Physiotherapy after Hip Replacement : Deformity correction

Physiotherapy after Hip Replacement : Deformity correction


Hi friends Many of our hip replacement patients when go back home after surgery they face two types of problems Number one the patient feels that their long standing hip deformity is still persisting OR their physiotherapist get confused about the exercise regime The exercises that we usually advise you are standard exercises to be followed by all patients but there are certain exercises which are deformity based Deformity is variable. Some patients have thighs fixed in outward position others have thighs fixed in inward position accordingly the physio regime is modified Similarly when we operate we keep the type of deformity in mind in some patients when they lie down on bed their knees dont touch the bed in others the spine is off the bed in some patients knees dont touch each other while lying on side In some patients their thighs touch against each other while walking they have difficulty wearing pants , they can’t ride a bike we have to keep all this in mind We will discuss about this topic today and will tell you some technical details which will be useful for patients as well as physiotherapists who are treating them after the surgery it’s particularly important for those patients who are from other cities and hence are unable to get proper guidance If we look at hip joint from front this is femur this is neck, head and this is socket this is pelvis and this is spine Looking from front there are two types of movements when leg goes inward it’s called adduction when leg goes outward it’s called abduction though there are other movements also like flexion, extension and rotations but from deformity point of view when the leg goes inward it’ called adduction and when the leg is fixed in this position it is called Adduction deformity it’s commonly seen in AVN patients When the legs is fixed in outward we call it Abduction deformity commonly seen in Ankylosing Spondylitis Though deformities can be found in different combinations sometimes we have adduction deformity in one leg and abduction in the other but broadly speaking we get adduction deformity in AVN and abduction deformity in Ankylosing Spondylitis The muscles that pull the leg inwards which are attached from here to pelvis they are called adductor muscles Muscles causing adduction are adductor muscles Muscles attached from pelvis to the outside of hip they cause abduction movement and hence called abductor muscles similarly Muscles causing internal rotation of hip are called internal rotators Muscles causing external rotation are called exterrnal rotators Now we ll talk about them in detail with diagram this is the diagram of a normal person this is hip joint leg these are adductor muscles and internal rotator muscles These are abductor muscles and external rotator muscles They work in groups So when the patient has adduction deformity like in this AVN diagram In this the legs are fixed inwards the thighs are very close to each other you must have seen such patients in our videos so when thighs are fixed inwards these adductor muscles become very tight and short and the abductor muscle are lengthened and any muscle that is lengthened is a weak muscle so what should be our approach — during surgery and after surgery During surgery we release the tight adductor muscles we increase their length so that thigh can move outward but the abductor muscles are lengthened and weak Hence it’ very important to strengthen them in post op period So in post op physio we stretch the adductor muscles to increase their length and we have to strengthen the abductors and shorten their length There are two advantages of this approach Patient’s thigh will move outward plus the limp caused by weakness of abductors will also be taken care of Now we come to Ankylosing Spondylitis this is the usual shape of their legs Thighs are fixed outwards when patient sleeps, knee never touches the bed They have wide legged gait in this case adductor muscles are lengthened and hence are weak and the abductor muscles are short and tight During surgery we lengthen the abductor muscles and post operatively it’s the job of physiotherapist to stretch the thigh inward so that the abductors gain length plus we srengthen the adductors so that when patient is lying on bed, he can hold it erect towards midline It will correct the deformity and improve the gait Saidul is a post operative patient of Ankylosing Spondylitis and his deformity before surgery was like this where limb was fixed outward in abduction In this case the adductore are stretched out and weak and the abductors become tight During surgery we released them and hence the limb has come to normal position Before surgery the knee could not touch the bed and the thigh was fixed outward alongwith we are strengthening the abductors Let me explain the movements this is called abduction and this is adduction abductors were tight, they were released Now we can make inward movement plus we will make abductors stronger The knee was like this before surgery and it remains like this while sleeping and knee doesn’t touch the bed in surgery muscles were released, and it has come down “how many days back were you operated, saidul ?” “four days” In four days the muscles are reasonably relaxed we are now strengthening the adductors Another thing that we talk about many a times is flexion deformity flexor muscles are tight in flexion deformity and extensor muscles are weak It’s too early for extensor strengthening Flexors were released during surgery and the limb has come down but extensor strengthening we ll start after one week of surgery Vinay is a case of post operative AVN hip Thighs were tightly close together he was not able to ride bike because of it we released the adductors now thighs can be spread out Due to adduction deformity, abductors were stretched out and hence becomes weak So during physio adductors will be stretched and the range of abduction will be gradually increased Along with we will strengthen the abductors these will be our two goals in physio one — stretching of adductors two — strengthening of abductors because the limping will persist if abductors are weak The message of today’s discussion is many a times when patients go home after discharge from hospital they don’t contact the physiotherapist and start exercises on their own But I will re emphasise it that technical help is must in follow up period after surgery Good surgery plus Good physiotherapy gives a Good result Physiotherapists are expert in the field of exercises, they are an integral part of treatment But unfortunately some of our patients especially those living in remote villages are not able to get the services of therapists The surgeon and the therapist should work as a team every patient is different all patients of hip replacement can not have the same regime of exercises We have to understand that What was the patient’s pre op deformity should be clear to everyone in the team Many of our patients tell us that after physio session the pain has increased This happens when the do’s and dont’s are not clear between the surgeon and the therapist we should be clear which exercise has to be done which muscle has to be strengthened which muscle has to be stretched which type of implant has been used, what is the quality of bone Regarding this we should be on the same page

12 comments on “Physiotherapy after Hip Replacement : Deformity correction

  1. styl uhg Post author

    डॉक्टर यू आर एक्सप्लेनींग वेल. आई अपरीसीयेट यूअर नाँलेज . आयम नाँट यूअर पेशंट बट दीस पर्टीक्यूलर एडवाइस हेल्पड मी

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  2. Af Sarfaraz Post author

    Dr sahb m avn ki patient hu age 39 hy dr hip replacement ka khty hen lkn kuch doctrs khty hn k ap jtna tolrat kr skti hen karien mujy jald hip replacement krwani chaihy ya jb tk pain ko torate kr skti hu karu mera b abducter tight hy limping h r shorting b ap ki vedios kafi infomative hti hen kindly sir ap mujy b guid kr dain thanks

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  3. Sourav VK Chandra Post author

    Thank you sir…..I am a Ankylosing spondylitis patient ….I have chronic Groin pain….may be my hips are partially fused…I can walk but I can't ride bike and can't do cycling….Any advise sir…I want to take treatment from you.
    Thank you sir

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  4. Vineet Gusain Post author

    Sir , metal rod in my leg is touching my knee cap… April this year it will be taken out… my knee bending is 100 degree.. will it get bend 180 or touch hip

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  5. Mona hair style mona hair style Post author

    Sir mujhe avn tha 12 sal sy.abi 6 month phly sergury krwai.doctor ne pyosothrapi ka mana kya k nhe krwani…mein ne nhe krwai..abi mein pori tra theek nhe hui..please ap batain k mujhe kya krna chaye…plz reply

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  6. Devesh Gaikwad Post author

    सर सेकंड टाइम हिप रिप्लेसमेंट कैसे होता है क्या चेंज किया जाता है क्या फायदे क्या नुकसान उसके बारे में जानकारी दें प्लीज़

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  7. Gulshan Aftab Post author

    excellent video
    i have already got my left hip and knee replacement by dr. ashwani maichand and I'm preparing for my next soon. Information you gave before or after any surgery is excellent. I'm going to see you soon sir

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