RESTORING BALANCE & FUNCTION AFTER HIP & ANKLE ARTHROPLASTY – JASON HANDSCHUMACHER
How many times have you heard a patient say, “I had my hip replaced three years ago and it doesn’t hurt now. However, I just never got all my strength back and I still feel like I could lose my balance and fall”?
Following lower extremity total joint arthroplasty, it is common to focuses on pain reduction, basic trans-fers, range of motion and basic strengthening. Oftentimes this is where we or the patients stop. Long-term functional improvement and ambulation safety can be overlooked.
This course aims to emphasize the long-term outcomes following ankle and hip joint replacement. We will examine what current literature says about which post-operative deficits are most impactful and the best means of improving balance after the surgery. What works may be surprisingly simple.
- Identify current options in total hip & total ankle arthroplasty
- Discuss gait & balance mechanics & how these can be maximized post-operatively
- Review ankle & hip joint anatomy, the concepts of hip strategies & ankle strategies for balance & the effect of surgery on joint receptors
- Examine current literature on the importance of balance & proprioceptive training following each procedure
- Demonstrate which exercises & activities are most helpful, when to initiate each & which ones the patient should continue independently
Current options in total hip and total ankle arthroplasty
- Review surgical techniques and components
- Common Dx leading to THA and TAA
- Post-operative timelines and when to initiate balance training with each population
Gait and balance mechanics to maximize post-operative outcomes
- Review ankle and hip motions in “Normal” gait to understand which motions to emphasize
- Does the prosthesis limit range of motion and strength gain potential?
- Deficits at 6 months and 2 years post-operatively
- What is the role of proprioception and muscular response in balance and gait
Strategies for post-surgical balance
- The role of neuroplasticity in balance recovery
- Role of symmetry training and impacts on the contralateral limb
- Why surgery seems to have greater impact on ankle joint receptors than in the hip
- Greater muscle mass in the hip and which muscles are the keys in balance
The importance of balance and proprioceptive training following surgery
- Impact on patient perceived long-term outcome and how this can differ from the therapist
- Importance of patients regaining confidence and impact of fear of falling on actual falls
- How is the patient functioning long after discharge from formal therapy?
Post-operative exercises and activities demonstration
- Single limb stance and tandem stance activity early and late in rehabilitation
- Varying sensory inputs for progressions
- Effective strengthening exercises and proper dosing/overload principles
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