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Physiotherapeutic Hip Arthroplasty Rehabilitation

THE FOLLOWING INSTRUCTIONS ARE WRITTEN BY MY PHYSIOTHERAPISTS: MARIA ANDRIOPOULOU AND DIMITRIS YAMA WHOM I THANK.

The physiotherapist

  • assess the condition of your respiratory and muscular system preoperatively,
  • will teach you the exercises to increase muscle strength and hip mobility,
  • teach you how to move from/to bed and in the chair, how to walk with an aid, as well as how to climb/descend stairs,
  • it will show you which movements and positions are prohibited,
  • will indicate the aids you will need postoperatively,
  • he will teach you how to dress, how to move to the toilet and shower,
  • And finally it will indicate any changes in your space, making your life easier postoperatively.

Preoperative evaluation

As part of the preoperative evaluation, the physiotherapist will teach you and your family the exercises you will perform both before and after the operation. Because of many months, even years, of pain and reduced physical activity, your muscles and respiratory system are probably not in the best condition. By performing the right exercise program for you, it will facilitate your movements postoperatively and reduce the risk of complications from your respiratory system. Also, the physiotherapist will choose the best walking aid for you (walker or elbow bacteria) and teach you how to walk and go up and down stairs.

The physiotherapist can examine your home environment if necessary, and suggest any changes that will make it easier for you, such as placing lifts on your bed, choosing a comfortable chair for you, removing carpets, cables, pets, placing everyday objects at your waist level, etc. such as the lifting toilet seat, special bathtub and wall safety handles, sponge with long handle, shoe aid with bone, hand aid, garters, orthopedic socks, etc.

Postoperative rehabilitation

An important part of your full recovery is an understandable physiotherapy exercise program. Physiotherapy begins immediately after surgery and continues on a daily basis until you are discharged from the hospital. The exercise program is maintained even after your exit, while after the assessment of the surgeon and the physiotherapist, the presence of the physiotherapist at home is likely to be recommended.

The first session includes simple exercises done in bed, sitting on the edge of the bed, as well as walking, if your general condition allows it. In the coming days, our goal is to regain muscle control of the lower limb, in order to improve the way the exercises are done, sitting in the chair, walking and ascending/descending the stairs. Your immediate mobilization is always encouraged, for your faster independence, but also for the optimal functioning of all body systems (venous, respiratory, gastrointestinal).

From the first hours you are allowed to use your leg normally, throwing all your weight into walking, with the use of bacteria or a walker, unless otherwise ordered by the surgeon. Initially, pain and fear may inhibit normal walking, but with the help of a physiotherapist it will soon be restored. Usually, the use of the walker or the two bacteria lasts for the first 2 weeks after surgery, followed by the use of one bacterium for about another 2 weeks. The total duration of use of aids can be either shorter or longer, depending on the patient’s capabilities and physical condition, without this determining the outcome of the operation.

Before the operation, it is very common to detect leg misalignment, i.e. due to arthritis the affected limb is shorter than normal. But your body has adapted to this change and despite the surgeon restoring the length of your limb, at first you will feel that the operated leg is now longer. The restoration of the normal walking pattern will return in the coming months with exercises and the process of readjusting your body to the new data.

Exercises

These exercises are performed both in the preoperative and postoperative stages. It is recommended that the exercise program be done 2-3 times a day.

If you are unable to perform these exercises because of the pain, do not continue them.

  1. Muscle pump exercise: move the ankle and fingers up and down. This exercise helps blood circulation and decongest swelling in the calf. In combination with the use of orthopedic stockings and medication anticoagulants, it reduces the chance of thrombosis. Repeat 100 times a day.
  2. Isometric quadriceps exercise: lying on your back with your legs extended and a towel roll under the knee of the operated limb. Press the towel down with the knee, tightening the thigh muscle. Keep counting to 5 and relax. Repeat 100 times a day.
  3. Isometric gluteal exercise: lying on your back, sitting or standing, tighten your muscles, buttocks. Keep counting to 5 and relax. Repeat 100 times a day.
  4. Triple flexion exercise: lying on your back, slowly bend the operated leg by sliding the heel on the bed and bring it back. The hip angle should not exceed 900. Repeat 3 sets of 10 repetitions.
  5. Short-range knee extension: lying on your back and with a pillow under the knee of the operated leg stretch the knee. Do not lift the knee from the pillow. Repeat 3 sets of 10 reps.
  6. Hip abduction and adduction: lying on the bed with your legs extended, you open the hip outwards and return to the starting position. The exercise can be painful due to the approach of the operating room, but it is of particular importance because it helps you to walk and get up and down from the bed. Repeat 3 sets of 10 repetitions.
  7. Knee extension: sitting on the bed or chair with the leg hanging down, stretch the knee. Do not lift the knee or thigh from the bed. Repeat 3 sets of 10 reps.
  8. Pelvic lift: lying on the bed, bend both knees so that the soles are against the bed, and lift your pelvis high by squeezing the buttocks. You can help your body by pressing your elbows against the bed. Repeat 3 sets of 10 repetitions.
  9. 9. Push-up on the chair: sitting on a chair with your hands, detach your buttocks from the chair using your hands (i.e. stretching your elbows). Start with a little help by pushing lightly with your feet, while gradually all the weight is taken by your hands.
  10. Breathing exercises. After receiving anesthesia, it is very important to perform breathing exercises.

