Hip Replacement Prehab

In England and Wales there are on average 160,000 knee and hip replacements annually (National Joint Registry 2017). This number is expected to grow as population numbers and life expectancy averages increase. A hip replacement is performed after years and years of progressive joint degeneration. This means that secondary problems like weakness, tightness and stiffness can develop over time, becoming issues that need to be managed with rehabilitation. A return to normal, pain free daily activity is the primary goal after joint replacement and that’s where a guided exercise program prior to surgery, or prehabilitation, can help you.

When it comes to progressive wear and tear of the hip, the lower back can stiffen and the knee and foot musculature can weaken and tighten resulting in muscle imbalances and altered walking patterns. These secondary problems can add to a slow deterioration in overall physical fitness, mobility and strength before surgery, making it harder to return to normal activity post-operatively.

Despite the fact that there is limited research for prehabilitation (prehab) in hip replacements, there is growing support for its implementation to help maximise an individual’s return to function post-operatively. Prehab been shown to assist in regaining some muscle strength and functional fitness before surgery. It will also help you prepare physically and mentally for the surgery and rehabilitation post-operatively. Furthermore, prehab has been shown to reduce hip pain and improve early post-operative function and as a result, reduce initial inpatient hospital time (Bortoli et al 2012). Finally, performing pre-operative exercise may also help to reduce overall intervention and related rehabilitation expenses (Topp et al 2002; Rooks et al 2006).

Your physiotherapist can help set you up with a specific prehab program. As hip osteoarthritis can also result in lower back stiffness and knee weakness, performing an in-depth assessment including biomechanics, functional capacity, muscle strength testing, flexibility, movement patterns, core stability and postural analysis can help tailor a program that is best for you. We recommend at least 6-8 weeks of prehabilitation, but starting earlier can always help to manage any current pain and stiffness symptoms. Below are some of the exercises you might complete in prehab:

  • Mini squat: With your feet hip width apart, slowly lower your body into a mini squat position (hips and knees at 45 degrees) while keeping your back straight and your knee caps over your second toes. 2×10
  • Heel raises: Holding onto a bench in front of you, slowly raise your heels to lift up onto the balls of your feet. Slowly lower. 2×10
  • Glut Bridge: Lying on your back with your knees bent and feet flat on the ground, contract your buttocks while lifting your bottom off of the ground to align your chest with your legs. Slowly lower. 2×10
  • Hip Flexion: Lying on your back with your knee bent slide your heel up the bed to bend your hip and knee further in towards your chest as far as able. Slowly slide back down. 2×10
  • Standing Hip Abduction: Hold onto a chair beside you for support. Move your leg towards the outside without lifting your pelvis and slowly lower back down. 2×10
  • Standing Hip Extension: Holding onto a chair in front of you for support, push your leg backwards while keeping your knee straight and your body upright. 2×10

Although two sets of 10 repetitions is a guideline, your physiotherapist will adjust your program and the amount of exercise you complete based on your presentation, pain level, mobility and independent goals.

Please read our blog: “Prehab for Knee Replacement” for more information about the benefits of prehabilitation.

References

Bortoli AD, Fujii EI, Ingham SM, et al. The role of preoperative physiotherapy in patients undergoing arthroscopic surgery for FAI. International Society of Hip Arthroscopy Annual Scientific Meeting. Boston, USA (2012); Paper 31.

 

National Joint Registry (2017). Joint Replacement Statistics. Retrieved from: http://www.njrcentre.org.uk/njrcentre/Patients/Jointreplacementstatistics/tabid/99/Default.aspx

Rooks DS, Huang J, Bierbaum BE, et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum 2006; 55(5):700-708.

Topp R, Ditmyer M, King K, et al. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clin Issues 2002;13(2):263-276.