Hip Resurfacing Exercises

Hip resurfacing was developed in Birmingham, UK, as an alternative approach to total hip replacement for the management of hip pain and hip arthritis. A much smaller amount of bone is removed during the operation, allowing the retention of much of the patient's bone stock for normal hip function and potential re-operations.

This metal on metal hip resurfacing technique has been developed to relieve some of the problems of standard hip replacement, although there are still hip resurfacing problems and hip resurfacing complications. Hip resurfacing surgery is claimed to be less traumatic and that hip resurfacing recovery is quicker than normal hip replacement. While result look good, normal hip replacement may still be better in the longer term than hip resurfacing. NHS hospitals do perform this type of surgery although standard hip replacement is much more common.

The limited bone removal and the large size of the metal replacement hemispherical shells means that the hip is naturally stable unlike the small femoral head implants used for cemented hip replacement. This means that rehabilitation in the early stages is not limited in terms of joint range of movement as the chances of dislocation are very low.

Typical exercises in the first six weeks after operation are:

• Ankle movements up and down

• Pushing the knees down to tighten the quadriceps

• Bending the hip up and down by sliding the heel up towards the buttocks

• Sliding the straight leg out to the side and back a small distance

• Bending the knee to 30 degrees and keeping the feet together, letting the knee fall out to the side a small distance and back

• Holding the unoperated knee so that the leg is bent up towards the chest, gently bending the operated side knee up and down a little.

Sitting exercises include:

• Going up on tiptoe then pulling the feet up so you rock back on the heels

• Straightening one leg repeatedly

Standing exercises include:

• Going up on tiptoes

• Swinging the operated leg forwards and backwards

• Swinging the operated leg out to the side

• With the leg behind and the toes down, straightening and bending of the knee gently

• Feet hip width apart, straighten and bend your knees to maximum fifty degrees

Typical exercises after the six week period from operation are:

• Lying on the back, bend the operated leg towards the chest and ease it up repeatedly but gently with the hands

• Lying down and with the unoperated leg bent up towards the chest as far as it will go, straighten the operated leg down to the bed and hold for ten seconds.

• Lying with knees bent to 45 degrees and feet together, allow the knees to fall apart as far as they can, increasing this distance until both sides move the same.

There is a video of exercises at VideoMD here and a discussion of rehabilitation at eOrthopod.com.

Hip replacement exercises are similar to those for hip resurfacing but need to be performed with slightly more caution due to the small head of femur and the increased likelihood of levering the head out of the socket, dislocating the joint. A physiotherapist can design a joint exercise program to follow after hip replacement surgery which takes care of the safety aspects of the new joint and works at developing full ranges of motion and muscle strength.

Post hip replacement exercises are usually sufficient, along with good walking technique, to bring the muscles and joints of the hip region back to normal working, however in some cases the joint is very tight and hip replacement stretches may need to be performed. These should only be done under the supervision of a physiotherapist due to the risk of dislocating the joint or a soft tissue injury.

Initially on presentation with an early arthritic hip the patient will be given exercises for joint pain by the physio as the first step, then if the operation goes ahead they will review the patient for the appropriate hip replacement therapy. To get the best out of cooperation with the physio in rehabilitation it is very enlightening to watch a total hip replacement video as the visual clarity of what actually goes on in the operation makes the instructions for the post-operative period clearer.