Hip & Knee Talks

This video is designed for patients having their operation at Horder Healthcare. If you are having your operation elsewhere, please check with your healthcare provider. Please refer back to this video as required and be sure to check out our other patient information videos. The reason you are watching this video is because you have either just had or about to have your hip replaced. There are many different reasons why someone undergoes a hip replacement, whether that be because of injury or trauma, but most commonly because of arthritis. Specifically osteoarthritis, although there are other forms. All of the information summarised in this video are in your Horder Healthcare booklets titled a Patient's Guide to a Total Hip Replacement'. Please ensure you refer back to your booklet throughout your recovery. If we think about the anatomy of the hip joint, the hip joint is a very stable but very mobile joint. It is composed of your long thigh bone or your femur. The head of the femur then sits in your socket or your acetabulum within the pelvis. The hip joint being very mobile can bring the leg up or flex. It can come out to the side or abduct, go out to the back, and it can also rotate inwards and outwards or circle. All of the muscles that perform those movements are located around the hip and in that outer buttock area, and also to the side of the hip. The exercises that you'll be taught by your physiotherapist after surgery will make sure that you regain full movement and good strength of your hip once again. Arthritis is a process which affects the cartilage that covers the ends of the bones. This cartilage normally allows that nice, smooth, guiding movement of the joint as you bend, straighten the leg, or as you wait there through that particular joint. This thinning or roughening can cause inflammation of the joint. This inflammation can cause stiffness, swelling, and pain. This means that normal activities of daily living, such as washing, dressing, completing housework or even walking or weight bearing can become difficult. The purpose of your total hip replacement is to replace the areas of the joint that have been affected by the arthritis and therefore address the pain and stiffness that you have been experiencing in day to day life. Would you believe that in order to perform a total hip replacement, your surgeon actually has to dislocate your hip so that the appropriate parts of the hip joint are exposed, and the procedure can take place? If we look at the components of a hip replacement, they are as follows. It is composed of a long stem, which would fit down inside the top part of your femur. A new head or a ball is then fitted on the end, and this sits in a new cup like so which would sit inside the acetabulum with inside the pelvis. This means that your nice smooth gliding movement of that hip joint is once again restored. Please don't expect to be pain free after you've had your operation. It is important to note that the pain that you are now experiencing is no longer your arthritic pain, but pain as a result of the surgery itself. It is very important that we get on top of your pain control straight from theatre, whilst on the ward, and then that you then continue to manage pain independently when you're at home. And there are many different ways that we can help address your pain post operatively. If you're in pain immediately on the ward, please make sure that you let your nurse or healthcare assistant know. There are many different forms of pain relief that we can give you, such as tablet, liquid form, or even intravenously through a cannula. There's also ice packs which are readily available for you to use at any point during the day or the night to help manage your pain. When you're at home, make sure that you do continue with your regular pain relief. You will be provided with some analgesia or pain medication to take home with you that you will use in the first couple of days after your operation to stay on top of your pain. As you go through that healing process, please make sure that you do continue to take your pain relief as indicated, so that you can get a good night's sleep, so that you are refreshed for the next day, so that it's comfortable when you weight bear through your new joint. But also, so that you can walk comfortably and confidently, both inside and outside. And also, so that you can regularly engage in your physiotherapy exercises, so that we can maximise the movement and the strength after your joint replacement. If you have any queries or concerns about pain management during your stay here or after your operation, please do not hesitate to contact us back here at Ward Healthcare. It is very common, as already discussed, to experience pain in your hip after you've had your surgery. But it is also common to experience pain referred down the leg, and this can be anywhere around your thigh and down into your knee itself. Alongside this, you might feel swelling around your hip joint, particularly where your wound or your incision is. During your hospital stay, and then when at home, please do make sure that you ice those affected areas regularly throughout the day, ten minutes at a time to help manage your pain and swelling. Hip precautions are no longer routinely followed after a total hip replacement due to evolving evidence in this field. However, in some circumstances a consultant may advise a particular individual to follow these. The physiotherapist who is treating you on the ward will make sure that you are fully aware of what precautions or restrictions you do or do not need to follow after your operation for the first six weeks post operatively. If you have been told to follow hip precautions, there