Populations across the world suffer from osteoarthritis (OA), the most common degenerative joint condition in world, causing large amounts of pain, disability and expense. Western developed populations are ageing and as the incidence of OA rises with each decade of life the impact of this condition will be felt ever more strongly. Less developed countries such as China will soon be joining the countries with ageing populations so the need for effective OA treatment will increase greatly. One of the approaches to managing OA is to perform joint replacement.
Medical interventions can be rated on a scale which calculates the improvement in quality of life which results and here hip replacement comes out top of all treatments. The 1960s saw its development into a standard treatment for hip arthritis but the 21st century has seen the technique evolve into a complex and predictable approach to many hip conditions, with excellent fifteen year plus results. Once conservative treatments have been exhausted due to a worsening joint then joint replacement becomes the standard choice.
In surgery the degenerative joint is excised and artificial components of alloy steel and plastic are substituted. The hip joint ball is removed and the socket cored out in preparation, the new ball and stem is inserted into pressurized cement in the femur and the new cup is pressed into cement in the socket. The two materials, steel alloy and ultra high density polyethylene, ensure very low friction in the joint similar to the original and contribute to low wear and long life of the joint.
The physiotherapist will review the patient's medical notes for their post-operative instructions and medical status and then assess the patient's respiratory and lower limb function. Assessment of leg muscle function and sensory ability is important to exclude nerve injury and the physio will give leg exercises to get the limb moving, although an epidural can slow this process by reducing power and feeling for a while. The patient will be mobilised up into walking by the physiotherapist and an assistant, using a frame or elbow crutches and observing hip safety precautions to avoid dislocation.
Hip flexion, knee extension, buttock and calf exercises are practiced whilst in bed to reactivate the leg muscles and pump the blood around the limb. Routine analgesia is very useful as reduced pain allows easier exercising and mobilising. Patients can now go to the toilet, wash and dress and walk about the ward with a helper if needed, at least three times a day to get their confidence. When sitting, correct height chairs are vital and patients should avoid having their feet up on a stool.
After hip replacement patients require instruction and correction to achieve a normal walking pattern, develop muscular power and improved function. Physiotherapists teach the appropriate gait at the time, often starting with "step to" where the patient moves the walking aid, steps the operated leg forwards and steps up to it with the other leg, a stable and safe pattern. Progression is to 'step through" where the unaffected leg steps beyond the other in an approximation of a normal walking pattern. Patients often progress naturally then to a gait where they move both the crutches and the affected leg forward at the same time and start to walk in a fully natural pattern.
Six weeks from discharge patients have usually developed a normal gait, good muscle power and have returned to many functional abilities including riding in a car, mounting stairs and normal walking. A stick can be used if the person is elderly or feels they have poor balance or stability. Sensible activities can now be performed as long as the precautions are observed: Avoid having the legs crossed in sitting. Standing on the operated leg and rotating the body is risky. Bending the hip more than 90 degrees should be avoided in such activities as sitting down quickly, sitting in low seats, crouching down or leaning forwards to the floor quickly. Inform a doctor if an infection develops in an area such as the teeth, bladder or chest, as these can track to a new joint.
Medical interventions can be rated on a scale which calculates the improvement in quality of life which results and here hip replacement comes out top of all treatments. The 1960s saw its development into a standard treatment for hip arthritis but the 21st century has seen the technique evolve into a complex and predictable approach to many hip conditions, with excellent fifteen year plus results. Once conservative treatments have been exhausted due to a worsening joint then joint replacement becomes the standard choice.
In surgery the degenerative joint is excised and artificial components of alloy steel and plastic are substituted. The hip joint ball is removed and the socket cored out in preparation, the new ball and stem is inserted into pressurized cement in the femur and the new cup is pressed into cement in the socket. The two materials, steel alloy and ultra high density polyethylene, ensure very low friction in the joint similar to the original and contribute to low wear and long life of the joint.
The physiotherapist will review the patient's medical notes for their post-operative instructions and medical status and then assess the patient's respiratory and lower limb function. Assessment of leg muscle function and sensory ability is important to exclude nerve injury and the physio will give leg exercises to get the limb moving, although an epidural can slow this process by reducing power and feeling for a while. The patient will be mobilised up into walking by the physiotherapist and an assistant, using a frame or elbow crutches and observing hip safety precautions to avoid dislocation.
Hip flexion, knee extension, buttock and calf exercises are practiced whilst in bed to reactivate the leg muscles and pump the blood around the limb. Routine analgesia is very useful as reduced pain allows easier exercising and mobilising. Patients can now go to the toilet, wash and dress and walk about the ward with a helper if needed, at least three times a day to get their confidence. When sitting, correct height chairs are vital and patients should avoid having their feet up on a stool.
After hip replacement patients require instruction and correction to achieve a normal walking pattern, develop muscular power and improved function. Physiotherapists teach the appropriate gait at the time, often starting with "step to" where the patient moves the walking aid, steps the operated leg forwards and steps up to it with the other leg, a stable and safe pattern. Progression is to 'step through" where the unaffected leg steps beyond the other in an approximation of a normal walking pattern. Patients often progress naturally then to a gait where they move both the crutches and the affected leg forward at the same time and start to walk in a fully natural pattern.
Six weeks from discharge patients have usually developed a normal gait, good muscle power and have returned to many functional abilities including riding in a car, mounting stairs and normal walking. A stick can be used if the person is elderly or feels they have poor balance or stability. Sensible activities can now be performed as long as the precautions are observed: Avoid having the legs crossed in sitting. Standing on the operated leg and rotating the body is risky. Bending the hip more than 90 degrees should be avoided in such activities as sitting down quickly, sitting in low seats, crouching down or leaning forwards to the floor quickly. Inform a doctor if an infection develops in an area such as the teeth, bladder or chest, as these can track to a new joint.
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for Physiotherapists in Croydon or elsewhere in the UK.
Posts
No comments:
Post a Comment