Total Hip Replacement


Total Hip replacement is a surgical procedure of removing the diseased the femur head and neck and replacing it with an artificial prosthesis.

Usually the patients considered for the total hip replacements are:

  • Young patient
  • Osteoarthritis of hip joint
  • Rheumatoid arthritis
  • Avascular necrosis
  • Septicemia
There is a progressive increase in chronic pain and difficulty in walking, stair climbing & even rising from a chair.
Difference in Cemented & Uncemented prosthesis:
Cemented prosthesis is usually used in older patients who are less active  and have less bone density.
Whereas uncemented can be used in younger andactive individuals.

The primary disadvantage of uncemented prosthesis is the extended recovery period.
Because it takes a long time for the natural bone to grow and attach to prosthesis, hence the person has to limit his activitites for upto 3 months to protect hip.

Your hospital stay may last for a week, if you go straight home you will need help for several weeks. The following steps can make you homecoming easier:

  1. In kitchen as well as other rooms, place items you use frequently within reach so you dont have to reach up or bend down.
  2. Rearrange furniture so you can walk easuily with walker or stick.
  3. Get a good chair: the one that is firm and higher than average sear
  4. Remove any throw rugs or area rugs that could make u slip.
  5. Securely fasten electrical cords around perimeter of the room.
  6. Install a shower chair, grab bar and raised toilet.
  7. Use assistive devices such as long andle sponge and a grabbing tool or reacher to avoid bending too far.
  8. Wear big pocket shirts or soft shoulder bag for carrying things.

Activities at Home:

  • Keep skin dry and clean,
  • Notify doctor if your wound drains.
  • Swelling is normal for first 3-6 months. elevate leg slightly <30 degrees on pillow and put ice pack for 15 20 min.
  • If u have calf pain, chest pain and shortness of breath notify immediately.

Resuming Activities at Home:
Once you get home, stay active. The KEY is not to overdo it, while you expect some good days and some bad days, you should notice gradual improvement over time.

Weight Bearing
Discuss with you physical therapist regarding the weight bearing of the operated leg as the rehabilitation protocol will be different for cemented and uncemented.

Driving
You can begin driving an automatic car in 4 to 8 weeks after consulting your doctor and your symptoms post surgery.

Sex
Some form of sex positions can be safely resumed 4-6 weeks after surgery. Ask you doctor regarding the same.

Sleeping positions

  • Sleep on you back with legs slightly apart on your side with abduction pillow.
  • Be sure to use pillow atleast 6 weeks ot untill doctor says not to use,Sleeping on stomach is alright,
Sitting
  • For atleast 3 months sit only on chairs that have arms.
  • Do not sit on low chair, reclining chairs.Donot cross your legs at knees.
  • Get up and move around possibly every 1 hour.

Climbing

  • Stair climbing should be limited if possible untill healing is far enough.
  • If you must go up stairs- The unaffected leg should step up first, then bring affected leg up to same step, then bring your cane.
  • To go down- Put cane first, next bring affected leg down to that step, finally step down with unaffected leg

Return to work:
Depending on the type of activiies you perform it may take as long as 3 months or 6 months to return to work.

Other activities:

  • Walk as much as you like once doctor given you go ahead, but remember don’t substitute walking for your prescribed exercise.
  • Swimming is recommended once sutures are removed and wound is healed, apporox 6-8 weeks after surgery,
  • Acceptable activities are dancing, golfing with spikeless shoes and cart , bicycling on level surfaces.
  • Avoid activites that involve impact or stress on joints such as tennis, badminton, contact sports such as baseball, football, squash, jumping or jogging
  • Lifting weight is not problem but carrying heavy awkward object thatr cause you to stagger is not advised esp if you must go up or down stairs or slopes

DOS AND DONTS:
The dos and donts vary depending on orthopaedic surgeon’s approach.
Your doctor and physical therapist will provide you with a list of do’s and dont’s to remember with your new hip.
The precautions will help you to prevent the new joint from dislocation and ensure proper healing.