In addition to calm and deep breathing, as you can see below, you will perform exercises with the help of a small plastic breathing exerciser, which allows both you and the physiotherapist to monitor your progress.

In the second stage of rehabilitation, which usually begins after the 1st month after surgery, you can strengthen the program with the following exercises:

  1. Lifting a stretched leg: lying on the bed, with the knee of the non-operated leg bent so that the sole rests on the bed, tighten the knee of the operated leg and lift the whole leg stretched up. Repeat 3 sets of 10 reps.
  2. Hip abduction from a lateral position: lying sideways on the bed with the operated limb up, we lift it up by abduction. In the beginning, this exercise will be done with the assistance of someone else and you will gradually gain full control of the movement.
  3. Flexion – extension – hip abduction from an upright position: standing position holding the walker or a fixed object (table, chair, bed), direct your limb forward, backward and to the side with slow movements.

Pool or sea

Exercises in water are the ideal form of exercise and are usually allowed after 4 weeks, as long as your wound has fully healed. However, it is forbidden to swim butterfly style before 6 weeks. Start with exercises that will initially last 10 minutes – 15 minutes, after consultation with your physiotherapist.

The exercises should be done deep between your waist and chest, as the deeper the water, the more difficult the exercises increase.

On-site walking

Stand upright holding a handrail if necessary. During on-site walking, the knees should not exceed hip height. Repeat for a few minutes.

Semi-seats

Stand upright and hold on to the handrail if necessary. Bend your knees but not more than 900. Repeat 10 times.

Hip abduction

Stand upright and holding a handrail if necessary. Open your leg to the side, hold for a few seconds and return to the starting position. Make sure that your toes are facing forward and that you are not leaning to the opposite side. Repeat 10 times.

Hip Extension

Stand upright and holding a handrail if necessary. Bring your leg back, hold for a few seconds and return to the starting position. Make sure that your toes are facing forward and that you are not leaning forward. Repeat 10 times.

Walking exercises

Walk forward: Make sure you are given the same amount of time to each step.

Walk backwards: good exercise to strengthen the glutes and hamstrings.

Walk to the side: in both directions.

The above exercises can be difficult either by increasing the number of repetitions or by increasing the speed at which you perform them. You can also use a small flipper or the special pool weights.

Discharge from the hospital

By car

Most patients are able to return home using a conventional car. The exact instructions are given below. Don’t forget to remind your companion to bring the appropriate pillows with them. If the route is long, it’s a good idea to perform the muscle pump exercises while sitting, and every 2 hours be sure to take a break in your journey, walking and changing position for a while.

By ambulance

Ambulance transport is necessary in case of difficulty accessing the house, such as a long uphill/downhill or many steps (depending on the patient’s physical condition).

By plane

If you need to travel by plane, it is important to arrange for your seat to be in the aisle or emergency exit so that you can have your leg free. Muscle pump exercises to prevent thrombosis and the application of orthopedic elastic stockings are recommended.

Daily activities

Gait

Don’t be afraid to put your weight on the operated leg, unless you have a different order from the surgeon. Stand with your back straight and start walking with the walker or bacteria with equal stride length. Your step should not exceed the aid you are using. We do not lean over the aid. The correct order is as follows:

Forward Drive

  • Walker or bacteria
  • Operated leg
  • Unoperated leg

Reverse Drive

  • Unoperated leg
  • Operated leg
  • Walker or bacteria

Progressively use the one bacterium by holding it from the non-operated side. You start with the bacterium, followed by the operated and then the unoperated limb.

Don’t forget that walking is the most ideal exercise for the surgery you have had. There is no specific walking protocol. Start with frequent and short walks, which you will increase as your endurance improves. It is very important not to exceed your limits. If you notice increased sensitivity, pain or swelling in the hip area, reduce your activity, place ice and lie down with your foot on a pillow. If the pain persists, contact your doctor.

12. Commuting in bed

Getting out of bed

Bend the unoperated leg and by lifting your pelvis bring your body to the edge of the bed . Move your body to the other side and lower your unoperated leg under the bed. Push the mattress with your hands and push your body up by bringing your operated leg under the bed. Use your hands to bring your legs straight.

