Hip Rehabilitation After Surgery
Hip replacement surgery is a very complex procedure. In order to ensure appropriate results of the surgery, it is important that you actively participate in the rehabilitation process and work diligently on your own to achieve optimal results for your specific circumstances. In order to help achieve the goals for a successful total hip replacement, you must actively participate in the rehab process and work diligently on your own, as well as the physical therapists, to achieve optimal results.
Your recovery programme usually begins the day after surgery. The rehabilitation team which may include physical therapists, a general practitioner, etc. will work together to provide the care and encouragement needed during the first few days after surgery.
The physical therapy will begin as early as 1-2 days after surgery. They will teach you some simple exercises to be done in bed that will strengthen the muscles in the hip and lower body. Remember that not all exercises will be appropriate for all persons - always stick to the exercises that the surgeon and physical therapist have instructed you to do.
These exercises may include:
- Gluteal sets: Tighten and relax the buttock muscles.
- Quadricep sets: Tighten and relax the thigh muscles.
- Ankle pumps: Flex and extend the ankles.
Your physical therapist will also teach you proper techniques to perform such simple tasks as:
- Moving up and down in bed.
- Going from lying to sitting.
- Going from sitting to standing.
- Going from standing to sitting.
- Going from sitting to lying.
IMPORTANT: Although these are simple activities, you must learn to do them safely so that the hip does not dislocate or suffer other injury.
Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and your therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance for accident or injury.
In some cases, the occupational therapist will also visit with you to teach you how to perform activities of daily living safely. Your rehabilitation team and your surgeon will provide you with a list of hip precautions which are designed to protect your new hip during the first 8-12 weeks following surgery.
Pre-Cautions and Warnings:
- Do not bend forward to reach your feet. You must maintain a 90-degree angle between your torso and legs and not bend forward further than that.
- Do not lift your knee higher than your hip on the operated side.
- Do not cross your legs.
- Do not allow your legs to internally rotate (feet turned in).
- Do not twist your middle or body while lying or standing.
- Sleep on your back with a pillow between your knees to prevent your legs crossing.
- Strictly observe your weight bearing precautions during standing or walking. Your surgeon / rehabilitation team will tell you what those are, i.e. how much you can carry with your new hip.
Also, the occupational therapist or physical therapist will instruct you in the proper use of various long-handled devices for activities of daily living.
These devices may include the following:
- A reacher to dress and pick things up from the floor.
- A sock-aid that will assist in putting on socks.
- A long-handled sponge to wash your legs and feet.
- A leg-lifting device to move the operated leg in and out of the car or bed.
- An elevated toilet seat so that you don’t violate your hip precautions when using the bathroom.
- An elevated bathtub chair to fit in the shower or tub.
The precautions following a total hip replacement must be strictly adhered to in order to prevent dislocation of the hip implant and the possibility of re-operation.
Following surgery, a physical therapist may help you with your rehabilitation protocol i.e. the exercises and do's and don’ts during your recovery and thereafter. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regular basis to further strengthen your hip muscles. An exercise and walking programme helps to enhance your recovery from surgery and helps make activities of daily living easier to manage. Here is a list of potential exercises that you may be asked to perform. If an exercise is causing pain that is lasting, reduce the number of repetitions. If the pain continues, contact your physical therapist or surgeon.
The following are examples of exercises your physical therapist may require of you to do. If you are uncertain about these, please ask him/her.
- Ankle pumps
- Quadricep sets
- Gluteal sets
- Heel slides
- Leg lifts
- Knee extension
- Hip abduction
While at home, you will continue to walk with the assistive device unless directed by your surgeon to discontinue use.
IMPORTANT: You must also remember to strictly follow the hip precautions and weight bearing instructions during the first few months following surgery. It is recommended that you do not drive unless you have been approved by your surgeon.
Long-Term Rehabilitation Goals
Once you have completed your rehabilitation programme, you can expect to be able to perform most activities of daily living with little to no pain or assistance. Patients following total hip replacement routinely are able to walk, dress, bathe, drive, garden, cook, and return to work. Although final outcomes may vary from patient to patient, total hip replacement surgery is frequently performed in modern medicine and most patients are able to lead a full life.