are very specific movements that need to be avoided. However, with specific restrictions every total hip replacement needs to be mindful not to do the extremes of movement after their total hip replacement. And these are as follows. The first movement we want you to be mindful of is hip flexion. Hip flexion is the motion of taking your knee upwards towards your chest. We want you to do this movement, and you'll notice it is one of your standing exercises. However, for the first six weeks, we need you to make sure that you do not exceed over a ninety degree right angle with this movement. So making sure that your knee does not come too close to your chest. This same reach in movement would be achieved if you were to reach something or down to pick something up off the floor like so. So avoid doing that the first six weeks. If you do drop something onto the floor, what you can do safely safely is place your operated leg out behind you, have something secure to hold on to, and reach down and pick something up from the floor like so. As you can see, my operated leg or my knee and my chest are far apart from each other, and therefore not exceeding that angle. If there is nothing to hold on to, you may find something like a handy helper or a long handled rubber beneficial in this instance. Because then you can simply reach down to pick something up from the floor like so. The grabbers are also useful when you are trying to get dressed. So when you are trying to reach down with the socks or shoes, again, you don't have to exceed that particular angle. So having a grabber is a beneficial use of equipment. The other movement in this position is exceeding more than a ninety degree angle is sitting on a chair. Make sure that your chair is at an appropriate height so that your knee is not raised like so. It should be at a slight downward angle. Sitting on a cushion or finding chair raises for chairs at home would be a beneficial and appropriate choice to protect the hip in the healing phase. The next movement we want you to avoid is internal rotation. This is when you rotate the leg inwards, like so. It's not a very comfortable or natural movement, but you may find yourself when approaching a chair, you might find a need or want to try and pivot. We say no twisting and no pivoting on the operated leg for six weeks post operatively, and in the future as well to protect that hip. Instead, ensure that you do little steps all the way around. Feel your good leg against the chair behind you. Bring your operated leg forwards. Reach back with both hands, and slowly descend into the chair. The final movement is a combined flexion and internal rotation, which looks something like this. Again, not necessarily a natural movement, but if you were trying to reach for a sock or a shoe, you'd have the need or the urge to bend down like so. That is a no. Again, a useful piece of equipment is a long handled shoe horn, where you can simply make sure that you go down on the inside of the leg, so that my leg is in an outwards rotated position. So these restrictions are all here to help you stay safe and protect the hip in the initial acute healing phase after the operation for six weeks post operatively. If you were to exceed these particular movements you'd be at risk of dislocating your hip. Getting a good night's sleep after your hip replacement is very important. When you've been at hospital, you've probably been lying on your back with your legs stretched out in front of you. Lying on your back is the most advised position. However, you can lie on either side of your legs post operatively. Obviously lying on your operated side in the first few days and weeks will be irritable and painful as if you're lying on a bruise. And essentially, that is correct. Don't be alarmed by this. What you can do is lie on your good side or your unoperated side, but you must put a pillow in between your legs so that your operated leg does not roll over onto that side. In order to optimize the outcome of your new joint replacement, it is very, very important to complete your physiotherapy exercises on a daily basis. You have been taught the appropriate exercises whilst you are here on the ward for the initial stage, and these are all detailed in your booklets with pictures which will guide you through that rehabilitation process. At the three week point, there are a new set of exercises titled your advanced exercises, and these again will help the progression of your exercises. We advise you to do your exercises around three to four times each day, but it's very important to pace yourself. You will have good days and you will have bad days throughout your recovery process over the next six weeks. But please persevere. If you are having a bad day, it's okay to do less exercises, making sure that you're staying on top of your pain relief and also your ice. If you're having a good day, please do not try and do more and more because you might overload or overdo it, and therefore your pain levels may increase. Above all else, the exercises treat as your full time job for the next six weeks. Stay dedicated, persevere and you will get there and the outcome that you desire. It's really important we get you up and moving as soon as we can after your joint replacement, as this will help with your healing process. Initially, on the first time that you stand and walk, you'll be using a frame. I shall demonstrate as follows. Frame, operated leg, good leg to join. Frame, operated leg, good leg to join. Make sure that if you're in pain, you can offload by leaning through your arms, through the frame as much as you like. As you get more confident, you will find yourself progressing to the following walking pattern. Frame, operated