  • Do not cross your legg at the knees for atleast 8 weeks
  • Do not bring your knee up higher than your hip
  • Do not lean forward while sitting or as you sit down
  • Do not try to pick something onfloor while you are sitting
  • Do not turn your feet excessively inward or outward when you bend down
  • Do not reach down to pull your blankets when lying in bed
  • Do not bend at waist beyond 90 degree
  • Do not stand pigeon toed
  • Do not kneel on knees on un operated leg
  • Do not use pain as a guide for what you may or may not do.
DO cut back on your exercise if your muscle aches but dont stop doing exercise.
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Exercising in Ankylosing Spondylitis


Treatment for ankylosing spondylitis is what many often enquire about. People ask for treatment that completely cures ankylosing spondylitis disorder. Well, there is no known curative treatment for ankylosing spondylitis. However, there are different techniques & methods that reduce the effects or intensity of ankylosing spondylitis considerably.
Understanding ankylosing spondylitis, is very important so that you can opt for the best suited treatment for it. Ankylosing spondylitis is an inflammatory arthritis that mainly affects spinal cord & sacroiliac joints, causing fusion of the spine- Bamboo Spine. It is of type autoimmune spondyloarthropathy. There may be involvement of other organs such as kidneys, lungs, eyes and heart. Hence, when your diagnosis is ankylosing spondylitis, you should immediately seek the treatment.

Treatment for ankylosing spondylitis includes various options such as medications, exercise & physiotherapy.
Goal of Treatment: Relieve pain, manage symptoms & prevent further progress of the disease.
Physiotherapy:
  • Various types of movements of back & neck
  • Deep breathing for expansion of lungs
  • Stretching exercises for joint mobility
  • Guidelines- Maintaining erect posture is also very important to reduce spinal scoilotic curvature. Slipping on firm surface & avoid use of pillow while sleeping
Yoga:
  • Yoga can provide a relief from pain, stiffness, improve breathing & improve the range of mobility.
  • Yoga also helps to reduce stress and maintain the energy of patients
  • Asanas: (positions in Yoga) such as Vajra Asana, Dhanura Asana, Makara Asana, Bhujanga Asana, Ardha Matsyendrasana & Neti kriya help to remove rigidity, improve flexibility of joints & also correct bad posture. Pranayama is helpful for muscle relaxation as well as to improve the movements of ribs & changes in pressure within abdomen & chest
  • Before practicing Yoga session, a person should perform stretching to prevent sprains, muscle strains or further injuries
Pilates:
  • Build flexibility, increase strength, endurance, & coordination in legs, abdominals, arms & back.
  • Help with maintaining the  natural curves of the body
  • Create a neutral position for each joint that is close to the optimal alignment of the head, shoulders, thorax, spine & pelvis which ensures that all sections of the body are in their ideal place
However, high-impact exercises such as jogging & sports are jarring to your frame and are generally not recommended. Instead, engage in Tai chi, Swimming because it involves all muscles & joints in a low-impact, buoyant environment. Cycling can also help restore lost movement.
Option of surgery is also viable, in case of severe ankylosing spondylitis condition. Joint replacement surgery, especially of hip and knees is opted for reducing further development of ankylosing spondylitis.
Significance
Exercise, even in small five to 10 minute doses, can improve posture & mobility. According to the Spondylitis Association of America, most people say that their condition improves after exercise. However, first consult a rheumatologist or physical therapist before you begin, because movements that may be beneficial under normal conditions may actually harm those with AS.
Time Frame
Convenience and consistency are the most important parts of your routine. If you feel stiff in the morning, then you may try to loosen up early & then exercise in the midday or evening. If necessary, you can split your exercises throughout the day. For example, you can first do exercises while lying down, and then later in the day you can work on neck stretches or deep breathing.
Much relief can be gained in ankylosing spondylitis by following an exercise regime consistently.
DISCLAIMER: Please consult your medical professional before beginning exercises.