The protocol of post operations of total hip replacement

among Khartoum state -Sudan May 2021

Supervised By: Weam Abdualaziz Makkawi

‫طﮫ‪114 :‬‬ ‫﴿ َوﻗُ ْل رَ بﱢ زِ دْ ﻧِﻲ ﻋِ ْﻠﻣًﺎ ﴾‬
Submitted by:
1. Marah Daffaalseed jubartallah.
2. Muzn Muatsim Elsir.
3. Amna osman Ahmed.
4. Abeer Ebrahim Abdallah.
5. Waad Hamid Abdulaal.
6. Safiya nagmaldeen Osman.
7. Alzelal Abdualfatah Osman.
8. Nehal kamal nouralgalel ahmed.
9. Mishal Abdalla Mohamed nour.
10. Ashwag Mohammed Ahmed Basheer.
11. Marah SaadAldeen Mohmed Hamdan.
The Hip:

hip joint is a ball and

socket synovial joint, its
forms a connection from
the lower limbs to the
pelvic girdle.
What is a Hip replacement?

A surgical procedure
that remove and
replaces diseased joint
surfaces with implants.
And meaning of the
total replacement is
remove the head of
femur and acetabulum.
 Anatomy of hip
bones of the hip:

- femur
- pelvis, which is made up of three bones:ilium, ischium and pubis.

ligaments of the hip:act to increase stability:

- iliofemoral
- pub femoral
- ishiofemoral

Nerves of the hip:

- femoral
- obturator
- sciatic
- lateral femoral cutaneous
Muscles of the hip:
The movements that can be carried out at the hip joint are listed below, along with
the principle muscles responsible for each action:
● Flexion – iliopsoas, rectus femoris, sartorius, pectineus.
● Extension – gluteus maximus; semimembranosus, semitendinosus and biceps
femoris (the hamstrings).
● Abduction – gluteus medius, gluteus minimus, piriformis and tensor fascia
lata.
● Adduction – adductors longus, brevis and magnus, pectineus and gracilis
● Lateral rotation – biceps femoris, gluteus maximus, piriformis, assisted by the
obturators, gemilli and quadratus femoris.
● Medial rotation – anterior fibres of gluteus medius and minimus, tensor fascia
lata.
Biomechanical of hip:
The basic mechanical principles which govern how the hip joint maintains
equilibrium and balance during standing and performing activities is
explained along with the consequences when this balanced system is
compromised. A description of the movements and forces acting around the
hip joint that are expected during activities of daily living is offered and also
how these movements are affected following total hip replacement, with
particular reference to femoral offset and leg length inequality.
Common hip conditions requiring total hip replacement:
1. Osteoarthritis: Is the most common reason for hip replacement surgery. This is a degenerative
joint disease that affects mostly middle-aged and older adults. It may cause the breakdown of
joint cartilage and adjacent bone in the hips.its the most

2. Rheumatoid arthritis: This type of arthritis causes inflammation of the synovial lining of the
joint. It causes extra synovial fluid. It may lead to severe pain and stiffness.

3. Osteonecrosis: In healthy individuals, old bone is always being replaced by new bone. In order
for this to happen, bones require a continuous supply of blood. Bones that lack an adequate
blood flow break down faster than the body can replace. Over time, the bone tissue will die and
collapse. This condition is known as osteonecrosis or avascular necrosis.

is commonly caused by a fracture, dislocation, or another joint injury that damages blood vessels.
Common hip conditions requiring total hip replacement:
4. Hip Fracture: Occurs when either the head of the femur or the acetabulum breaks.
These injuries are often caused by falling or blunt trauma. Osteoporosis, which is a
condition that weakens bones, as well as obesity, can also make bones more susceptible to
a fracture.

5. Bone Tumors: When cells divide abnormally, they can form a lump of tissue called a
tumor. While most bone tumors are benign, they can be serious if they weaken bone or
interfere with the body’s structures
Gender Differences:

● Most commonly in geriatric specially female gender due to deficiency of

calcium in bones that makes it so weak and most susceptible to fractures.
Operation time:

● The surgery usually takes about one to two hours to complete.

