Ask a PT: Out-patient physical therapy after total hip replacement

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Hip ImplantQuestion: I am planning to have a total hip replacement in one month. The doctors I have met with don’t feel physical therapy is necessary in the out-patient setting after the procedure is done. Is this true?

Answer: While it may be common for the majority of physicians to forego ordering out-patient physical therapy for patients who have had a total hip replacement once they are living back at home on their own, frequently these patients do not reach their full potential without hands-on treatment to address sore muscles and scar mobility, flexibility exercises, and strengthening the very important hip muscles that will allow faster return to a high level of function. Problems that can arise due to inadequate physical therapy include extended pain and weakness for months after the procedure, difficulty getting out of a chair, ascending stairs, getting out of a car, and getting on and off a toilet. Lack of physical therapy can lead to on-going weakness and chronic pain in the back, hip and/or knee if these symptoms are not recognized early after surgery and addressed by a physical therapist.

Better yet, if physicians would refer every patient undergoing this very involved procedure to out-patient physical therapy, even if the patient is doing well, the patient would benefit from the re-assurance of a review of the hip precautions, a complete review and progression of their home exercise program, and new and important questions answered as the patient is getting accustomed to living their normal daily life and function back at home with their new hip. A recent study by Coulter et al (2013) published in the Journal of Physiotherapy supports the idea that out-patient physical therapy can improve patients’ function faster in terms of improved hip strength, improved gait speed, and in achieving a more normal gait pattern compared to patients who did not receive formal physical therapy in the out-patient physical therapy setting following hip replacement surgery.

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Reference:

Coulter CL, Sacrvell JM, Neeman TM, Smith PN. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. J Physiother. 2013 Dec:59(4):219-26.