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Contents: How is the rehabilitation done Muscles that do the work - abductor muscles
How is the rehabilitation done Length of stay in the hospital after total hip replacement has decreased from two weeks to only about five days. For patients operated on with the modern surgical technique, called Minimally Invasive Surgery, the stay is even shorter, these patients leave hospital the operation day or the next day after surgery. Obviously, giving detailed advices on rehabilitation through Internet site would be meaningless. These advices must be given i, before and after surgery to every patient individually. You should also advices how much weight you can put on your new total hip. You should have learned individually your rehabilitation program already before the operation. After surgery, there is then time to give the finishing touches to this program. During the few days you will stay in the hospital after surgery, your muscles would not have time to regain the previous power, so that much training remains after leaving the hospital. Depending on your condition, you may require a stay at a rehabilitation facility or you may go home. That is a decision that you can come to with your surgeon and PT depending on what you feel you can cope with and what you are able to do. If you go home, a PT will take over your rehabilitation, seeing you two-three times a week during the first months. During a typical session, the PT may apply ice to reduce pain and swelling, and prescribe specific exercises for you to do at home to restore range of motion and muscle strength in your new total hip. It is important that your PT has close contact with your surgeon concerning the surgical approach and restrictions to certain movements in your new hip joint. With this knowledge your PT then prescribes individual exercises to you with respect to the muscles that were moved, released, and sutured back during the surgery. Home exercise program is an extremely important aspect of your recovery. Be prepared to continue with a home exercise program for at least three months after surgery, but it could require as much as one year to achieve optimum muscle strength and range of motion in your new total hip.
The muscles that do the work Remember that even the most advanced, best models of the total hip device will be propelled by your own muscles. You will do the work once the operation is finished.
The limp - lack of muscle power The lack of power in the abductor muscles causes that the rump drops down when the patient puts weight on the operated on leg. The patient with weak muscles around the total hip is limping. Scientist call it positive Trendelenburg’s sign. The muscle weakness causes unsight gait pattern.
Limp = Trendelenburg's sign Show Picture: Trendelenburg's sign
Left picture: Normal abductor muscles of the left hip joint. The normally strong abductor muscles of the left hip joint keep the pelvis horizontally when patient raises the right leg. This is the most important function of the two gluteus muscles (the middle and the small gluteus muscles) - to keep the pelvis in horizontal position when the person stand on one leg. Right picture shows a patient with weak abductor muscles of the left hip. This becomes apparent when the patients rises the right leg. When the patient puts the body's weight on the left leg (and hip), the weak abductor muscles cannot keep the pelvis horizontally. The pelvis sinks to the right (healthy) side. During a walk the pelvis sinks periodically to the healthy side. The walk is unsightly, duck- like. Statistics demonstrated that about 80% of all total hip patients had weak abductor muscles before the surgery. 3 months after surgery the muscle strength improved so that only 12% of them had Trendelenburg’s sign= still is limping. The muscle power increases continuously even after the three months passed so that one year after surgery only 5% of all total hip patients re still limping (Downing 2001). The range of motion in the operated on hip It increases successively. The maximal range of motion after total hip replacement depends on the preoperative range of motion. Patients with good range of motion will achieve even better range of motion. Patients with very limited range of motion before the surgery will achieve considerable improvement of their range of motion but seldom an excellent range of motion. ___________________________ References: Downing ND et al: Hip abductor strength following total hip arthroplasty. A prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand 2001;72:215-220
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