leg, good leg through. Frame, operated leg, good leg through. As you can see, this demonstrates more of a normal walking pattern. When you feel happy and confident walking around the room or in the ward by yourself with the frame, it's ready to then progress to either elbow crutches or walking sticks. It's a similar technique to the frame, and the member of the physiotherapy team looking after you will progress you to either. Right now, I'm gonna demonstrate how to use sticks, but it's the same technique for both crutches and sticks, which will get you up on your feet and help you progress your walking. When using walking sticks or crutches, it's similar to when you use the frame. You put your sticks forwards first, your operated leg, and then your good leg to join. Sticks operated good. Sticks operated good. As you become more confident with sticks, you can start to step through just like you did with the frame. So sticks operated good. Sticks operated good. Over time, that particular process will become easy, and it might feel quite slow. Therefore, you can adopt the following pattern. Operated leg and opposite hand forwards at the same time, and then alternate. Bear with this technique as it takes quite a lot of concentration and coordination until you feel more confident. When your knuckles are no longer bright white, where you've been clinging on to the walking aids for dear life, and you feel confident pottering around inside at home, that is the time to go down to one walking aid. When you use one walking aid, you have it in the opposite hand to your operating leg. Let your other hand just relax and swing as you would do normally. If when you've gone down from two walking aids to one, or when you go down from one crutch or one stick to nothing. If you find yourself limping, picking up any bad habits, or if it feels painful, you're just not ready for it. In those instances, just reintroduce a walking aid because this would improve the quality, the comfort, the confidence, and speed of your walking. There's no true specific time frame for this, but most patients go down to the one walking aid at around the three week mark inside your house or home, and then going down to the one stick or nothing outside at a later date. If you know that the weather is poor or the outside surfaces are slippery, or if you're going to a public place, please do use the two just to increase the awareness of people around you. In terms of walking progressions, just gradually increase the distance of your walking on a regular basis. Don't be too over ambitious, and remember however far you go one way, you then have to go back the other way. Choose a destination where you know that there are regular rest stops or chairs positioned, or that it's a safe and flat surface. With regards to the walking, pacing yourself is very important. And as you continue to increase the distance that you are walking, at that point, you might be doing less exercises during the rest of the day. Building up to what you want to be doing whether that be golf, countryside or beach walking, getting the most out of your new joint replacement. There will be certain expectations that you have for yourself and that the consultant will have for your new joint replacement at six weeks. Firstly, we want your pain to be well controlled. Secondly, we want you to regain good movement and good strength in that new joint, and have the confidence to start to resume your normal activities of daily living and return to your hobbies and interests. We want you to be able to comfortably weight bear through that new joint, like so. In terms of stairs, by six weeks, you will probably be able to put one foot on each of the steps like so. With regards to walking, you may be using one aid still, whether that be a crotch or walking stick, or you may be independently mobile, and that is fine because everybody is individual and unique. With regards to driving, normally you can resume driving at the six week mark, and this is so that you can safely maneuver pedals and you must be able to perform an emergency stop. Your recovery process will continue beyond this point. The six weeks is the acute stage and you'll continue to see vast improvements in your movement, strength and function well beyond six months and even into a year post operatively. So please do persevere. It's really important that you have goals that you can work towards throughout your recovery. And these will change on a regular basis to being short term and long term, and these are specific for you. This could be regaining movement, regaining strength, the ability to do things by yourself, simply washing or dressing, or getting back to things like swimming or golf. If you are a keen swimmer it is okay to return to swimming once you've had your wound checked and that you are told that your wound is healed and fully dry. Please bear in mind that some pools are challenging to get in and out of, so maybe choose a pool that has steps that you can gradually walk your way down into. Please avoid doing breaststroke for the first three months post operatively, as the rotational element of this movement would put at risk that particular joint and would also be painful. Please do however perform any of the exercises as per your booklets in the pool as this can really help with that strengthening process. If you are a keen golfer, it is okay to start golf at the six week mark, but only half a swing. Gradually build yourself up to be able to complete a full swing at three months or twelve weeks post operatively. As I said, goals are specific for you. They direct your rehab and they can maintain your engagement. So persevere and ask for help or guidance along the way from your physiotherapist.