Total Hip Replacement (THR) Prehab with Blood Flow Restriction Training – Part 1/?

The hip joint, which is formed by the ball-and-socket connection between the femur and pelvis, is very susceptible to osteoarthritis (OA). As a result, THRs are very commonly performed in orthopedics with an extremely high patient-reported success rate.

Hip dysplasia is a coverage abnormality of the femoral head and is strongly associated with the development of Hip OA. Subsequent joint failure is common necessitating treatment with THR when the cartilage degeneration is severe and diffuse. It should be noted that high-grade diffuse chondral (bone) injury associated with severe OA is often very pain full during light activities and even rest.

Because of this most people become less active due to the pain, while muscles atrophy and function diminish. That is why prehab is paramount and can mitigate these losses leading to an accelerated recovery post-op. with the goal of a healthy functioning hip and importantly pain-free movement. Prehabilitation in THR is simply important to improve outcomes and speed up recovery Post Operations.!

The focus should be on strengthening the muscles surrounding the hip, such as the quadriceps, hamstrings, and glutes, with the keyword “muscle memory”.

Maintaining or improving Range Of Motion (ROM) Pre Operation. can also improve post-op. outcomes and the functional ability of the hip post-op. Though, is worth mentioning that mobility drills/stretches in hip OA are often associated with pain flair-ups neglecting the stiffness and decreased ROM as a protective physiological reaction. But if THR is already planned one could argue that this is of less concern relative to the inter-individual pain experiences and acceptance.

In the video, Alex is doing his prehab exercises before an inevitable THR. In his case, hip dysplasia and repeated physical stress are thought to be the primary causes of his sudden onset of severe uni-lateral osteoarthritic (OA) pain.

Intuitively, conventional resistance training was not an option because of the severity of the OA, prohibiting even moderate-heavy resistance type of exercise Pre-Op.

This is yet another example of a case with pain and load intolerance making BFR the obvious choice for prehab. As always, this recommendation is relative to patient preferences, but if ASAP returns to full functioning and strenuous physical activity is the main goal post-op, BFR can be a game changer!

Disclaimer: Always individualize the prehab. It’s recommended to discuss individual needs and goals with a physical therapist and the surgeon before THR.

Source:
Mats Brittberg et Conrad Slynarski (2021) Lower Extremity Joint Preservation: Techniques for Treating the Hip, Knee, and Ankle

Jørgensen et al. (2022) Effects of Resistance Training Prior to Total Hip or Knee Replacement on Post-operative Recovery in Functional Performance- A Systematic Review and Meta-Analysis

Bielitzki et al (2021) Time to Save Time- Beneficial Effects of BFR and the Need to Quantify the Time Potentially Saved by its Application during Musculoskeletal Rehabilitation

Secondary Source:
Franz et al. (2022) Impact of a Six-Week Prehabilitation With Blood-Flow Restriction Training on Pre- and Postoperative Skeletal Muscle Mass and Strength in Patients Receiving Primary Total Knee Arthroplasty

Davidson et al. (2017). Lean Muscle Volume of the Thigh Has a Stronger Relationship with Muscle Power Than Muscle Strength in Women with Knee Osteoarthritis

Masaracchio (2023) Resistance Training in Individuals With Hip and Knee Osteoarthritis: A Clinical Commentary With Practical Applications

Dalton et al. (2023) Blood Flow Restriction Training for Individuals With Osteoarthritis