Why limp after hip replacement

Side planks with leg lifts is a good exercise to help eliminate the limp after hip replacement. Video of the Day. Heed Your Hip Precautions. Weakness and Trendelenburg Gait. Hip Abductor Strengthening Exercises. Perform 10 repetitions of each exercise, working up to three sets in a row.

Side-Lying Leg Raise. Lie on your unaffected side with your legs stacked on top of each other. Bend your bottom knee, if needed, for comfort. Lift your top leg up toward the ceiling as high as possible. Hold for one to two seconds; then slowly lower back down. Add Clamshells to Your Routine. Clamshells are also performed while lying on your unaffected side.

Keeping your legs stacked, bend both knees to approximately 45 degrees. Tighten your abs to help stabilize your core. Keeping your feet together, lift your top knee up toward the ceiling — opening your legs like a clamshell. Hold for one to two seconds; then lower back down. Make this exercise harder by looping an elastic resistance exercise band around your thighs. Try the Fire Hydrant. Begin on all fours with your wrists in line with your shoulders and knees in line with your hips.

Keeping your knee bent, lift the affected leg up and out to the side. Keep your back flat and abs tight during this movement. Alleviating the Limp after a Total Hip Replacement. The figure 4 stretch. In-person and virtual physician appointments. Book online. Urgent Ortho Care. Same-day in-person or virtual appointments. Get care. Departments and Services. Make an Appointment. Do not allow your pelvis to rotate during this exercise. Lifting the knee as high as you can without rotating the pelvis, breathe for 1 long second at the top and bring your leg back down.

Do this about 10 times. After 1 set, rest for 20 seconds and repeat this exercise for 2 more sets. Scoot all the way to the edge of your exercise table. Let your recovering leg dangle in a relaxed state while you do this.

This stretch will create some tension in the front of your thigh and in your hip. Modified anterolateral Watson-Jones approach: The skin incision for the modified anterolateral Watson-Jones approach extended from the tip of the greater trochanter to the ASIS. The tensor fasciae latae and the anterior border of the gluteus medius muscle were identified before the hip joint was entered Figs. The anterior capsule was identified and was cut in a T shape.

The femoral neck was identified and was cut as per the preoperative template 7. The gluteus medius muscle was retracted posteriorly, and the tensor fasciae latae was retracted anteriorly to allow entry into the hip joint. We began with reconstruction of the femur first so that we were able to test the impingement immediately after completing the insertion of the trial acetabular component.

If impingement of the acetabular cup and femoral neck was identified, we modified the anteversion of the acetabular cup until there was no impingement.

For the posterior approach, the posterior capsule and short external rotator were reattached to their insertion points. For the direct lateral approach, the anterior aspect of the gluteus medius muscle was repaired to the point of its insertion. For the modified anterolateral Watson-Jones approach, it was necessary to repair only the anterior capsule.

Patients were encouraged to walk on the first postoperative day, and they were discharged when they were walking with walking aids and did not need intravenous pain medication. Follow-up evaluations were performed at 2 and 6 weeks; at 3, 6, and 12 months; and annually thereafter.

Anteroposterior and lateral cross-table radiographs of both hips were made at each follow-up. We computed the differences in the rates of limping, sex, operative site, and dislocation with use of the chi-square test. Continuous data e. We identified patients who underwent a primary total hip replacement: 1 Group I 43 patients, posterior approach , 2 Group II 53 patients, direct lateral approach , and 3 Group III 56 patients, modified anterolateral Watson-Jones approach.

No patient was lost to follow-up. Overall, limping rates were low and were not significantly different: 6. The Harris hip score, alignment of the acetabular component, and blood loss were not significantly different between the 3 groups, but the modified anterolateral Watson-Jones approach was associated with the longest mean operative time Table III. The preoperative and postoperative hip abductor muscle strength was not significantly different between the 3 groups Table IV.

The preoperative hip abductor muscle strength of patients with femoral neck fractures was excluded because pain precluded its assessment; therefore, preoperative strength was only assessed for 7 hips that were treated with the direct lateral approach.

No postoperative complications such as groin pain, pseudotumors, squeaks, ceramic fractures, pulmonary embolism, deep vein thrombosis, or aseptic loosening of the femoral or acetabular component were seen. However, 2 patients 1 who had had the posterior approach and 1 who had had the direct lateral approach had infections at the operative site following urinary tract infections and required a 2-stage revision total hip replacement.

The prevalence of limping following primary total hip replacement is a controversial topic. Some studies have shown the same prevalence in association with the direct lateral and posterior approaches 3 - 5 , whereas others have shown higher rates in association with the direct lateral approach range, This study has different results from previous studies for several reasons.

First, the procedure described in the present study involved cutting less of the gluteus medius muscle than is the case with the original Hardinge approach 15 ; therefore, the strength of the gluteus medius would be expected to revert to normal or nearly normal after the operation Table IV.

Second, we excluded patients who had other causes of postoperative limping, including decreased horizontal offset, non-restoration of the center of rotation, limb-length discrepancy, and superior placement of the acetabular component 21 - Therefore, our data on postoperative limping are specific to the surgical approach. The present study had some limitations.

First, it was a retrospective cohort study, and, as the patients were not randomized, there may have been selection bias. Second, patients with femoral neck fractures were managed with the direct lateral approach, which is associated with postoperative limping. Third, we did not perform magnetic resonance imaging MRI or electromyography EMG to detect degeneration or rupture of the abductor muscle, although all patients had only mild to moderate limping and no lateral hip pain.

The postoperative hip abductor muscle strength was also similar between the 3 groups. In conclusion, the present study did not reveal significant differences between the 3 approaches in terms of the prevalence of postoperative limping. The direct lateral approach was associated with a low rate of postoperative limping despite the necessity of cutting the anterior part of the gluteus medius muscle. Disclosure: The authors indicated that no external funding was received for any aspect of this work.

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