A Novel Multidisciplinary Approach: Hydrotherapy and XSENS Motion Analysis in Rehabilitation of Avascular Necrosis Post-Total Hip Replacement with apoplexy- A Case report

Background: Avascular necrosis (AVN) of the femoral head is a progressive orthopedic condition that may require total hip replacement (THR) in advanced stages. Rehabilitation becomes more complex when compounded by neurological impairments such as stroke-induced hemiparesis. This report highlights a multidisciplinary approach involving orthopedic surgery, neurorehabilitation, hydrotherapy, and XSENS motion analysis in a patient with coexisting AVN and stroke. Case presentation: A 56-year-old male with a history of right femoral neck fracture managed previously with a vascularized fibular graft presented with chronic traumatic AVN (Grade IV) of the right femoral head. He also had residual left hemiparesis following a recent ischemic stroke. The patient underwent THR with intraoperative precautions due to neurological risks. Postoperatively, he experienced a tonic-clonic seizure, managed with antiepileptic therapy. A staged physiotherapy protocol, incorporating hydrotherapy and objective motion assessment via XSENS technology, was implemented to address both musculoskeletal and neurological deficits. The patient demonstrated gradual improvement in hip function, mobility, and independence in activities of daily living. Results: THR was successfully performed with minimal intraoperative complications despite the patient’s complex history. Postoperatively, the patient experienced a tonic-clonic seizure managed with antiepileptic medication. The physiotherapy program facilitated gradual improvement in hip function and mobility, while addressing neurological deficits and promoting independence in ADLs. Conclusions: This case underscores the importance of a personalized, multidisciplinary rehabilitation plan in patients with coexisting musculoskeletal and neurological conditions. Early diagnosis, comprehensive surgical planning, and integrated postoperative rehabilitation can significantly improve outcomes and quality of life in complex cases like AVN with stroke-related hemiparesis.