Total Hip Replacement (THR) Decoded: Insights for Patients

In this article, we will delve into the realm of total hip replacement (THR), answering common questions and shedding light on this crucial orthopedic procedure.

Before we dive into the topic, please note that this is written from a physiotherapist’s perceptive, and not a surgeon’s. The information provided may not be universally applicable, so it is essential to consult with your surgeon or physiotherapist before making any changes to your exercise routine.

1. Determining the Need for THR

One of the first questions that often arises is, “How do you know if you need hip replacement surgery?” Surgeons generally consider three primary factors: pain, function, and radiological changes. Osteoarthritis of the hip is the leading cause for THR in over 90% of cases. However, it’s important to understand that pain associated with osteoarthritis can vary, and radiological changes don’t always correlate with symptoms or function. In most cases, non-operative management is attempted, including exercises, weight management, and other interventions for about six months. If you experience worsening pain, loss of function, decreased quality of life, and corresponding radiological changes, it might be time to discuss the possibility of THR with your surgeon. Each individual’s decision regarding the timing of surgery is unique and should be based on their pain, function, radiological findings, and overall quality of life.

2. Range of Motion Precautions and Risk of Dislocation

Another common query revolves around range of motion precautions after THR and the risk of dislocation. Surgeons may prescribe specific precautions to minimize the risk of dislocation, which can vary among patients. These precautions are more commonly associated with the posterior approach. Research suggests that these precautions might not significantly reduce the risk of dislocation, and patients often recover faster and report higher satisfaction when not given these restrictions. The risk of dislocation is relatively low, with most revisions occurring within three months post-surgery. The occurrence of dislocation is influenced by various factors, including surgical approach and individual patient characteristics.

3. Longevity of THR

Many individuals wonder about the lifespan of a total hip replacement. Data from a 2019 systematic review and meta-analysis in The Lancet indicate that THRs have an average lifespan of 15 years at a success rate of 89%. After 20 years, the success rate is around 70%, and it decreases to 58% after 25 years. With advancements in techniques and implants, these numbers are expected to improve. Revisions may be necessary over time, but the decision to undergo revision surgery should be made based on individual circumstances.

4. Maintaining Joint Health and Activities After THR

Individuals who have had a THR often inquire about the exercises and activities they should avoid to maximize the lifespan of their implant. The general consensus among experts is that no exercises need to be entirely avoided at the gym. It is more about finding exercises that are comfortable and do not cause discomfort. Modifying the load, frequency, tempo, and other parameters of your exercise routine can help ensure a comfortable and effective workout. It’s essential to maintain overall health by not smoking, eating well, and exercising regularly. Maintaining a balance of activities and not overexerting yourself is key to prolonging the life of your implant.

5. Activities After THR

Many individuals are concerned about which activities they can engage in after a THR. The activities you can participate in post-surgery are extensive and may vary based on your surgeon’s recommendations. While some surgeons advise against high-impact activities or contact sports, the majority allow for activities like golfing, hiking, and working out. Engaging in activities like yoga, golf, hiking, and weightlifting is generally safe, as long as you respect your limitations and make necessary adjustments.

6. Running After THR

Running after a THR is a common desire, and it is possible with the right approach. While the technique for running can be similar to your pre-surgery form, it’s essential to discuss your intentions with your surgeon. Some studies have suggested that high-impact activities may affect the longevity of the implant, so it’s crucial to weigh the risks and benefits. Your surgeon can provide guidance on when and how to safely reintroduce running into your routine.

7. Pacing Yourself

If you are young and active, pacing yourself can be a challenging decision. It’s crucial to understand the potential risks associated with high-impact activities and consider whether the immediate benefits outweigh the potential risks down the line. It’s essential to strike a balance between enjoying the activities you love and taking care of your implant for the long term.

8. Rehabilitation and Walking After THR

Post-operative rehabilitation plays a significant role in regaining your mobility and strength. If you experience hip flexor issues, it’s crucial to confirm the diagnosis and then modify your exercise routine accordingly. Exercises should focus on improving your range of motion, strength, endurance, and balance. As for elderly patients relearning to walk, the process is generally straightforward. The use of assistive devices may be necessary initially, but gradually reducing their dependence on these devices while working on strength and balance is the key to successful rehabilitation.

9. Putting On and Taking Off Shoes

When it comes to post-operative tasks like putting on and taking off shoes, it’s crucial to make the process as simple and safe as possible. Look for shoes that are easy to slip on and do not increase the risk of falls. Comfortable, easily manageable footwear can contribute to a smoother recovery.

In conclusion, Total Hip Arthroplasty is a transformative surgery that can significantly improve your quality of life. The decision to undergo THR is a highly individual one, based on your unique pain, function, radiological findings, and overall quality of life. While there are some precautions and considerations post-surgery, the procedure can offer a new lease on life and a return to many activities you love. It is essential to consult with your healthcare provider to tailor your post-operative journey to your specific needs and goals. Remember, your comfort and well-being are paramount as you embark on the path to recovery and an active, pain-free life.