What is Hip Replacement? A Review of Total Hip Arthroplasty, Hip Resurfacing, and Minimally-Invasive Hip Surgery.

Edited By: Seth S. Leopold, M.D.
Last updated Friday, January 12, 2007

Rehabilitation

What types of physical therapy do patients require after total hip arthroplasty, hip resurfacing, and minimally-invasive hip surgery for hip arthritis?

Following hospital discharge (or discharge from inpatient rehabilitation), patients who undergo total hip replacement will participate in either home physical therapy or outpatient physical therapy to a location close to home.

Depending on the surgical approach used, that therapy can begin right after discharge, or it will start at six weeks after the surgery (the time when tissue healing of an important tendon has taken place). The surgeon will help you make the necessary arrangements.

The length of physical therapy varies based on patient age, fitness, and level of motivation, but usually lasts about a month. Two to three therapy sessions per week are average for this procedure.

The specific therapy procedures vary with surgical approach, but balance, safe walking, and reviewing hip precautions are emphasized early, and muscle strengthening are goals later on.

Can this rehabilitation after total hip arthroplasty, hip resurfacing, and minimally-invasive hip surgery for hip arthritis be done at home?

As mentioned, this depends on each patient’s individual circumstances. Age, fitness level, and having adequate help around the house are some of the elements that guide the choice.

All patients are given a set of home exercises to do between supervised physical therapy sessions, and the home exercises make up an important part of the recovery process. However, supervised therapy--which is best done in an outpatient physical therapy studio--is extremely helpful, and those patients who are able to attend outpatient therapy at the appropriate times after hospital discharge are encouraged to do so.

For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

What is the usual response to rehabilitation after total hip arthroplasty, hip resurfacing, and minimally-invasive hip surgery for hip arthritis?

On average, patients walk with a walker (or two crutches) for about 3 weeks, then a cane for another month or so.

The deep pain from the arthritis is usually noticeably absent right after surgery; the post-operative pain gradually improves, and most patients have quit taking narcotic pain tablets by about a month after surgery.

The large majority of patients are able to walk without a limp, and to resume reasonable personal and recreational activities gradually in the weeks and months following surgery.

How long after total hip arthroplasty, hip resurfacing, and minimally-invasive hip surgery for hip arthritis will patients be able to return to ordinary daily activities?

The goal of total hip replacement is to return patients to a good level of function without hip pain. The large majority of patients are able to achieve this goal. However, since the joint replacement components have no capacity to heal damage from injury sustained after surgery, we offer some common-sense guidelines for athletic, leisure, and workplace activities:

Recommended:

• Swimming
• Water aerobics
• Cross-country skiing or Nordic Track
• Cycling or stationary bike (see figure 10)
• Golf
• Dancing
• Sedentary occupations (desk work)

Permitted:

• Hiking
• Gentle doubles tennis
• Light labor (Jobs that involve driving, walking or standing but not heavy lifting)

Not recommended:

• Jogging/running
• Impact exercises
• Sports that require twisting/pivoting (aggressive tennis, basketball, racquetball)
• Contact sports
• Heavy labor

Since the joint replacement includes a bearing surface, which potentially can wear, walking or running for fitness are not recommended. Patients generally feel well enough to do this, and so need to exercise judgement in order to prolong the life-span of the implant materials. Swimming, water exercises, cycling and cross country skiing (and machines simulating it, like Nordic Track) can provide a high level of cardiovascular and muscular fitness without excessive wear on the prosthetic joint materials (see figure 10).

As mentioned, certain precautions should be maintained for life in order to minimize the likelihood of dislocating the ball from the socket. Avoiding extreme twisting and bending from the hip are the most important of these.

How can the costs of rehabilitation after total hip arthroplasty, hip resurfacing, and minimally-invasive hip surgery for hip arthritis be anticipated?

Most insurance plans cover the costs of total hip replacement (including anesthesia, surgical fees, hospital stay, lab tests, and medications). Many also approve inpatient rehabilitation following the surgery. Most cover home or outpatient physical therapy following hospital discharge.

Many insurance plans have deductibles or co-payments; the only way to be sure in each individual’s case is to contact your insurance provider. UW has expert social workers who can help guide patients through the process.

Medicare pays 80% of the costs, and good Medicare supplemental programs usually cover the balance. Again, the only way to know what your supplemental covers is to ask. UW social workers can help with this, as well.

Surgery for hip arthritis at the University of Washington

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