Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hip Replacement, Total


Related Terms

  • Hip Arthroplasty
  • THR
  • TJR
  • Total Joint Arthroplasty

Specialists

  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

  • Bursitis
  • Obesity
  • Osteoarthritis
  • Other musculoskeletal disorders of the back, pelvis, and lower limbs
  • Presence of disease in the other (contralateral) hip joint
  • Rheumatoid arthritis

Factors Influencing Duration

Length of disability may be influenced by complications from the procedure, any underlying disease process, age, and the individual's job requirements. Sedentary and light work can be performed sooner if done sitting. Hip replacement is not compatible with heavy work. Disability may be permanent.

Medical Codes

ICD-9-CM:
81.51 - Total Hip Replacement; Replacement of Both Femoral Head and Acetabulum by Prosthesis; Total Reconstruction of Hip

Overview

© Reed Group
A total hip replacement (THR) is a surgical procedure whereby the diseased connective tissue (cartilage) and bone of the hip joint are surgically replaced with artificial materials. The hip joint is a ball and socket joint. The ball is the head of the thigh bone (femur). The socket (acetabulum) is a cup-shaped indentation in the pelvis.

During hip replacement surgery, the head of the femur is removed and replaced with a metal ball set on a stem. The stem is inserted into the canal of the femur. It may be fixed in place with cement, or the stem may be designed for placement without bone cement. The socket is sanded down to healthy bone, and a plastic cup or socket is held in place with screws and/or bone cement.

Source: Medical Disability Advisor



Reason for Procedure

The most common reason for performing the total hip replacement procedure is progressively severe degeneration of the hip joint (arthritis) that causes pain. The most common type of arthritis leading to THR is degenerative arthritis (osteoarthritis) of the hip. Other conditions leading to THR include bony fractures of the hip joint caused by trauma (such as a fall), and death (necrosis) of the hip bone.

Hip joints are replaced when individuals have severe pain, significant loss of motion, and an inability to perform routine and recreational activities. THR is elective surgery; the decision to proceed is largely the individual's and is based primarily on pain. Even if the hip joint is damaged, hip replacement is generally not performed if the individual is not in pain.

The most common site individuals experience pain is in the hip joint where the ball and socket meet. Here, the joint surfaces may become damaged as the cartilage layer breaks down. The resulting friction during movement can create excruciating pain.

Hip replacement cannot be done if there is active infection in the joint or if the quality of the bone will not support the implants and increased weight bearing.

Source: Medical Disability Advisor



How Procedure is Performed

Hip replacement surgery normally is performed under regional or general anesthesia. During hip replacement surgery, the surgeon removes the diseased bone tissue and cartilage from the hip joint; the healthy parts of the hip are left intact. The surgeon then replaces the head of the femur and the acetabulum with new, artificial parts.

The surgeon may use a special glue or cement to bond the new parts of the hip joint to existing, healthy bone. This is referred to as a "cemented" procedure. In an "uncemented" procedure, the artificial parts are made of a porous material that allows the individual's own bone to grow in to the pores and hold the new parts in place. Sometimes a "hybrid" procedure replacement is performed, which consists of a cemented "stem" and an uncemented "socket." The new socket may be screwed to the hip bone. Hip replacement surgery usually lasts between 2 and 3 hours.

Some surgeons are beginning to employ a “minimally invasive” technique. An otherwise standard hip replacement, it uses from one or two smaller, less invasive incisions. The technique may reduce bleeding, as well as muscle and soft tissue trauma during surgery, and may in some cases allow earlier discharge to home or a slightly quicker return to full activity (Skerker). Some clinicians advocate using a direct anterior approach to further minimize soft tissue disruption and to possibly reduce some complications such as dislocation. (Lovell). Clinical research regarding these potential benefits, and any potential drawbacks, is ongoing but promising (Harkess; Swanson).

