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Quality of Life Following Proximal Femoral Hip Replacement Surgery

Hip joint which is also known as a ball & socket joint is a special type of joint. While the cup side of the joint is known as acetabulum, the ball side is recognized as the head of femur. Part of the thigh bone (femur bone) is replaced with a metal component which is inserted into the lower part of femur in upper-end femoral replacement surgery. Acetabulum is then replaced with another plastic component. Patients will be encouraged to mobilize as soon as possible following proximal femoral hip replacement surgery. For this purpose, adequate pain relief is invariably prescribed in order to make this possible. However, patients must ensure that they stock up plenty of painkillers at home & while they are in hospital. They should make it a point to speak to nurses & doctors in case they feel pain is beyond control.

Proximal Femoral Hip Replacement Surgery

Immediately After Proximal Femoral Hip Replacement Surgery

Generally, patients are encouraged to get out of bed on the day after surgery with assistance & help of a walking aid. However, they will only be initially allowed to partially bear weight through the affected leg. This effectively means that patients can only take about half the body weight through the operated leg & not the entire weight. Mobility will gradually be progressed through sessions with the physiotherapist. Physiotherapists will advise patients as to how far they should be mobilizing & which walking aids are appropriate for them. Normally, patients initially start with a walking frame & subsequently progress to crutches. It is also considered important that patients should carry out some exercises regularly in order to strengthen muscles around the damaged hip. Physiotherapists may often also advise patients to perform additional exercises which may also be beneficial. However, due to the position of the wound, there exists a slight risk of hip dislocation until the soft tissues surrounding the new hip heal completely. Patients should heed the physiotherapist’s advice so as to help reduce this risk & be able to gain maximum benefits from the new hip.

Precautions to be followed with the New Hip

In order to reduce risk of dislocation following proximal femoral hip replacement surgery, patients must take the following precautions for at least a period of 3 months.

  • Patients should not bend the operated hip past a right angle (90 degrees). They should also avoid low chairs. It is advisable that they check the heights of chairs at home with their occupational therapist. They should not raise their knee higher than the hip while sitting. They should also keep their shoulders behind hips & not lean forwards while sitting. Patients should also not bend at waist in order to pick up any items from floor.
  • Proximal femoral hip replacement surgery patients should not cross their legs.
  • They should not turn the operated leg inwards like in pigeon toe position. They should avoid swiveling while turning & always lift the feet for the purpose. They should also not twist the torso while standing, lying or sitting.
  • Proximal femoral hip replacement surgery patients should not lie or roll on the un-operated side. They can however lie on the operated side if it is comfortable to do so; this is usually possible when the incision wound has healed.

Exercises following Proximal Femoral Hip Replacement Surgery

Following exercises need to be regularly performed throughout the day in order to reduce risk of developing chest infection or blood clots in calf. Moreover, patients who have undergone proximal femoral hip replacement surgery should start these exercises as soon as it is possible following the operation.

  • Deep Breathing

    • Take a deep breath inside through nose.
    • Hold air inside for 2 – 3 seconds.
    • Breathe out through mouth.
    • Perform 3 – 4 breaths like this & then, relax.
  • Circulatory Exercises – Ankle Pumps

    • Point & bend ankles for a minimum of 10 times during a session.

Following exercises should be started on the day after proximal femoral hip replacement surgery & should be performed 10 times each, for 4 times every day with each leg. Physiotherapists can practically help patients & help explain how to perform them.

  • Static QuadsLying with legs out straight in front. Then tighten muscles on front of thigh by squashing the knee down into bed & pulling the toes up towards the body. Hold count till 5 & then relax completely.
  • Gluteal SqueezeSqueeze both buttock muscles together as tightly as possible to a count of 5 & then relax completely.
  • Hip Flexion / Heel SlideLying with legs out straight in front. Slide heel of the operated leg up towards the bottom while allowing the knee & hip to bend. However, do not let the hip bend more than 90 degrees (right angle). Slide the heel back again & relax completely.
  • Hip AbductionLying with legs out straight in front. Keep both legs straight & toes pointing towards the ceiling all through the exercise. Move the operated leg out very slowly to the side. Return the operated leg back to the start position & then relax completely.
  • Long Arc QuadricepsWhile sitting in the chair, kick the foot forward & straighten the operated leg very slowly. Hold like this for 5 seconds & then slowly lower down the leg back to the starting position before relaxing completely.

