2. Background
•Total hip replacement (THR) is surgically
replacing the femoral head and acetabular
surface of the hip.
•Hemiarthroplasty refers to the replacement
of the femoral head only.
• Today, there are more than 300,000 THRs
implanted worldwide annually.
6. Another classification
• 1. Constrained: there is a link between the two
components and all anatomical movements are
restricted to a greater or lesser extent.
• 2. Semi-constrained: some movement is allowed
in all planes.
• 3. Unconstrained: permits free movement in all
anatomical planes.
7. Indications
•are pain-limiting function secondary to
osteoarthritis, rheumatoid arthritis.
•avascular necrosis, or congenital dysplasia
of the hip.
•Sepsis of the involved joint is always an
absolute contraindication.
•N.B. the recommended age is above 60
8. Prosthetic Design
•The prosthesis attempts to reproduce normal joint
anatomy. The femoral component is usually made of a
variety of materials, including titanium alloys, ceramics,
and cobalt–chrome alloys.
•The acetabular component is usually composed of
ultra-high-molecular-weight polyethylene.
• Fixation techniques include cement, porous
coating, hydroxyapatite coating, and press-fit
stabilization.
9. Fixation
•Cement fixation is strongest immediately after curing,
whereas
•cementless (bio in growth) fixation is at its weakest
immediately after insertion of the device. Micro motion
should be avoided for at least 6 weeks in cementless
systems. Studies have shown that cementless systems offer
stronger long-term fixation and thus longer life of prosthesis
before revision.
• Cementless technique is preferred in younger
patients under 65 year
10. Complications
• Complications of THRs, like most orthopedic
procedures,
• include aseptic loosening,
• infection,
• deep vein thrombosis (DVT),
• heterotopic bone formation,
• urinary tract infections,
• dislocations,
• and neurological deficits.
11. Incision Sites
• 1. Anterolateral: between tensor fascia lata
and glutei
• 2. Posterolateral: through the posterior
capsule
• 3. True lateral: greater trochanter is excised
and re-atttached with wire fixation
12. Global Precautions
DO NOT bend hip more than 90 degrees,
Do NOT rotate hip inward or outward (keep knee
and toe facing forward),
NO lying flat,
NO lying on stomach, and NO bridging.
Avoid sitting on low, soft surfaces . Use a raised
toilet seat for 6 weeks – 3 months.
NO Lifting, Sporting activities (golf).,Drive, Bath – Showers
only, Twist or squat-3 months
Total hip precautions after surgery
should be followed for 3 months
15. • Patients with a high risk of dislocation or with
a history of recurrent dislocations are often
treated with a hip brace to maintain hip
precautions.
16. Rehabilitation
• Both cemented & uncemented replacements follow
a similar regime except for time of weight bearing.
• - Uncemented prosthesis will remain partially or
non-weight bearing for 6-12 weeks.(1,5:3 months)
• - Cemented prosthesis begins weight bearing 1st
day postoperatively.
17. • Abduction pillow or wedge should be used
while patient is lying supine or on the non-
operated side
• SLR is discouraged until full quadriceps and
iliopsoas control has returned (due to
incisional weakness ) nearly after 7-10 days
19. Weight Bearing
• • In cemented joints weight bearing is
increased until minimal assistance is required
from a walking aid.
• • Uncemented prosthesis will remain on
cruthes or a frame for 6-12 weeks.
• Start of sitting is delayed for patients with
posterolateral incision to prevent dislocation
20. Preoperative training session
• • Safe transfere technique
• • Proper use of assistive devices (2 0r 3 point gait)
• Postoperative exercises e.g.
• 1. Ankle pumps
• 2. Quadriceps sets
• 3. Gluteal sets
• 4. Active hip and knee flexion (heel slides)
• 5. Isometric hip abduction
• 6. Active hip abduction
21. Day of surgery
• • Goals:
• A- protect healing tissues,
• B- prevent postoperative complications,
• C- improve volitional control of involved lower
extremity
• 1. Respiratory exercises
• 2. Ankle pumps
• 3. Quadriceps sets
• 4. Gluteal sets
• 5. Repositioning of the patient every 2 hours with the
abductor pillow in place
22. Postoperative day one
• 1. Same previous exercises
• 2. Upper extremity exercises
• 3. Transfer training from supine to sitting, and
from sitting to standing, while observing
precautions and emphasize the use of upper
extremity in shifting weight, avoid pivoting on
the affected leg
• 4. If not complaining of excessive pain,
fatigue, or dizziness, gait training may begin.
23. Postoperative day 2
• 1. Hip ROM exercise
• 2. Heel slides
• 3. submax Isometric or active assisted hip
abduction
• 4. Active assisted short arc quadriceps sets 5.
Gait training (front wheeled walker for older
patients & 3-point crutch pattern for younger
patients).
24. Days 3-7 (until discharge)
• • Goal:
• improve UL & LL strength
• 1. Heel slides
• 2. Hip abduction
• 3. Terminal knee extension
• 4. Resisted shoulder exercises
• 5. Stair training (upstairs with unaffected &
downstairs with affected)
25. Discharge criteria
• 1. Patient is able to demonstrate & state
precautions
• 2. Independent with transfers
• 3. Independent with the exercise program
• 4. Independent with gait on level surfaces to
100 feet
• 5. Independent on stairs
26. From 1_st :6_th week
• Goals:
• A- improve strength of LL
• B- improve balance
• C- promote return to activities
• 1. CKC exercises
• 2. Pool therapy
• 3. Treadmill
• 4. single point cane. (starts 3-4 weeks after surgery &
discontinued after 3-4 more weeks)).
• 5. Step over step stair climbing
• 6. Driving is allowed 6 weeks after surgery