Getting on the bed

You sit on the edge of the bed. Place your hands behind the pelvis and pull your body in. Slowly tilt your body back, bringing the operated leg onto the bed. Bring the unoperated on the bed and help your body get into the right position. If you can’t get your foot up on the bed, you help it with the unoperated one.

 

13. Sleep

You can sleep on your back with a pillow between your legs for the first 6 weeks. In a side position with the operated leg on top, with a pillow between the legs. In a side position with the operated leg underneath, you can fall asleep after 6 weeks.

 

14. Steps

When you climb the stairs, always remember that in the first time the unoperated leg goes first. When you go down, you put the operated one first. Always keep the handrail on one side and the bacteria on the other.

15. Seat

When sitting in the chair, bed, or toilet, move closer to the rim of the chair so that you can rest it with the back of your feet. Put your hands on the arms of the armchair, lean and sit leaving your body slowly, with your operated leg stretched so as not to feel discomfort. Conversely, you get up. It is recommended to avoid prolonged sitting for more than 30 minutes in the first 4 weeks to avoid leg swelling. You can get up for a walk and sit down again after a while. In the toilet you use a pillow in the toilet lift and in the chair.

16. Automotive

In the car, you sit in the passenger seat. The seat is pulled as far back as possible to leave you plenty of legroom. Place a pillow on the seat. Approach the seat with the bacteria or the walker and sit with your legs out. Pull back a little further and bring both your legs in at the same time and put a small pillow between them.

17. Driving

To drive you almost have to be in pain, not use walking aids, have sufficient range of motion and have sufficient reflexes to manage a braking emergency situation. This happens about 4-6 weeks after surgery and after consultation with the surgeon.

 

18. Dressing up

When dressing, it is easier to wear the garment first from the operated side. Undress in reverse, first taking off your garment from the non-operated side. To put on your underwear, socks or tights, use the corresponding aid.

 

19. Bath

Bathing is allowed after cutting the sutures 15-20 days postoperatively. Ideally, the use of a shower is ideal. If there is none, for the first 4 weeks you sit in the toilet bowl with the lifter and you can bathe sitting with the spiral. After 4 weeks and if you have good balance with the help of a special handle, you enter the bathtub.

 

20. Kitchen

In the kitchen, reposition the contents of your refrigerator and cabinets so that you can reach what you need without bending over. A high stool or a high chair is useful for sitting, for example when preparing food. All heavy work e.g. vacuuming, making beds and cleaning the house must be done by someone else. Follow the above instructions for at least 2 – 3 months.

 

21. Sexual activity

It is recommended that the return to your sex life takes place after 6 weeks, starting from the back.

 

22. Sports and Engagement

Permitted activities include walking, swimming, and stationary cycling. High impact sports such as jogging, running, jumping, tennis, basketball, football and volleyball are allowed after 3 months and again with caution. Sports such as downhill skiing, cycling, horseback riding can only be allowed to patients who have been involved in the past although they are considered high risk and certainly after 3 months. Gardening is allowed, although heavy work is prohibited for the postoperative period of 3 months

What is prohibited after a total hip replacement for the first 3 months

  • Do not bring your hip to a smaller angle to the rectum. That is, it is forbidden to bend over whether you are standing or sitting, and to sit on low chairs, sofas, stools, a low toilet bowl. Any seat must be at the correct height, i.e. one palm above your knee.
  • Do not wear your socks, tights or footwear without the special aid.
  • Do not bend down to grab objects from the ground, low shelves, cabinets, washing machine, oven, etc.
  • Do not cross your legs when you are lying down and when you are standing. It is forbidden to sit cross-legged. Always place a pillow between your legs when lying on your back or side.
  • Do not twist your leg inward or twist your body with your feet firmly on the ground.
  • Do not perform sudden movements.
  • Do not sleep on your stomach for 3 months and sideways on your operated leg for 6 weeks.
  • Do not drive without your doctor’s permission.
  • Do not risk walking on slippery surfaces (snow, ice) or on obstacle courses (uneven terrain, small furniture, carpets, pets, babies).
  • Do not increase the number of exercises without the consent of the physiotherapist and do not continue the exercise when symptoms of pain, severe fatigue and swelling appear. Remember that normally fatigue and pain after exercise should last around 1 hour. Nocturnal discomfort or longer-lasting discomfort indicates severe fatigue.
  • Do not switch from the walker or the 2 bacteria to the use of a bacterium if you do not have the necessary strength and balance.

To get the maximum possible results from a hip arthroplasty, you need to realize that total hip replacement is a substitute for the joint, and it is not entirely a normal hip. That is why it may not be able to withstand very intense sports activities, such as a normal joint.