Total hip replacement (THR) surgery entails removing damaged or worn out cartilage in the hip and replacing it with metal, plastic, and/or ceramic implants. Estimates for hip replacement surgeries performed each year in the United States range from 120–300K. The recovery process for THR includes an early phase (1-2 weeks) which are aimed at pain reduction and early mobility, and a later phases (2 weeks +) with priorities of regaining strength and balance. Physical and Occupational Therapy are standard participants in the recovery process and help with, among other areas, regaining balance. Below are a list of 5 balance exercises (listed and referenced by number from the Haas Balance Book: 100+ Exercises for PTs & OTs) that are particularly useful for PTs and OTs helping patients improve balance following THR:
- Weight shifting (Forward-Back [Exercise 7], Lateral [Exercise 5], Hip Swivels [Exercise 8], Ankle Strategy [Exercise 9], and Hip Strategy [Exercise 10]) to help improve strength and weight acceptance on affected side. Emphasis is on equal movement excursions to affected and unaffected sides. Benefits include improved weight acceptance on affected side during gait and reaching tasks.
- Use of unstable surface (foam, rocker board, inflatable disc, small ball, etc.) under foot on unaffected side [Exercise 25]. Combine with sit to stands [Exercise 26] or reaching challenges [Exercises 11-15, Exercise 71, Exercise 88-93, Exercise 95-97] to increase level of balance difficulty. Benefit is increased reliance/demand on affected side for support in standing which helps increase strength and balance.
- Split stance [Exercise 17] + reaching challenges [Exercises 11-15, Exercise 71, Exercise 88-93, Exercise 95-97] that emphasize weight shifting forward and back. Benefit is stability in standing during reaching and weight shifting movements.
- Gait- Sidestepping [Exercise 41] in parallel bars (or at edge of counter) with reduced or no hand support. Typical hand support progression is two hands, one hand (contralateral side), one hand (ipsilateral side), and no hands. Benefits include building lateral hip strength and improving weight acceptance on affected side.
- Randomized Stepping with unaffected leg using balance dots [Exercise 73] or half of clock face (Clock Yourself app) [Exercise 75]. Benefit includes emphasis on improving weight acceptance and strength in affected side. If needed, add unstable hand support (ball, stick, etc.) for ipsilateral hand to give light balance assistance.