Aquatic exercise boosts recovery from

Young Adult Hip Surgery

Recent years have seen advances in hip surgery for younger patients. This is largely attributable to improved understanding and recognition of the potential hip problems for this age group, and advancing surgical techniques that have developed in order to address these issues. Minimally invasive surgical procedures are more appealing to both patients and surgeons by offering improved recovery times. If problems are discovered early enough in the younger patient, then often there is the chance to preserve the life of the hip joint by performing surgery before more serious problems arise. There are many factors which may determine the type of surgery performed and at what age a patient requires intervention.

Below we outline the benefits of using aquatic-therapy post operatively, discuss two common young adult hip problems, and the surgical techniques which are now more commonly used.

Young Adult Hip Surgery Aquatic-Therapy benefits:

• As is evident in the video clip embedded in the case study below the body’s natural buoyancy in water relieves body weight, allowing for easier walking and functional movements (such as walking, step up’s, running, and eventually more challenging exercises like hopping and jumping) after the surgery. *It is important that these exercises are gradually introduced by an Aquatic Specialist Physiotherapist at the right stages of recovery.
• The hydrostatic pressure of the water has positive effects on reducing swelling which occurs post operation, which in turn helps regain more range of motion and reduces pain.
• Further positive influences on pain regulation are due to the relaxation effect of warm water and suppression of the sympathetic nervous system associated with water submersion.
• The sensory input of the water can also increase body position sense enabling improved feelings of balance and confidence.
• Through increased confidence and reduced pain patients are able to move more freely, which often leads them to report reduced fear and anxiety about the recent surgery. This has a feed forward effect where future behaviours and movements over the early stages of recovery will greatly determine long term outcome.

Hip Dysplasia

Hip dysplasia is characterised by the socket of the hip joint being too shallow. This condition is more common in women, and is a cause of hip arthritis in older patients. Patients who have hip dysplasia often start to get symptoms in their early 20’s or 30’s.

Pain starts to occur due to the abnormal stresses the misaligned hip has to withstand. This is usually due to impairment of the hip joint at the edge of the socket during movement. Unfortunately, if left untreated the result of this is progressive cartilage damage and the gradual development of hip osteoarthritis.

Periacetabular Osteotomy (PAO) is one of the more advanced surgical techniques available to treat hip dysplasia. “Periacetabular” means around the acetabulum (hip socket). “Osteotomy” means to cut bone. Therefore, PAO means to cut the bone around the acetabulum and reposition the hip socket to get improved joint mechanics.

PAO is a very effective procedure for the treatment of symptomatic acetabular dysplasia but requires an extended period of recovery post operatively to allow for the pelvic bones to heal. Recent advances in surgery have meant a smaller anterior (frontal approach can be used, sparing the gluteal muscles from trauma during the surgery.

Patients can only partially weight-bear whilst the pelvis bones around the hip socket are healing and this is one of the main reasons recovery in the buoyant environment of a pool is excellent in the early (0-12 weeks) recovery phase and beyond.

Femoroacetabular Impingement

Femoroacetabular impingement (FAI) describes a condition where typically on flexion (upward movement) of the hip, irregular contact (impingement) occurs between the outer edge of the hip joint socket and femoral head-neck junction (the thigh bone). This problem is more common in males, and tends to show a typical pattern of symptoms. The significance in the early recognition and undertaking of suitable surgery for the treatment of FAI looks to be high, in that the development of early osteoarthritis may be slowed or even prevented.

Early conservative treatment should involve activity modification and physiotherapy prescribed exercises. If, however symptoms are unable to be managed or the individual is unable to continue with their usual activities or chosen sports then surgical intervention should be considered.

Surgery for FAI looks to alter the shape of the femoral head and to address the injury that may have occurred to the hip joint socket. This aims to improve the available range of movement in the hip without bony abutment, thus improving pain and hopefully preventing or slowing arthritis development in the joint. This type of procedure is now commonly completed via key hole surgery (arthroscopy) which vastly improves the speed of recovery when compared too previous ‘open’ procedures.

Hydrotherapy can begin almost immediately after the operation and some hospitals will provide this for patients as early as the next day after surgery. This aims at working on offloaded walking practice and maintaining hip range of motion. Usually patients are given crutches for a period of 2 to 4 weeks and therefore low impact exercise which can be completed in the pool is very useful. The importance of being able to move naturally in the pool early in the recovery phase unrestricted by weight bearing restrictions or pain cannot be understated. This can form a large part of a low impact exercise programme for 2-3 months following the operation and help speed up recovery.