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.

1. Identify current options in total hip & total ankle arthroplasty
2. Discuss gait & balance mechanics & how these can be maximized post-operatively
3. Review ankle & hip joint anatomy, the concepts of hip strategies & ankle strategies for balance & the effect of surgery on joint receptors
4. Examine current literature on the importance of balance & proprioceptive training following each procedure
5. 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