleep on the non-operated side for the three months following surgery because this will increase the risk of dislocation.

How to sit

It is important to control movement when you sit and when you get up. It is easier to sit in an armchair with armrests and a seat high enough to avoid bending over 90 °.

How to go to the bathroom

It is recommended to install a raised toilet seat, if your toilet is of standard size, up to three months after surgery, to avoid flexing the hip more than 90 °. Always leave a space between your legs.

How to get dressed

During the first 6 weeks, you must receive help to put down your stockings and wash your leg because it is forbidden to fold your hip more than 90 °. Adaptations are also available. After 6 weeks, you can probably bend over 90 ° and it will be easier to dress without any help.

Driving

You must get your doctor’s permission before driving following your surgery. With regard to the position as a passenger, make sure that the seat is retracted as far as possible and that the seat is tilted backwards to respect the bending contraindication. You can place a cushion to raise the surface if the seat is too low.

How to pick up objects on the floor

You have 2 options if you dropped an object on the ground and you are alone to pick it up: 1) you get long-handled pliers to reach down to the object; 2) Place the operated leg behind you (keep it extended) and hold onto a counter or handrail and lean carefully to pick up the object.

Sports and other activities

Following the surgery, some sports are no longer allowed if you do not want to complicate or use too quickly your prosthesis. Among others, contact sports and racket sports like tennis, badminton and running. Six months after surgery, you can start cross-country skiing, golf and dancing, to name a few,  according to tolerance. Walking and swimming can be started as soon as the wound healing is complete. In general, the stationary bike is allowed at all times while respecting the contraindications.

Walking

In the beginning, depending on your agility, you will walk with crutches or a walker. It may be that the doctor recommends you not to put too much weight on your leg. Nevertheless, you must try to have a normal gait pattern to avoid creating new undesirable habits. As you heal, you will walk with the cane and then without technical help when you are strong enough.

Physiotherapy Treatment

Physiotherapy is always necessary following this type of surgery. These physiotherapy treatments include: muscle strengthening, stretching, manual therapy, antalgic treatments (pain control), and transfers training. Walking and staircase training will also be used to ensure that you are able to regain maximum function.

In summary

In summary, the surgery requires that a part of the coxal bone and the femur be replaced. Thereafter, you must respect a lot of instructions during everyday activities, whether it is to pick up an object or simply when sitting, because you must avoid any risk of dislocation or other complications. Also, physiotherapy is necessary to ensure that function is maximized and that you should be able to return to your normal activities in the future.

Sabrina Paquet TRP
Clinique Physiomédic