Home Exercise and Rehab
Gina John is a Pilates Practitioner and Registered Osteopath who has spent many years offering help and advice, especially to the over 50 age group.
She is founder of The Osprey Clinic in the St. Johns Wood area of London and now specialises in Home Exercise and Rehabilitation Programmes. For further advice on exercising safely, and a selection of exercise films for general fitness and medical conditions, visit the website: www.home-exercise-rehab.com
This month: Can hip replacement surgery be delayed and will exercise help to manage the pain?
Hip replacement surgery is offered to patients who have osteoarthritis or other forms of hip-related arthritis whereby the surfaces covering the articular surfaces of the joint have undergone significant degenerative change or erosion. Younger people may also require replacement surgery if they have suffered an injury or engaged in regular high impact sports. Also, correction for a congenital or developmental anomaly may be necessary.
Since the first successful design was developed in 1960 by Sir John Charnley, technological advances have aimed to achieve high performance, long wearing prostheses, to enable patients to have surgery just once in their lifetime, rather than undergoing revisionary surgery. Research suggests that patients below the age of 65 are likely to require at least one revisionary procedure, based on average UK life expectancy, so it may be beneficial to delay surgery if at all possible, until you are in your 70s.
If surgery is indicated, it is likely that you will be offered one of the two most common kinds of hip replacement operations. A Total Hip Replacement involves replacing part of the thigh bone and the articular surface which form the hip joint. As the joint is configured as a ‘ball and socket’, the head of the thigh bone (the femur) is replaced by an artificial curved surface, while the surface of the ‘socket’ (the acetabulum) is filled with an artificial material, to articulate with the curved surface of the thigh bone. Thus, creating a new artificial ‘ball and socket’ joint. Alternatively, a Metal-on-Metal Resurfacing of the hip joint may be performed rather than a Total Hip Replacement. This involves covering the existing joint surfaces with metal rather than replacing them with other materials.
Artificial joint components are usually fixed to bone by acrylic cement, although the materials used are at the surgeon’s discretion. Sometimes, if the bones are strong and healthy, the joint surfaces are simply treated to help embed the artificial parts securely into the joint. Artificial parts may comprise plastic (polyethylene), metal or ceramic materials and are used in different combinations, i.e. a metal ball with a plastic socket, which is the most common, or a ceramic ball with a plastic or ceramic socket. The latter and full metal replacements may be considered for younger or more active patients.
Total Hip Replacement Surgery may fail for several reasons. If significant bone loss occurs, the prosthesis may loosen. This may be due to osteoporosis or by the body’s natural response to the artificial components of the joint. For example, particles are produced in the joint from normal weight-bearing activities from the pressure, on the polyethylene surfaces or the interface between the cement and the bone. The body’s natural defences respond with antigen-fighting cells, termed macrophage, which contribute to the breakdown of healthy bone by the production of enzymes. Consequently, advances in hip replacement surgery are aimed at reducing the need for artificial components or consider how particles in the joint can be reduced. A combination of a ceramic head on a ceramic-lined socket and the use of Vitamin E-infused Polyethylene, have proven to minimize risks of prosthetic loosening.
Complications may also occur with Metal-on-Metal Resurfacing from particles which are released from the metallic surfaces within the joint. These particles may cause inflammatory reactions and subsequent negative health effects. Complications are higher amongst women and older age groups and therefore, younger men are more likely to be offered this surgical option.
The prescription of strengthening and muscle balancing exercise, prior to surgery, including core stability (abdominal and pelvic floor) strengthening is deemed to help the rate of recovery, and enable patients to become weightbearing, and take their first few steps, post-operatively.
Post-operative rehabilitation is also facilitated by recent surgical advances which approach the anterior aspect of the joint, rather than the posteriorly, as in the past. This ‘anterior approach’ minimizes the risk of muscle or nerve damage surgical.
Research continues in terms of techniques and component designs aimed at surgical optimization and this has engendered the use of surgical satellite navigation systems, thereby, improving the accuracy in positioning artificial components.
It is always prudent to seek consultation with an Orthopaedic surgeon for hip replacement surgery if you are suffering pain and mobility problems. After taking your general health and lifestyle issues into account you will be advised on whether surgery will be appropriate and which approach, as discussed above, would be considered to provide the best results.
If you are awaiting surgery or you wish to delay this option, drug interventions, including corticosteroid injections can be considered. Osteopathy is an effective natural treatment method for the relief of pain and inflammation and involves assisted stretches, massage and gentle joint articulation. Ultrasound and acupuncture are also used by many osteopaths.
The following exercises will help to strengthen the muscles around the joint and to relieve stiffness. However, exercise may be uncomfortable if inflammation is present, so discontinue the exercise if you feel pain and restart the exercises, when this problem has reduced, i.e. by medication or osteopathic treatments.
Please send your questions for future columns, or feedback, by email to Gina John on firstname.lastname@example.org
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