Hip Replacement and Quality of Life - A Plan Of Action
Peri Buckley is a World Cup and Olympic hockey umpire and a lifelong athlete. She is also one of the approximately 2.2 million Australians of all ages and backgrounds that are affected by Osteoarthritis.
After a period struggling with painful symptoms, Peri elected to undergo hip replacement surgery. Like many people contemplating surgery, maintaining an active lifestyle has been important to Peri. Because of this, she was keen to take an active part in ensuring the best outcomes possible. Her path to surgery and beyond, to a mobile rehabilitation, shows how people of all ages and demographics can approach their journey beyond a hip replacement.
Before Surgery – What should I know?
Like all people approaching a major surgery, Peri discussed her risk factors with her surgeons. In her case, being relatively healthy to begin with, she was advised to maintain a healthy weight, stay active and mind that her diet remained nutritious. If you are considering hip replacement surgery, being aware of any risk factors that may apply to you is key.
Risk factors common to many people include:
• Being overweight
• Being anaemic
• Have been diagnosed with Diabetes
• Dental issues
• Smoking
• Drug use (opioids particularly)
• Malnutrition, and especially vitamin D deficiency.
If you think you might fall into any of those categories, it’s best to discuss an approach for combating them with your medical practitioner. Managing these risks will help you improve your outcomes post-surgery; areas such as pain, potential infection, joint function and overall quality of life can see vast differences!
Before surgery – what can I do?
Advice has now been developed that prehabilitation exercises can play just as big a role in your surgical outcomes as rehabilitation. Peri in particular undertook a program of prehabilitation exercises, designed to send her into surgery with strong, resilient muscles. Pre-operative exercises focusing on cardiovascular and joint strengthening activities can vastly improve your surgical outcomes, as well as keep you an engaged participant in your treatment. Studies have shown that prehabilitation activities, including education and exercise can have a positive effect on post-operative pain levels, and can even improve post-operative function.
How to approach prehabilitation:
Whilst it is important to simply remain active overall, it is also important to learn specific exercises that will help you in your efforts recovering from surgery, like how to turn your core muscles on as they support your spine and pelvis. Peri’s routine focused on Pilates, and other strength and mobility-based exercises, as well as her normal activities such as walking.
For many that have been suffering from immobility due to ongoing pain, unused muscles can become weak and do not work as well. This can lead to problems such as back pain, stiff hips and poor balance – all things we want to avoid in general, but particularly with a new joint and rehab to come! The Canadian Guidelines Exercise for Hip Replacement Surgery list two exercises that can help turn on your core. You can read more about those exercises here.
Your surgery – what’s involved
Not all hip replacements are alike! It can be helpful to know just which procedure your surgeon has will opt for. Nick Wilson from Body Systems in Hobart outlines the two approaches most commonly taken. These are the Anterior Approach, and the Postero-Lateral Approach.
“The direct anterior approach is a relatively new procedure which involves total hip replacement surgery whilst minimising the impact on the surrounding muscles and soft tissues. The final outcome is the same as the other approach, but no muscles need to be cut during the procedure”, Nick says. Patients receiving this kind of surgery will experience a more rapid return to function, and less restriction than other methods, as well as quicker gains in strength post op. This is down to the reduced muscle damage that this more minimal approach incurs.
Though less commonly used as a procedure, Postero-Lateral patients do fare quite differently in recovery. During this procedure, Nick outlines that “patients have had their gluteal muscles and deep hip rotators cut during the operation. This will lead to less dynamic hip control during exercise and increases the chance of hip dislocation” Post-operative movement will need to be more conservative and return to usual movements will take longer.
After surgery
Peri remembers being up and out of bed the day after her surgery without the use of heavy painkillers – only Panadol for this patient! With a tailored physiotherapy program and Pilates as rehabilitation work Peri, now ten years post -surgery, describes having the procedure as being “given another lease on life”, noting that of all the people she knows that specifically continued rehabilitation activities and exercising post -surgery, all had experienced good outcomes – “To me it’s an opportunity to have a second chance at doing things”.
