Many of our clients have participated in the GLA:D program offered at the clinic: Education and Exercises for hip and knee arthritis. Whilst our goal is to avoid joint replacement surgery where possible, some clients will be unable to manage symptoms with exercise and self management tips and require joint replacement surgery. So how do you know if you have reached that point and what questions do you need to ask before proceeding with surgery?

For those clients who have been struggling with hip arthritis symptoms, there may come a time when their sleeping pattern is significantly disrupted, they are unable to manage symptoms with medication, and leisure or work activities become severely impacted. If you are in the private setting there is often discussion with the orthopaedic surgeon as to the benefits and risks associated with surgery, whilst in the public system there is often less opportunity to discuss prosthesis type, the timing of surgery or the surgical approach.

What is the life of the prosthesis?  Will I need another joint replacement?
The answer to this depends on a number of factors, how you look after your new joint and what are the requirements. There has been significant improvements in types of prosthesis in the last 20 years, they are easier to revise (replace) than previously and also different materials improve the longevity of the prosthesis with higher impact activities. Undertaking exercises for a number of months prior to surgery (pre-habilitation) is more effective in maintaining joint flexibility, improving muscle length and movement symmetry. Connecting with your Physio some months prior to surgery is important as depending on the surgical approach (anterior approach or the more common posterior approach), there will be a different emphasis with exercises.

• Discuss with your surgeon your post operative requirements, are you requiring ROM or the ability for high impact activities.
• In order to maintain the longevity of your prosthesis, you need to have good muscle strength and good movement patterns, while not progressing to extremes of range of movement (ROM).
• Excessive translation (shear force) results in wear of the prosthetic hip. The deep muscles decrease the shear force, so it is important to progress your post operative exercise program to provide the best joint support possible.
• With activities such as Yoga, don’t go to the extremes of ROM as you need to decrease the translational movement. Remember with a prosthesis you no longer have the ligamentum teres (the cord like structure that connects the femoral head (ball)  to the acetabulum(socket)) So with Yoga focus on the strength components for all hip poses and ask your Physio for appropriate modifications .
• Post operative exercises are often given as a generic list, and it is time that a more specific exercise approach be provided depending on surgical approach and also the age of the client and joint requirements as we continue to see younger clients requiring hip joint arthroplasty (joint replacement).

At AB Physio we endeavour to:

• Get the foundations right and normalise symmetry (use the mirror!).
• Not start resistance work too early, but use your body weight with progressive loading depending on the surgical approach and also provide hydrotherapy.
• Advise patients of appropriate precautions for 3-4 months until capsular repair has healed.
• Provide exercise progressions appropriate to joint requirements, and encourage joint longevity.

You can learn more about managing your hip and knee arthritis and about joint replacement surgery in our upcoming FREE GLA:D education session, check our Facebook or Instagram for the details.