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| Division of Occupational Therapy - OT Connect Hip Replacement
Common Symptoms/Course of disease In most cases, a THR is likely to occur after a traumatic event, or after alternative forms of treatment have been unsuccessful in decreasing one’s pain and increasing one’s mobility. Some common traumatic events leading to a THR include: car accidents, excessive forces, and falls; with falls occurring most frequently. Those individuals suffering from severe pain in the hip as a result of arthritis, cancer, or other diseases, may opt for a THR after other treatments have failed. Common Risk Factors:
Age of Onset: Individuals 65 years of age and older receive 65% of THR’s. (Guthrie, 2001.) Sex Bias: Studies show that women receive THRs more frequently than men. (Ontario, 2002; Australian, 2003) Current Medical Treatment: A THR is a surgical procedure that involves the removal and replacement of the hip joint. The end of the thighbone, or femur (the ball portion of the joint), is removed from the bone and an artificial replacement is connected to the thighbone. The hipbone (the socket portion of the joint) is then reinforced with an artificial cup-shaped piece. After the procedure is complete a period of about 2 months (time varies depending on doctor’s orders) is needed to allow for proper healing of the involved tissues. A THR can be expected to last for approximately 10-15 years in 94% of people. Some of the possible complications experienced by persons following THR are:
Occupational Therapy Involvement Occupational therapy (OT) plays an important role with persons both prior to and after receiving hip replacements. Pre-operative education and home visits are widely used by occupational therapists to help people prepare for their impending surgery and post-operative needs. Findings of a study by Spalding (2003)suggest that pre-operative education provided by the occupational therapist is beneficial in reducing anxiety for patients awaiting a total hip replacement. Upon receiving a THR, numerous changes must be made in the ways daily activities are performed in order to allow for proper healing of the hip area. OT typically begins within 1-3 days following a THR in order to inform the patient about his/her hip precautions. Hip precautions are positions of instability of the hip that are to be avoided for 6-8 weeks (time varies according to patient) because these movements place the hip into positions that put extra pressure on the new hip. Hip precautions generally include: no crossing of the legs, no outward or inward turning of the foot on the operated side, and no bending beyond 90 degrees at the waist. The occupational therapist also teaches the patient safe techniques to get in and out of bed, and assists him/her in doing so. The OT instructs the patient in proper sleeping and sitting positions that stay within the guidelines of the hip precautions. Patients are given instruction regarding proper transfer techniques to/from a chair, commode, walk-in shower, shower/tub combination, and a car. The patient receives education about specialty devices (referred to as adaptive equipment) used to assist the patient in daily activities such as lower-body dressing, lower-body bathing, homemaking, cleaning, and any activity of importance to the patient. OT’s also provide patients with helpful tips to make their environment safer, including: eliminating all throw rugs and clutter from floors, increasing the amount of light in rooms and hallways, and installing grab bars or handrails in the home. References
How OT Makes a Difference: Evidence-Based Practice Early inpatient rehabilitation after elective hip and knee arthroplasty. Munin MC, Rudy TE, Glynn NW, Crossett LS, Rubash HE. JAMA. 1998 Mar 18; 279(11): 847-52. The aforementioned study was conducted in order to determine the more advantageous time at which to begin rehabilitation for individuals receiving hip or knee surgery. The study concluded that by beginning rehabilitation on postoperative day 3, rather than on postoperative day 7, individuals achieved short-term functional goals at a faster rate along with acquiring fewer expenses. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomized, controlled trial. Tidermark J, Ponzer S, Svensson O, Soderqvist A, Tornkvist H. J Bone Joint Surg Br. 2003 Apr; 85(3): 380-8. The purpose of the study listed directly above, was to establish the most effective treatment for elderly (average age of 80 years old) individuals with a fractured thighbone. The results of the study illustrated that a total hip replacement was the better choice over an internal fixation surgery that simply uses two screws to repair the fracture. The THR allowed for more functional use including movement of the hip and walking than the internal fixation surgery did. Individuals who received a THR also required far less modification procedures than those undergoing internal fixation surgery. Mr. Jones beamed as he told me about his large vegetable garden, his strawberry patch, and his impeccable yard. He went on to inform me that he does all the gardening and yard work by himself, which is quite amazing considering that he is an 87 year-old man. Mr. Jones had fallen down and broken his hip 10 years ago and consequently received a total hip replacement. Following his THR, Mr. Jones was prescribed occupational and physical therapy treatment. He recalls the challenge of “getting back to normal,” but follows that thought up with “it was worth it.” Mr. Jones has yearly check-ups with his doctor concerning the hip replacement but he hasn’t had any problems with it yet. Today Mr. Jones is thankful for the surgery and therapy he received, explaining “I wouldn’t be as independent as I am now had I not had the surgery [THR].” (The name Mr. Jones has been used to respect the identity of the man in the story above.)
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