PT on the Net Research

Hip Replacement and Exercise


Question:

What are some restrictions for a person with a hip replacement and a rod running into their femur? Also, are there any exercises to strengthen the hip after they have gone through physical therapy?

Answer:

There is a great variation in "success" for people with hip replacements. The success is dependent on age, sex, level of health and fitness, bone and muscle mass and the reason for the replacement. Restrictions to exercise after replacement surgery are designed by the MD, the physical therapist and the RN. Your client has already been through this portion of their rehabilitation and now wants to improve their health, fitness and function.

Most prosthetic hips have a "rod" running into the femur. The rod is part of the prosthesis. It looks like a ball peen hammer, with the handle making up the rod portion and the head of the hammer making up the greater trochanter or knob of the hip. The other side of the hammer fits into the pelvic "socket" or acetabulum. This is like a half-moon shaped cup that has some synthetic material laid into it to handle the new metal end.

The rod is the important part of your question. If your client has poor bone mass and is or has been immobile, then the rod can be displaced easier. The limitations for them are in the hip flexion portion of movements. If a person goes through a large degree (over 90 to 100 degrees) of hip flexion with a load, it is possible for the rod to "tear" the bone. Then you have a problem.

To prevent the problem, minimize the ROM (range of motion) on the leg press to 90 degrees at the knees. This will usually prevent extreme hip flexion and decrease the chance for something negative to occur. Other exercises like leg extension, leg curl and standing calf raise should present no problems. To target improved function, you need to work the hip flexors while standing (raising the knee up to the waist), hip extension with and without load, any standing lifts for the upper body and trunk area and working some balance boards and exercise balls.

Don't forget flexibility for both hips - easy on internal/external rotation, abduction/adduction should present little problem for injury. Hamstrings, quads and spinal muscles (low back) stretches are very important for these folks. They are somewhat fearful of moving, so their ROM decreases fast, and muscle atrophy soon follows. Keep the communication line open. Don't push them too hard, and they will gain confidence and reassurance in you. Good luck!

References:

  1. Loudon, J et al. The Clinical Orthopedic Assesment Guide. Human Kinetics. Champaign, Ill.
  2. Talbert Hospital. Educational update for Health Care Professionals on care for hip replacement rehabilitation. (Sept.2000)