The type of metal:
● Artificial replacement parts can be made of strong plastic, metal, or
ceramic. In most cases, the femoral stem component is built from
titanium, titanium cobalt, stainless steel, cobalt-chromium alloys, or a
titanium and cobalt mixed metal. The headliner and acetabular parts can
be made of either metal, plastic or ceramic, or a combination of the
above. Implant materials have to be strong but flexible in order to allow
for everyday movement. They also must be biocompatible (meaning
suitable for the body and won’t cause any reactions).
Complication of hip surgery:
● During operation:
1. Infection. Infections can occur at the site of your incision and in the
deeper tissue near your new hip.
2. Fracture. During surgery, healthy portions of your hip joint might fracture.
3. Nerve damage:- Rarely, nerves in the area where the implant is placed can
be injured.
4. Bleeding.
5. Blood vessels injury.
Complication of hip surgery:
● post operation:
1. Blood clots. Clots can form in your leg veins after surgery.
2. Dislocation. Certain positions can cause the ball of your new joint to come out of
the socket, particularly in the first few months after surgery.
3. Change in leg length. Your surgeon takes steps to avoid the problem, but
occasionally a new hip makes one leg longer or shorter than the other.
4. Loosening. Although this complication is rare with newer implants, your new joint
might not become solidly fixed to your bone or might loosen over time, causing
pain in your hip.
5. Pain
6. Stiffness
Steps of physiotherapy post operation:
● On the first or second day after your surgery, a physical therapist will come to
your bedside to begin your postoperative treatment. Your physical therapist
will review any post surgical precautions to take to prevent reinjury and to
help restore your full function.
● Depending on your particular case/surgical procedure, you may be asked to
limit the amount of weight you put on the surgical leg. It may be as little as a
toe touch, or as much weight bearing as you can tolerate. Your physical
therapist will teach you how to correctly put weight on the affected leg, and
will recommend an assistive device, such as a walker or crutches, to minimize
discomfort as you work to restore your physical function.
Steps of physiotherapy post operation:
During your acute-care recovery (the first 3 to 5 days after surgery), your physical therapist will work with you to help
you safely:

● Turn in bed and get up to a sitting position.

● Get out of bed to stand and move to a chair.
● Walk with the assistive device (walker or crutches) for short distances
● Perform gentle range-of-motion and strengthening exercises in bed.

After surgery, your physical therapist may advise you not to:

● Bend your new hip more than 90°.

● Bend forward more than 90° (eg, you will not be able to bend over to put on your socks and shoes for a while).
● Cross your leg with your new hip over the other leg.
● Turn the leg with the new hip inward.
● Physical therapy will continue for a number of weeks after your surgery. Depending on your overall situation,
you may need to recover in a short-term rehabilitation facility. Some patients are discharged to their home
without nursing home care, depending on the help available at home and their ability to stay safe. Your physical
therapist will help make this determination for you.
Steps of physiotherapy post operation:
As you progress in your recovery, you will continue to work on:

● Walking and stair climbing

● Balance – after surgery your balance may be impaired, which could put you at risk
for falls
● Transferring to the bed, a chair, and a car
● Full movement of your leg and new hip (such as putting on socks and shoes)
● Specific muscle strengthening exercises to improve your ability to stand and walk
safely and independently
● When you can perform these activities without help or guidance, you will be ready
to fully function at home. However, you may still need to continue physical therapy
in an outpatient clinic.
Steps of physiotherapy post operation:
● Outpatient physical therapy sessions will continue your work on
range-of-motion (movement) and stretching exercises, and
weight-bearing activities to restore your function to its highest possible
level. At this point, your physical therapy will focus on activity-specific
rehabilitation for your specific goals, such as a return to work or sport.
Your physical therapist will incorporate exercises that simulate those
activities. Your exercise regimen may include lifting techniques, pushing,
pulling carts, climbing ladders, agility exercises, or light jogging,
depending on your specific goals, your recovery progress, and your
activity level.
Referenc
1. https://teachmeanatomy.info/lower-limb/joints/hip-joint/
2. https://www.nhs.uk/conditions/hip-replacement/
3. https://www.beaconortho.com/blog/conditions-treated-by-hip-replaceme
nt/
4. https://www.drugwatch.com/hip-replacement/complications/
5. https://www.sciencedirect.com/science/article/abs/pii/S187713271630047
1
6. https://peerwell.co/blog/different-types-of-hip-replacement-implants/