When the individual awakens, there will be an intravenous (IV) tube in place to administer fluids, pain medication, and antibiotics. There will be a small drainage tube called a "hemovac" collecting blood from the surgical site. A Foley catheter may be in place to drain the bladder until the individual is able to urinate independently. A removable brace or a firm pillow will be between the individual's legs to prevent rotating the hip or crossing the legs. Several measures are used to prevent blood clots, including wearing special stockings, the use of foot and calf pumps, oral, or subcutaneous injection of blood thinners. Hospitalization usually lasts for about 3 to 7 days.

Source: Medical Disability Advisor



Prognosis

The long-term prognosis remains good for most total hip replacement procedures. In general, total hip replacements currently last from 10 to 15 years (Skerker).

Source: Medical Disability Advisor



Rehabilitation

Ideally, rehabilitation begins before surgery by assessing the individual’s medical and social condition in order to determine what the individual might require postoperatively for a successful outcome. The main goal of rehabilitation after a total hip replacement is to restore function by controlling pain and normalizing gait.

Preoperative education and exercise emphasizing cardiovascular fitness, strengthening, and gait training is recommended (Hegmann). The main goal in the inpatient period is early ambulation and decrease of pain and swelling. Because many individuals experience an antalgic gait or limb weakness preoperatively, postoperative gait training and exercise may be beneficial (Roos). Stretching the hip flexors may also be useful (Harkess). Thrombolytics will be used during surgery and postoperatively to reduce the risk of blood clots (Skerker).

Individuals who undergo total hip replacement require both physical and occupational therapy. Occupational therapy is needed after surgery for instruction in adaptive equipment needs and activities of daily living modifications. Individuals can be assessed and trained by the occupational therapist in the use of equipment such as an elevated commode, tub seat, reacher, long-handled shoe horn, and long-handled sponges, as these facilitate independent activities of daily living in the postoperative period (Crowe).

Postoperative physical therapy is necessary for training in bed mobility, transfers, and gait on level and uneven surfaces, such as stairs. Weight bearing status is determined by the physician, and individuals may use assistive devices as needed. Knee and ankle range of motion exercises are indicated to prevent the development of postoperative circulatory complications, and to maintain strength and range of motion in these joints during this period of limited mobility. Some postoperative protocols dictate the use of hip exercise while others do not. Instruction in hip exercises is based on the surgeon's protocol and should be incorporated only if prescribed. When indicated, isometric exercises of the lower limb and the hip abductors help to regain muscle recruitment and strength. Cryotherapy and acupuncture are effective methods of pain relief (Hegmann). After discharge from the hospital, physical therapy may continue with the goal of normalizing gait, range of motion, and muscle strengthening of the involved lower extremity, according to the recommendations of the surgeon. Aquatic therapy may be useful for some individuals, especially if land exercises are not tolerated (Bartels). Individuals older than 60 may shorten their hospital stay and improve activity levels if they receive multidisciplinary therapy (Khan-Cochrane).

An important goal of therapy is to teach hip precautions to the individual and should be reinforced by both the physical and occupational therapists (Grissom). Care must be taken to protect the integrity of the prosthesis and the surrounding soft tissue during all activities and while at rest. All weight bearing and exercise activities should be continued under the direct guidance of the surgeon and within the movement limitations necessary to protect the integrity of the hip prosthesis. Restrictions of range of motion and weight bearing depend on the surgical approach; however, they are usually recommended for 6 weeks postoperatively. Later programs emphasize the progression of cardiovascular fitness and strengthening, with at-home exercise programs often sufficient for some individuals (Hegmann).

Most individuals can return to usual ambulation in 12 weeks (Skerker). The final goal of physical therapy is increasing functional abilities. The functional abilities include not only walking, but also abilities required for vocational and recreational activities. Muscle strength recovery can be slow, and by 6 months, only 50% of strength may have returned. Continuation of exercise therapy is encouraged to rebuild strength, but postoperative manual labor may be discouraged (Harkess).

