Total hip replacements and Occupational Therapy

I have a vested interest in this post. I am about to have a total hip replacement. I decided that it was time to get up to date with the latest does and don’ts and to see what online advice is out there. I was interested to see how well occupational therapy was using the internet to advise those needing surgery. What have I found?

Interesting there is little change in the advice since I trained 30 years ago.

What did I find and what did I expect to find:

  1. I expected to see a more occupation focus to the occupational therapy information. Most information talks only about ADL’s and related equipment. In living with a hip that needs to be replaced there seems to me to be a lot more that could be talked about. It was even difficult to find concepts such as energy conservation and work simplification.  
  2. I expected that there would be presurgery advice. I don’t mean information given out a week or two before surgery and associated with preparing for surgery and the weeks after, but rather advice to assist from the time the possibility of surgery is identified.  Advice that includes priniciples of joint protection on both the affected and unaffected side and that helped you keep in the best shape physically before surgery and helps you keep engaged and participating as things get harder to do (as of yet I haven’t found any info that would cover this).
  3. I found that there is an assumption in the information that if you are having surgery you are in the older age group and  not it seemed doing a lot! e.g. only needing to dress, shower, eat prepared meals for one, sit a lot (in the same chair) and occassionally drive a car!. Yet I know that  there are many very busy active 60 plus’s, and then there are the people like me I meet who are working, paying mortgages, engaging in a wide range of activities, some with young families,  all heading towards a hip replacement.
  4. That occupational therapists would have got together with consumers and worked up some really good information that all occupational therapists could use, after all there is no sense everyone reinventing the wheel. 
  5. That the advice would be consistant. There seems to be differences in some advice and no rational given for why the advice may differ e.g  whether you should sleep on the operated side or the nonoperated side, the precautions associated with internal and external rotation, and moving the operated hip backwards.
  6. Occupational therapy advice seems hooked on equipment, rather than techniques  e.g. what happens after the first week or so when the person get more active e.g what do you do if away from home and needing to go to the toilet and there are no high seats?

Therefore…

If you are heading towards a total hip operation what do you need to know in relation to the tasks and activities you want and need to do? Perhaps then occupational therapists will take up the challenge to design information that helps you.

and occupational therapists what are the best examples of information from occupational therapists already online? and why? and what evidence is there that should we be calling on in the information we put online?

I look forward to hearing your thoughts.

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11 responses to “Total hip replacements and Occupational Therapy

  1. Hi there,
    I was really interested to read your blog about OT and hip replacement surgery. I work as an OT Technician at the Royal National Orthopaedic Hospital in the UK and am also training to be an OT at Brunel University, London. I work mainly with patients in the short space of time that they are in hospital after hip replacement surgery. The work that OTs do has become so driven by discharge that I would agree that we seem to be fixated on equipment and generic information rather than treatment/therapy that’s tailored for the individual and giving accurate advice that doesn’t conflict with what other colleagues are telling patients. Your blog has opened my mind to considering how I approach my intervention and what patients really need to know both before and after surgery.

    Best wishes

    Michelle

  2. It would be of immense help to have the services of an occupational therapist after such a replacement. It will help you a lot in your mental and physical health. An OT will give you better ideas for coping with post operational issues. Your Occupational Therapist will help you in maintaining a health chart for you.

  3. Thank you, I’ve recently been searching for information about this topic for a while and yours is the greatest I’ve discovered so far

  4. I was excited to find this blog, but then saw the original post was from a year and a half ago. Being a little over 3 weeks out from a total hip replacement, I am looking for OT advice. I saw an OT once or twice in the hospital (while still on the narcotic pain killers that muddled my mind.) I think it was an OT who showed me how to use the device for putting on socks. But then I was on my own for 2 weeks, trying to figure out what daily living tasks I can do given my “posterior hip precautions.” After 2 weeks I have been getting physical therapy, but not occupational therapy. I would think both would be helpful as I work to get my life back.

  5. occupationaltherapyotago

    Hi Joan
    Great to hear from you. Yes I have been a bit lazy lately with the blogging I keep saying that it was time I did a bit more. I have just been remembering back to my first few weeks post surgery. I needed to be on crutches from the first six weeks and remembered the frustration of how to work out how to do all the things I wanted or needed to do. The standard things like sitting on a high chair to ensure the angle at your hip was more than 90%, the not bending down etc. But for me the harder thing was figuring out how to move stuff around to where I needed to use it, the phone was never with me when it rang and by the time I got there it would have stopped. I solved this when I found that I had a small cloth over the shoulder bag which meant I always had it with me. I got myself a thermal cup with a lid and a handle this I could carry as I clucked a crutch as well, the lid stopped the tea coming out. I needed to move carefully but it did mean that I didn’t need to stay in the kitchen to have a hot drink, if I was at home alone. I remember the freedom when I got down to one crutch and finally had a hand free! I got really good at putting things on a large dinner plate which I could carry with one hand (I couldn’t manage a tray). So at times I would be carrying a cup of tea with the dinner plate on top with a sandwich, fruit etc on top of the plate, but it meant only one journey 🙂 I also got really good at one pot fast meals as standing for a time was hard work ( perhaps I should write a recipe book although I suspect that I was sacrificing style and flavor for a meal taking as little time as possible). Looking back now I wonder why I didn’t get a perching stool for the kitchen. I also never managed to train the cat to keep out of the way.
    I hope all is going well with you. Jackie

  6. Emily Hodgkinson

    Really good information on here Jackie! Will be passing this onto my grandmother for when she has her next go at!
    Cheers,
    Emily

  7. occupationaltherapyotago

    Thanks Emily let me know if there is anything that could be added as a result of her experience
    Jackie

  8. I agree that the focus is more on discharge and not treatment. I am an OTA student and am working on a project about total hip replacements. In the project, I am supposed to include 5 functional treatment activities and can not find any resources to guide me in coming up with these treatment activities. It is really quite frustrating. I can only imagine how much more frustrating it would be if I was the one with a THR looking for guidance.

    • Hey Kat… I am now an OT student myself interning on an ortho floor. I am going crazy trying to think of occupation-based activities for my patients. Everything just seems so biomechanical. What did you find in your research? Would love some advice!

  9. Pingback: Ot After Hip Replacement

  10. Pingback: Occupational Therapy Activities For Total Hip Replacement

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