Once proximal femoral hip replacement surgery patients are mobile with help of a frame or crutches, they can then progress to the following exercises. However, they should make sure that they are holding onto a firm surface while they are performing all standing exercises. They should also be performing 10 of each of these exercises for 4 times every day.

  • Hip FlexionPatient should slowly lift knee of the operated leg towards their chest. Moreover, they should not bend the hip more than 90 degrees (right angle). Finally lower the foot back to the original position before relaxing completely.
  • Hip ExtensionThe patient should keep the body upright throughout this exercise. Then slowly move the operated leg as far back as possible. Finally, return to the starting position before relaxing completely.
  • Hip AbductionThe patient should keep the body upright throughout this exercise. Then slowly move the operated leg out towards the side while keeping the toes pointing forwards. Finally, return to the original standing position before relaxing completely.
  • Hip HitchingWhile keeping the body upright, the patient should keep the legs straight & feet together. Then shorten one leg so as to lift the foot. Repeat this exercise on the other side before relaxing completely.

Exercises for Mobility / Walking

Proximal femoral hip replacement surgery patients while standing to use frame must pay attention to the following.

  • Standing Up

    • Shuffle the bottom to the front of chair
    • Tuck feet back underneath the body
    • Use arms of the chair to push up for standing
    • In case it is painful, move the operated leg forward before standing so that more weight is put upon the non-operated leg.
    • Once balance is maintained, reach for the frame.
  • Sitting Down

    • Chair must be high enough, so that the knee is higher than the hip
    • Patient must stand close enough to feel the chair against the back of legs
    • Let go the frame & reach back to arms of the chair
    • Slide the operated leg forward
    • Gently lower the body into chair
  • Walking With a Frame

    • Always, move the frame first
    • After which, step the operated leg forward
    • Push down through the frame while stepping forward with the non-operated leg
  • Points to Aim While Walking

    • Patients must ensure that both steps are equal in length
    • Patients must try to spend equal amount of time on each leg
    • They must also try to put the heel of each foot to ground first
    • Gradual increase of walking distance & amount of activity done each day is recommended
  • Getting Out of BedIt is not generally necessary to get out of bed with the operated leg first. But then, patients need to carefully observe hip precautions that were discussed earlier. Particularly, they should not allow the operated leg to cross midline.
  • Moving Up & Down the StairsPhysiotherapists would usually practice moving up & down stairs/steps with patients prior to discharge if required. Patients will however need to use crutches or a stick on stairs in case there are only one or no rails present for support. Some patients may also require to have sticks/crutches or extra frame so as to enable them have something to walk with when they reach the top of stairs.

Ascending

    • Hold on to the rail/rails
    • Step first with the un-operated leg & then use the operated leg
    • Follow this by the stick or crutches

Descending

    • Hold on to the rail/rails
    • Place stick or crutches down one step
    • Step down, first with the operated leg & follow it up with the un-operated leg
  • Getting In & Out of the Car

    • While positioning the car, hip replacement surgery patients should sit in the front passenger seat of the car because there is more leg room here. They should also make sure that the car is parked at a distance from the curb, so that they can be at the same level as the car before they try & get in.
    • The seat should be pushed back as far as possible so that it is slightly reclined. Patients should go bottom first into the car & slowly lower themselves to the edge of the seat. They can also use the arms to lift the bottom further across the seat towards the side of the driver. Finally, they can very slowly lift their legs into the car.
    • Plastic bags can help swivel their legs inside the car more slowly, but these bags must be removed before driving.
    • This procedure is to be reversed when the patient is getting out of the car.

Pain Following Proximal Femoral Hip Replacement Surgery

Some pain may persist for a few weeks after proximal femoral hip replacement operation & therefore patients must use these instructions as guide while increasing daily activities. Moderate type of ache which quickly settles is acceptable, but severe pain taking hours to settle is unacceptable. Patients should immediately stop all activity in case they are experiencing sharp pain. Moreover, in case these symptoms persist, they should contact the general physician for advice. They should also immediately contact the general physician in case area around the wound is turning red, increasingly becoming more painful, discharging pus or when the patient is unwell or running high temperature.

Swelling Following Proximal Femoral Hip Replacement Surgery

Swelling in leg operated upon for hip replacement surgery may remain for up to 3 months of time following the procedure. Patients must have their legs kept elevated while resting in bed for at least a few hours every day & which will help them control swelling.

