Background & Etiology
The hip joint is one of the largest joints in the body. It is composed of one osseous (bony) joint. The hip is built for weight bearing and movement in several different planes. Most of the stability of the hip is derived from the joint design, joint capsule, ligaments, muscle and a cartilaginous tissue called the labrum.
Bone and Joint
The hip, like the shoulder, is a ball and socket joint. It is formed by the head of the femur (thigh bone), which sits in the acetabulum, a part of pelvis. The head of the femur is a large ball and the acetabulum is a shallow socket. This design of the joint allows for greater mobility.
The bony joint surfaces of the head of the femur and acetabulum are covered with articular cartilage. The articular cartilage has a smooth and shiny surface that allows the ends of the bones to slide freely over each other. This is what enables the joint to move smoothly.
Arthritis
Arthritis is the wearing, degeneration or loss of articular cartilage in a joint. The three most common types of joint arthritis are osteoarthritis, Rheumatoid arthritis, and traumatic arthritis. The most common cause of hip pain is arthritis. These different types of arthritis can damage the hip joint so much that it functions very poorly. In these cases, a surgical procedure called hip resurfacing may be necessary.
Traumatic Arthritis
Traumatic arthritis occurs as a result of blunt, penetrating, or repeated trauma to a joint. Damage to the articular cartilage can occur when extreme force or pressure is exerted on a joint, causing the cartilage to tear or break off into small pieces. These pieces can become lodged in the joint, where they will rub against the other joint structures. This trauma can make the joint weak, causing the inflammation and pain associated with arthritis.
Hip Resurfacing
This surgical procedure is an alternative to total hip replacement. Younger individuals tend to be good candidates for this procedure. It involves the placement of a cap over the head of the femur and the use of a metal cup in the acetabulum. There is less bone loss required in this procedure and the risk of dislocation is reduced. It is recommended for patients who do not have large bone loss, rheumatoid arthritis or osteoarthritis.
The most common conditions that lead to a hip resurfacing are mild arthritis or traumatic arthritis. A hip resurfacing is not typically recommended for patients suffering from osteoarthritis or Rheumatoid Arthritis.
- Severe pain and aching in the hip
- Loss of range of motion of the hip
- Swelling around the joint
- Increased size or visible deformity of the joint
- Weakness that makes daily activities, particularly those that require bending at the waist, running or walking difficult
- A sensation of “cracking” or “crunching” in the hip joint
- Stiffness, that can be extreme, causing tremendous difficulty moving the joint
A hip replacement is a surgical procedure. A hip can be resurfaced, or the joint can be completely removed and replaced with artificial material.
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.
Following joint resurfacing surgery, a program of physical therapy interventions will be essential to recovering from the procedure and regaining range of motion and proper function of the hip complex. Common Physical Therapy interventions in the treatment of post-surgical hip resurfacing include:
- Manual Therapeutic Technique (MTT): Hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the hip. Use of mobilization techniques also help to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the shoulder and upper extremity to support, stabilize and decrease the stresses place on joint cartilage and hip joint.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement techniques and mechanics (for example, running, kneeling, squatting and jumping) of the involved lower extremity to reduce stress on bursa and tendons in daily activities.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser and others to decrease pain and inflammation of the involved joint.
Prognosis
Following surgery, it is important that the patient returns to full activity gradually. Instruction in daily activities and a comprehensive home program are helpful for regaining strength and range of motion in the hip as the surrounding tissues work with the new artificial joint to control the leg. Patients do well following a three-month regiment of physical therapy and may see improvements for up to 6 months to a year following the procedure.
