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Hip Replacements—Anatomy, Physical Therapy, and Full Recovery

man moving boxes with back painHip replacement surgery is the most common type of joint replacement surgery across patients in the United States. When in ideal condition, this ball-in-socket joint allows for the round head of the femur (the ball) to glide against the labrum that lines, protects, and supports the acetabulum (the socket).

The hip joint is also supported by a complex of muscles, ligaments, and tendons that allow for proper, smooth function of the hip joint. However, when the structural components of the hip are degraded or compromised, a hip replacement surgery may be necessary. Physical therapy plays an extremely important role in the success of a newly-placed hip joint.
frontal right hip joint

Physical Therapy and Hip Replacements

Many patients partake in pre-surgical physical therapy to prepare the hip’s supportive muscles for the surgery. The efficacy of this practice in the reduction of post-surgical complications is well-supported by research. A 2014 study on pre-surgical physical therapy for total joint replacements demonstrated a 29% decrease in post-acute care such as inpatient rehab and reliance on home health care in patients who enrolled in pre-surgical physical therapy [1].

Rehabilitation efforts will resume or begin immediately after the surgery with the intention to mobilize the joint as quickly as possible. Patients begin with walking exercises that allow for the completion of daily activities and restore gross function. In the weeks and months following surgery, physical therapists will help to ensure strength and flexibility at the hip joint itself as well as within the surrounding structures [2].

The total duration of the post-surgical rehabilitation process cannot be estimated based on the joint in question alone. Factors include, but are not limited to, age, integrity of the surrounding bone, muscle strength, diet, adherence to the physical therapist’s treatment plan, and willingness to engage in home exercises.

Patient Perspective

Below, we took the opportunity to interview our own Dr. Charlie Bissell about his personal experience in getting his hip replaced. Check out this Q&A pooled from patient questions about Dr. Bissell’s experience and expertise pertaining to the process of a hip replacement.
Why did you need to get your hip replaced?

I had a congenital anomaly called acetabular impingement at my left hip. This means that the head of my femur was pinched up into my hip socket. This causes excess wear and tear on the labrum, which protects and stabilizes the socket, causing bone-on-bone grinding at the hip joint. I needed a hip replacement because this condition offsets the load on the hips and essentially wears out the affected joint more quickly. This is like driving a car out of alignment and not getting the expected miles out of the tires.

What did you try before getting your hip replaced?

I tried lots of things to try to avoid getting my hip replaced because I was worried about the complications. I got cortisone shots, tried physical therapy, and other mobilization work. I also had a consultation for PRP but I was not a candidate due to the advanced degenerative change visualized on my x-rays and MRIs.

What made you finally decide to go through with the hip replacement?

I decided to get my hip replaced because I couldn’t live comfortably in my daily life. For example, I couldn’t put my shoes and socks on and couldn’t sleep well due to a constant ache at my left hip. I also couldn’t comfortably play golf, which is one of my favorite hobbies.

What was your recovery process like following your surgery?

I had an in-home nurse/physical therapist for 4 days following my surgery. She was focused on helping me mobilize the joint as soon as possible and helped with walking exercises. I also worked with two of our physical therapists, Kim and Karen, for my physical therapy care.

What advice would you give to a patient thinking of getting a hip replacement?

If you think you need a hip replacement, you should have your hip pain evaluated. This may be by a medical doctor, osteopath, or chiropractic doctor. If the doctor thinks that imaging is appropriate, they will order imaging to assess the integrity of the joint and will advise about next steps. I also advise meeting with at least two surgeons to find a surgeon that feels like your right fit. This way, you can also get as much information about your condition and surgical process as possible.

What was your biggest challenge in getting your hip replaced?

The most challenging part was the fear I had about getting my hip replaced. Once I made the decision and woke up from surgery, the recovery was very smooth.

Are you happy you had your hip replaced?

Yes, because I was able to regain function and mobility at my hip joint. I am also happy to be back at the golf course regularly without pain.





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