Driving Following Proximal Femoral Hip Replacement Surgery

  • Hip replacement surgery patients should not drive until the doctor tells them that they are fit enough to do so. This normally takes about 3 months of time after the operation.
  • Patients need to be nearly pain-free in order to be able to drive. They should also not be dependent on walking aids & must have a good range of movement along with sufficient reflexes so as to manage emergency stops.
  • Patients must remember to undergo a ‘test drive’ & also practice emergency stops accompanied by an experienced driver.

Discharge Following Proximal Femoral Hip Replacement Surgery

Proximal femoral hip replacement surgery patients are usually discharged when the healthcare team feels they are ready to do so. They will subsequently either move to a rehabilitation center or to home depending upon medical requirements. However, before leaving the hospital, physiotherapists would discuss with them as to which exercises they should be continuing to do at home & how to systematically progress with their mobility.

More about Hip Replacement Surgery

Salvaging the hip diseased with severe proximal femoral bone loss can be a challenging task. With an ever increasing number of hip arthroplasties which are performed around the globe among an advancing age of target population, arthroplasty surgeons are faced with more severe instances arising of this difficult situation. There are numerous factors contributing to eventual loss of femoral bone stock, including periprosthetic fracture & osteolysis infection. In cases where proximal femur is severely deficient, treatment options are drastically limited.

Surgical Options for Hip Replacement Surgery

Resection arthroplasty allows patients to have limited walking ability & function due to the short limb. Other surgical options in such cases include use of cemented or cementless long femoral stems which are intentionally designed to bypass the deficient proximal femur, impaction graft with cement & use of allograft-prosthesis composite. Last option however, is a major undertaking for the elderly frail patient which requires a substantial period of protective weight-bearing following the operation. Moreover, this can also be followed by escape of greater trochanter, junctional nonunion & graft resorption.

Segmental Modular Replacement System

Segmented modular replacement system or MRS in short is also known as ‘Megaprosthesis’ was initially developed as a replacement for proximal femur patients with neoplastic conditions. These implants come in both, cemented & cementless versions & are modular so as to allow for replacement of exact length of femur which is deficient. These implants also have an inherent advantage over other options which typically serve to address severe proximal bone loss, like the allograft-prosthesis system. These include availability of implant & avoidance of risk of disease transmission which is generally associated with use of allografts. Even though a number of research papers have addressed functional outcomes of patients who have undergone proximal femoral replacement for severe bone loss, they do not specifically address quality-of-life outcomes of patients receiving modular replacement system. MRS can generally improve quality of life among patients with severely compromised bone stock. However, special attention needs to be given towards stability of the hip intraoperatively along with a constrained acetabular liner which should be used whenever risk of postoperative dislocation is high.

Low Cost Total Hip Replacement Surgery in India

With rising costs of healthcare all across the world, over the past few decades India has emerged as a pleasant surprise for people seeking affordable medical solutions outside their own country. Apart from the comparatively low cost of medical procedures in the country, quality of healthcare in India is also excellent. Large pool of expert doctors & surgeons in the country are some of the best & globally reputed with quite a few having initially trained & experienced for decades in medically advanced western countries like UK, Canada & United States before deciding to get back to their homeland. Most hospital facilities in India are equipped with the latest technologies & are also nationally & internationally accredited for high quality of standards. Managed by English speaking skilled nurses & professional staff, these healthcare institutions provide a great opportunity for international patients to seek medical solutions for their healthcare problems.

Also Read: Total Hip Replacement Surgery

Affordable Hip Replacement Surgery with IndianMedTrip

IndianMedTrip is one of the fastest growing global medical tourism companies based in western India. Associated with the top doctors & surgeons & some of the best nationally & internationally accredited hospital facilities, this company is well placed to pass on valuable cost benefits to patients coming here for treatment from all around the world. Along with a wide spectrum of affordable medical procedures offered by IndianMedTrip, vast range of seamless services provided by IndianMedTrip include identifying the best doctor & the most ideal treatment facility for treatment, assisting the patient obtain medical visas for him/her & the accomplice, a warm reception at airport on arrival for treatment, convenient mode of local travel, comfortable accommodation option which includes budget & luxury hotels or serviced apartments near the treatment facility, scheduled appointments with doctors & surgeons for diagnosis & treatment procedures, option for an exotic recuperative holiday at reasonable costs, follow-up evaluation checks at the treatment facility & an affectionate farewell when the patient is heading back home following recovery.

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