Hip Rehabilitation after Surgery

Hip replacement surgery is a very complex procedure. However, the outcomes following hip replacement are usually very successful. One of the important critical success factors for a successful outcome is following the physical rehabilitation process. 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.

Early rehabilitation

Your recovery program usually begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement needed during the first few days after surgery.

You may be given a device called an incentive spirometer that you inhale and exhale into. It measures your lung capacity and assists you in taking deep breaths. These exercises reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs following surgery.

The physical therapist 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 extremity. These exercises may include:

1. Gluteal sets: Tighten and relax the buttock muscles.
2. Quadricep sets: Tighten and relax the thigh muscles.
3. Ankle pumps: Flex and extend the ankles.

Your physical therapist will also teach you proper techniques to perform such simple tasks as:

1. Moving up and down in bed.
2. Going from lying to sitting.
3. Going from sitting to standing.
4. Going from standing to sitting.
5. Going from sitting to lying.

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.

The occupational therapist will also visit with you to teach you how to perform activities of daily living safely. They 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.

Precautions:

1. Do not bend forward to reach your feet. You must maintain a 90 degree angle between your torso and legs.
2. Do not lift your knee higher than your hip on the operated side.
3. Do not cross your legs.
4. Do not allow your legs to internally rotate (feet turned in).
5. Do not twist while lying or standing.
6. Sleep on your back with a pillow between your knees to prevent crossing.
7. Strictly observe your weight bearing precautions during standing or walking.

Also, the occupational therapist will instruct you in the proper use of various long-handled devices for activities of daily living. These devices may include the following:

1. A reacher to dress and pick things up from the floor.
2. A sock-aid that will assist in putting on socks.
3. A long-handled sponge to wash your legs and feet.
4. A leg-lifting device to move the operated leg in and out of the car or bed.
5. An elevated toilet seat so that you don’t violate your hip precautions when using the bathroom.
6. 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.

At Home

Following surgery, a physical therapist may help you with your rehabilitation protocol. 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 regularly basis to further strengthen your hip muscles. An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to mange.

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 physician.

• 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. 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 not drive unless you have been approved by your doctor.

Long-term rehabilitation goals

Once you have completed your rehabilitation program, 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 one of the most successful procedures in modern medicine and most patients return to a full and active life.

Some Content Courtesy of Smith & Nephew Orthopaedics