- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad, what do you wanna talk about today?
- Well, Bob, I wanna talk about hip replacements.
- Okay. - Okay?
That's why we got the skeleton here.
We got the hip facing right towards the camera
so we can get right into it.
Now, if you need a hip replacement it's
because you have pain there from arthritis, typically.
- Sure.
- So the doctor's gonna explain to you
about how the procedure goes.
And right here...
Bob, maybe you can zoom in. - Yeah, I'm gonna ahead-
Yeah, I'll go to zoom.
Yeah, this is gonna,
I'm gonna kind of run this show here, Bob.
- [Bob] All right.
Like he thinks he always does.
- You take care of the camera
because we need some good close up shots.
- [Bob] All right, got it.
- [Brad] Okay, now a lot of people aren't really familiar
what the hip is, but you got the pelvis bone here,
that's a paddle-like bone,
and then the ball inside it right there is your hip
and what they're gonna do is cut right through here
and take the ball off and replace it.
And actually, while it's out, they're gonna saw,
it's amazing how they can take the acetabulum
or the socket, saw all the way around it,
and then they're going to cement in
a new socket as well as the ball.
Sometimes they only do one or the other,
That's called the hemiarthroplasty,
but we're gonna, we're talking about a complete one.
And then they're gonna tell you about precautions,
what to do, and specifically, what not to do,
because if this dislocates after surgery,
it's a big problem.
You do not want that to happen
and it can easily happen if you do the wrong things.
- [Bob] Can you show a dislocation on there, Brad,
or is that too tight?
- [Brad] Oh no.
We can dislocate this model.
- [Bob] So dislocating means basically
the hip comes out of joint.
- [Brad] Right, so if you dislocate the hip
literally it's gonna pop out like this.
And you know, obviously it's not gonna come off.
There's enough connective tissue that's gonna hold it
close to there, but it's gonna be painful
and they have to get that back in where it belongs
and then the tissues that you ripped apart
from doing the wrong movements,
- Has to heal. - Will have to heal up again.
- [Bob] Yep.
- Big no-no, I've had at least a half a dozen people
in the last 15 years do this.
- [Bob] I've had a couple myself.
- I've had two of 'em go to a restaurant
and gettin' in and out of a booth is where it happened.
- [Bob] Interesting.
- Yeah, so, and you can imagine why,
why you have to go through the precautions.
Now there's two major surgeries that they're gonna do.
The most popular one is the posterior hip surgery
and that's where they're gonna cut in more
from the back side of the buttock there.
On here, it's gonna be back in here.
They're gonna get in and do their work.
And then there's the anterior and then what that means
is they're gonna come in through the front side.
Anterior means front.
They're gonna cut in here and open it up from the front.
Okay?
Now, we'll put our friendly skeleton off to the side now,
and we're gonna go through precautions.
Posterior, if you got a posterior,
the most common one in the back,
one of the big no-no's is let's say,
well, let's get a chair here, Bob.
- [Bob] Okay.
- This is the one they're gonna tell you about the most.
'cause it's most easiest thing to happen
is if you lean forward, you drop your pen
and you lean forward to pick that up,
that is a really good way to dislocate that hip
if it's a posterior procedure.
Okay?
So no bending forward.
Here the hip is at 90 degrees.
You do not want to bend forward when you're sitting
or if you're standing, you're not gonna bend over
to pick something up like that.
- [Bob] So when you say 90 degrees, Brad,
you're talking about a right angle.
- Right, exactly.
No pun intended, right here.
- So one line runs here, one line runs here.
That's a right angle.
As soon as he leans forward,
that's less than a right angle and puts stress on.
- Stress in all those surgical sutures.
Mm hmm, okay, the next one.
Posterior, you can't cross your legs, okay.
They say no induction or if you're sitting like this,
you don't wanna do this either.
There's the midline here,
that's right down the middle of your body.
If this was the hip that was done,
we can't go past that midline.
That's number two.
And number three is, if this is a leg that's done,
don't let those toes turn inwards like that.
Now the biggest problem-
- [Bob] This is all still posterior, right Brad?
- Right, all posterior hip
and where this is gonna happen most is if you're standing
and you go right down to the feet, Bob.
- [Bob] Yep.
- Here's the foot that was done
and I'm gonna turn the walker this way
and I keep my foot planted and right there, okay.
It's not gonna matter where I turn.
- [Bob] Show it, do it wrong once Brad.
Do it, go all the way through it once and do it wrong.
- [Brad] Here, I'm turning and going that way.
That is gonna be a-
- [Bob] Show how to do it right now.
- [Brad] Okay, you simply take
small steps. - Take little steps.
- And keep your toes pointed in the direction you're going.
Small steps, take the stress off.
- [Bob] And just as a reference,
that is exactly how the two or three that I've had
actually dislocated their hip was they were standing
and they did exactly what you just showed.
They stood on the one leg
and then crossed over the other one.
- Now, the anterior procedure coming in from the front,
this actually has some of the opposite precautions.
Because they come in from the opposite side,
You can bend over all you want and it's not gonna dislocate
'cause they didn't come in from the backside.
Okay, so that's nice.
However...
And this one's kind of hard to do this.
You're probably not gonna do this anyways,
but you're not supposed to bring your hip back like this
or extend back like that.
Typically you're not gonna do that anyways.
You're gonna walk in a normal walk but you're probably not
gonna do a stretch like this after hip surgery.
So that's not a big deal.
The other one is hip external rotation.
So we just talked about the hip.
You can't point in, but now with that anterior,
you cannot point out and this one's a little easier to do
'cause if you're sitting,
a lot of people may have a natural tendency
to let that leg come out like that
so you gotta be a attentive to that foot
so the toe is straight out.
Do not let it go out.
You can let it go in.
You know, some people have that natural tendency.
I'm one of those people that that's comfortable.
I'd really have to be careful for that, okay.
So, and also when you're walking,
if you're walking, you go to a right hand turn
and the right leg is the involved one,
I'm not gonna point like this and make the turn.
Again, small steps.
- [Bob] Small little steps.
- Mm hmm.
- The other one's really easy.
You cannot lay on your stomach.
Most people have no interest in laying on their stomach
after their hip surgery.
And the last one, this is a very common
strengthening exercise for the hip.
It's called bridging.
It's used very commonly,
but you cannot do this and bridge up.
They do not want that to happen.
Okay, like that.
No bridging.
All right, so, go through. 'em quickly again.
Posterior coming from the backside,
no hip flexion greater than 90.
You can't bend forward.
You cannot cross the midline,
in other words, crossing your legs,
and you don't want the toe to point in.
Anterior, opposite.
You can bend forward.
You cannot bend backwards.
The foot you cannot externally rotate or point the toes out,
cannot lay on your stomach, and no bridging.
Okay, what do you think, Bob?
- I would say with all these Brad,
I would make sure to confirm these
with your therapist or your doctor.
They might even have a couple other precautions.
- Sure.
- I've had patients that are not allowed
to go into abduction at all.
- Sure.
- I just had one right now.
- Oh really? - Yeah.
And I'm not certain why, but there there may be something
that they found in the surgery.
So, you know, these are good to go over with your physician
or usually your physical therapist
and then you can, if these are all, what he says is correct,
then you can review it on our our video tape.
- You better believe it. - To make sure you understand.
- Yeah, and if you're forwarding over, 40 and over,
you might need a speech therapist to speak.
- That's right.
- But otherwise, tune into our video.
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- You better believe it.
- All right, thanks.