CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL, FINGLAS, DUBLIN 11.

The Sisters of Mercy

TOTAL HIP REPLACEMENT (T.H.R.)

PHYSIOTHERAPY PROTOCOL
APPROVED BY: Physiotherapy DATE: October 2007

PRE-OPERATIVE:

• Where possible all patients should be evaluated prior to surgery.

• Explain post-operative physiotherapy management.
• Complete subjective evaluation.
• Assess pre-operative joint range of motion, muscle strength,
mobility and general function.
• Respiratory assessment and treatment if necessary.
• Teach the patient deep breathing exercises, anti-DVT exercises.
• Teach patient independence with bed mobility and transfers.

POST-OPERATIVE:

• Check operation notes and post-operative physiotherapy and

mobility instructions.
Day 1

1. Check respiratory status and treat if necessary.

2. Check circulatory exercises.
3. Check static quads and static gluts.
4. Stand patient out of bed towards the operation side with a frame
and assistance of 2 or more as appropriate.
5. Practice stepping on the spot as able.
6. Return patient to bed or sit out for a short period if appropriate.

Day 2

1. Stand patient out of bed with assistance of 2 towards operation

side.
2. Mobilise with frame, assistance of 2 and partial weight bearing
unless otherwise instructed.
3. Sit patient out of bed for short periods.
4. Promote safety awareness and T.H.R. post-operative precautions.
5. Some patients if well can commence hip mobility exercises and
gait re- education (as day 3).

Day 3 onwards

1. Commence hip mobility exercises as appropriate. Avoid hip

adduction beyond the mid-line and flexion beyond 90º.
2. Gait: assess and progress. Frame, crutches or sticks as appropriate.
3. Transfers: assess and progress to restore independence.
4. Step or stair practice.

Attend Occupational Therapy Hip Education Group when independently

mobile.

Discharge Criteria

• Independent with appropriate walking aid.

• Independent with transfers.
• Steps/stairs negotiation if appropriate.
• Aware of precautions and possible complications.

Patients are invited to contact the Physiotherapy department to arrange a

review appointment three months post surgery.
Liase with other disciplines and family as necessary.
Refer for convalescence or community services as necessary.

Crutches are indicated in the following circumstances.

• Bone grafting.
• Revision surgery.
• An un-cemented prosthesis.
• Surgeons request.
• Lateral approach with Trochanteric wiring