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Rehab Protocol for Hip Resurfacing

Posted on: 04/10/2008
Hip joint resurfacing has been developed for younger, active patients with debilitating hip arthritis. Joint resurfacing involves smoothing down the surface of the hip joint. Then it is covered with a metal cap on the ball side and a thin metal cup on the socket side.

Because this technology is fairly new, the long-term results are being studied. In this report, the functional outcomes of patients were reported one year after a metal-on-metal (MOM) hip joint resurfacing procedure. Measures included pain, range of motion, and strength. The ability to walk and climb stairs was also measured.

Most of the patients were less than 60 years old. All were very active and had good bone quality. After the MOM procedure, everyone was in a standard rehab program. The rehab protocol used was the same one used for total hip patients.

Patients begin walking on the first day after surgery. They gradually increase the amount of weight placed on the leg and the distance walked. Exercises to improve motion and strength are also increased. Frequency, intensity, and duration are advanced as quickly as possible. This is referred to as a progressive exercise and mobility program.

Three-fourths of the patients had a satisfactory outcome with very few problems. They had high levels of function and activity. One quarter of the group (25 per cent) had less than optimal results. They had persistent pain, loss of hip motion, and decreased strength. These factors resulted in decreased balance, difficulty walking, and limits in what they could do (function).

The authors suggest there is a need for a special rehab program for patients with MOM hip resurfacing. Just using the same protocol used for total hip replacement patients may not be enough. The timing of more intense activities may be important in getting optimal results.

Perhaps having a later phase of outpatient rehab is needed. Such a program could focus on regaining all hip motions. This is especially needed for functional activities like putting on socks and shoes or bending down to pick something up from the floor.

A second phase of rehab after discharge could also focus on improving balance, gait (pattern of walking), and postural stability. All three of these skills could help prevent falls and fracture.

Meredith A. Newman, MSc, MCSP, et al. Outcomes After Metal-on-Metal Hip Resurfacing: Could We Achieve Better Function? In Archives of Physical Medicine and Rehabilitation. April 2008. Vol. 89. No. 4. Pp. 660-666.

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