So, what should you be doing post-surgery? In short, moving! But just how that will look will vary – you should always get specific individual advice from your surgeon but there are some rules of thumb.
Nick Wilson reminds us that regardless of the procedure used, “patients should avoid high impact exercise after a hip replacement such as running and jumping.” This is because the impact through the new prosthesis can impact on the bone, especially under the socket and over time cause this to loosen. Any damage of this sort could result in additional surgery.
For patients who’ve undertaken the anterior procedure, they can start very gradual strength training with supervision (ideally from a physiotherapist) in a gym environment after 12 weeks. While individuals will need to have a plan tailored to their situation, goals and recovery, exercises can include squats, deadlifts, lunges and other weighted movements. You can at this stage, also include gentle low impact activities such as swimming and cycling, with your surgeon’s approval.
Nick encourages patients to build up strength and conditioning exercises slowly to see long term benefits. “The key to this is to build up slowly under supervision and ensure good technique. Having a good physio or trainer that understands the operation is very valuable.”
After 6 months for this type of replacement, Nick happily shares that “patients can return to social sports as long as they minimise the impact going through their new hip. Common sports to return to are social doubles tennis, golf, non-competitive cycling, swimming and rowing.”
Post operation, patients should remember that there are no sensory receptors around the new joint, and as such repetitive end range movement can damage the componentry and lead to hip joint dislocation and/or early revision surgery. Because of this, caution is advised when recommencing stretching based exercises.
For patients who have had the more invasive postero-lateral procedure, Nick advises that any movements involving deep hip flexion, or sudden changes of direction should be avoided. He recommends walking, cycling and swimming as great long-term options for patients in this category, stressing that strength training can be undertaken, but only with very strict supervision.
As with any major surgery – it’s best to clear your exercise plans with your surgeon or physio. Learning to listen to the joint will be your best friend – if anything is causing you discomfort, stop and talk to your team about how to progress. Making sure you’re staying in regular communications with your rehabilitation team will help you keep active safely.
Hip replacements, as patients like Peri prove, can be an opportunity for better function and improved quality of life. A decade on, Peri is hiking, playing lawn bowls and has even started using a home gym. By being informed, active and engaged in your health care from prehabilitation right through to post-surgical rehabilitation, you too can enjoy positive outcomes.
REFERENCES
1. WALL, C, DE STEIGER, R 2020, ‘PRE-OPERATIVE OPTIMISATION FOR HIP AND KNEE ARTHROPLASTY’, AUSTRALIAN JOURNAL OF GENERAL PRACTICE, VOL. 49, NO. 11, PP. 710-714.
2. NELSON, M, BOURKE, M, CROSSLEY, K, RUSSELL, T 2019, ‘TELEREHABILITATION IS NON-INFERIOR TO USUAL CARE FOLLOWING TOTAL HIP REPLACEMENT – A RANDOMIZED CONTROLLED NON-INFERIORITY TRIAL’, PHYSIOTHERAPY, <HTTPS://DOI.ORG/10.1016/J.PHYSIO.2019.06.006>.
3. EICHLER, S, SALZWEDEL, A, RABE, S, MUELLER, S, MAYER, F, WOCHATZ, M, HADZIC, M, JOHN, M, WEGSCHEIDER, K, VÖLLER, H 2019, ‘THE EFFECTIVENESS OF TELEREHABILITATION AS A SUPPLEMENT TO REHABILITATION IN PATIENTS AFTER TOTAL KNEE OR HIP REPLACEMENT: RANDOMIZED CONTROLLED TRIAL’, JMIR REHABILITATION AND ASSISTIVE TECHNOLOGIES, VOL. 6, NO. 2, PP. 1-12.
4. VANCOUVER COASTAL HEALTH 2005, ‘EXERCISE GUIDE FOR HIP REPLACEMENT SURGERY’, PP. 1-44.
AUTHOR
AMY CONLEY, OLIVIA CLAYTON
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