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistHip Replacement, Total
Occupational TherapistDaily inpatient
Physical TherapistUp to 12-16 visits in 12 weeks
Note on Surgical Guidelines: Amount of outpatient rehab is very variable as per the physician's protocol.
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

As with all major surgical procedures, complications can occur. The most common complications following hip replacement surgery are deep vein blood clots (thrombophlebitis, deep vein thrombosis), infection, dislocation, and loosening of the prosthesis.

Thrombophlebitis can occur after any operation but is more likely after surgery on the hip, pelvis, or knee. Deep vein thrombosis occurs when blood clots form within the large veins of the leg. Pulmonary embolus occurs when the clot breaks off and goes to the lungs. Pressure stockings to keep blood circulating and medications to thin the blood can be used for prevention.

Longer-term complications may include decreased muscle strength, limited range of motion and flexibility, and gait abnormalities. These functional limitations have persisted as long as a year following surgery; some cases of hip joint weakness have persisted as long as 2 years. In light of these potential complications, extending therapeutic exercises and their potential benefits past the initial recovery period of 12 weeks when appropriate is considered reasonable (Skerker).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations should include no prolonged standing, limited stair climbing, frequent rest periods, and use of a walker or cane during early recovery stages. Stooping, squatting, and excessive forward bending should be avoided for 6 weeks. Riding in a car is permitted, but frequent stops (hourly) must be made to get out and walk and stretch.

A higher chair or firm cushions added to a low chair will be necessary to assist in standing. A chair with armrests to assist in standing may be needed.

In some cases, therapeutic exercise will continue past the initial 12-week recovery period.
With proper physical therapy, the individual should be able to return to an active lifestyle.

Source: Medical Disability Advisor



References

Cited

Bartels, E. "Aquatic Exercise for the Treatment of Knee and Hip Osteoarthritis." Cochrane Database of Systematic Reviews. Ed. E. Bartels. Issue 4 ed. John. Wiley & Sons, 2007. NA.

Crowe, J., and J. Henderson. "Pre-Arthroplasty Rehabilitation is Effective in Reducing Hospital Stay." Canadian Journal of Occupational Therapy 70 2 (2003): 88-96. National Center for Biotechnology Information. National Library of Medicine. 5 Dec. 2008 <PMID: 12704972>.

Grissom, S. P., and L. Dunagan. "Improved Satisfaction During Inpatient Rehabilitation after Hip and Knee Arthroplasty: A Retrospective Analysis." American Journal of Physical Medicine and Rehabilitation 80 11 (2001): 798-803. National Center for Biotechnology Information. National Library of Medicine. 5 Dec. 2008 <PMID: 11805449>.

Harkess, James W., and John R. Crockarell. "Arthroplasty of the Hip." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Hegmann, Kurt T., et al., eds. Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers. 2008 Revision 2nd ed. ACOEM, 2008.

Khan, F. , et al. "Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy." Cochrane Database of Systematic Reviews. Eds. W. Laupattarakasem, et al. John. Wiley & Sons, 2008.

Lovell, T. P. "Single Incision Direct Anterior Approach for Total Hip Arthroplasty Using a Standard Operating Table." Journal of Arthroplasty 23 7 Supp (20087): 64-68. National Center for Biotechnology Information. National Library of Medicine. 13 Feb. 2009 <PMID: 18922376>.

Roos, E. M. "Effectiveness and Practice Variation of Rehabilitation after Joint Replacement." Current Opinion in Rheumatology 15 2 (2003): 160-162. National Center for Biotechnology Information. National Library of Medicine. 5 Dec. 2008 <PMID: 12598806>.

Skerker, Robert S., and Gregory J. Mulford. "Total Hip Replacement." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

Swanson, T. V. "Posterior Single-incision Approach to Minimally Invasive Total Hip Arthroplasty." International Orthopaedics 1-5. National Center for Biotechnology Information. National Library of Medicine. 13 Feb. 2009 <PMID: 17653544>.

Source: Medical Disability Advisor






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