Physical Therapy After Your Total Hip Replacement

Your full recovery from your total hip replacement surgery is going to take several months. This pamphlet will help you understand your recovery. Guidelines are included which discuss precautions to protect your new joint, exercises that increase you hip strength, and activities of daily living that will help you become an active partner in your care and recovery.

The Normal Joint

Your new hip is a ball and socket joint where the thigh bone (femur) meets the pelvis. A healthy hip has layers or smooth cartilage that covers the ball-shaped end of the femur and socket part of the pelvis. The cartilage acts as a cushion and allows the ball of the femur to glide easily within the socket of the pelvis. The muscles around the joint support your weight and help move the joint smoothly so that you can walk without pain. Everyone recovers differently, this is a guide you may accelerate your rehab faster if you desire, or slower depending on your physical strength and your surroundings.

Your Replacement Hip Prosthesis

Your new hip prosthesis has a femur and pelvis part made from ceramics and polyethylene or plastic. We also utilize metal on metal surfaces. The cup replaces the worn hip socket of your pelvis. The ball replaces the worn end of your femur. The ball is attached to a stem that fits into your femur. The cup and stem are sometimes cemented, or metals may have a porous surface that bone will grow into and create a tight fit. We rarely cement the devices in place.

Guidelines to Protect Your New Hip Joint

Your hip surgery did not involve cutting muscles. Motion is usually improved after surgery. Most patients can place all of their weight on the new hip. Having the hip dislocate or "pop out of socket" is almost unheard of with modern implants and techniques. That is one reason we are more relaxed in our hip precautions. We are not as worried about hip dislocation as some are due to changes in implant design and surgical techniques - many in the hospital will go over precautions used by others below are general suggestions for the first 3 weeks. We do want the soft tissues to relax after surgery so extremes of motion are discouraged for the first three weeks. These are general guidelines to ease recovery of soft tissues in the first 3 weeks:

  1. You may bend past 90 degreees if your elbow is inside your knees or you do not rotate the knee inward (or toward the midline) as you bend.
  2. It is ok to cross your legs.

You may reach down if your elbow is inside your knees. You may lift your foot up and cross your leg. Check with Dr. Hickman if you have any questions about your precautions.

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When you are in bed, keep your legs apart.
 You may want to place a pillow between your legs for comfort if lying on your side.

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You may sleep on the  side of your new hip while in bed. It may hurt but you are unlikely to do damage.
 

Due to less invasive posteriorlateral and direct anterior approaches to hip replacement we do not limit patients significantly after surgery.  

MOST PATIENTS MAY PUT ALL THEIR WEIGHT ON THE HIP AFTER SURGERY. Most all walking normal in 3 weeks. Due to new techniques and advances in rehap most are walking normally in 3 weeks, walking long distances at 3 weeks, golfing and other activities as well. .

The physical therapist will teach you to use a walker or crutches during the first week. You will be quickly progressed to a cane. Some patients may not be allowed to put all their weight on the hip at first. Your physical therapist and Dr. Hickman will tell you how much weight you can safely put on your new hip. At your 3 week checkup, Dr. Hickman will tell you if your hip has healed enough to progress to sports or other activities. 

Your balance might be shaky for a while.

  • Use handrails on steps.
  • Use low-heeled or flat shoes.
  • Avoid wet or waxed floors.
  • Keep your floors free of items that could trip you. Throw rugs or small objects should be kept off of the floor for your safety.
  • Watch for pets or other animals that could get in your way.
  • Avoid ice or snow.

If you are riding in a car, stop every hour or so.
Get out and walk around for a few minutes. This will help the circulation in your legs and keep your muscles from stiffening up. Check with Dr. Hickman when you can resume driving after your surgery.

Talk to Dr. Hickman about when sexual activity may be resumed and what positions should be avoided.

Adaptive Equipment

After your total joint replacement, you may benefit from several pieces of equipment to make your daily activities easier and safer. As your soft tissues heal (though preserved they are irritated) these devices may make certain activities more comfortable.  Dr. Hickman and your physical therapist will recommend the equipment that best suits your needs.

57323_total_hip-14.jpg Seat / Shower Bench: This seat allows you to sit while bathing and provides you safety while you are in the shower.
  Seat Cushion: Cushions are used to elevate the seat height of a chair, couch, car, or other surfaces.
57323_total_hip-18.jpg Elevated Toilet Seat: This device is attached to your toilet seat to elevate its height. 
57323_total_hip-15.jpg Reacher: A reacher is used to pick up items off the floor and help you with dressing.
57323_total_hip-16.jpg Dressing Stick: This device has a hook on one end and a pusher on the other end. It is used to help put on pants, skirts, pull up zippers, etc.
 
Sock Aid:
This aid helps you safely put on your sock.
57323_total_hip-17.jpg Long-handed Bath Sponge: This sponge helps you clean hard to reach areas while bathing.
  Long-Handled Shoe Horn: This shoe horn is attached to long stick and allows you to put on your shoes while sitting or standing.

Not all of these devices are needed for most patients however in some patients several of the these aids may be beneficial and simplify recovery 

 


Managing Activities of Daily Living Following Your Hip  Replacement

Chair Transfer: Avoid recliners and soft couches until otherwise told by Dr. Hickman. Stiff-backed chairs with armrests are ideal to sit in. If the seat is low, you may place 1 or 2 pillows in the chair to elevate the seat and facilitate transfers.

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  1. Back up to the chair until you feel both Iegs touching the chair.
  2. Slide your operated leg out in front of you as you reach back with one hand for an armrest.
  3. Lower yourself slowly, keeping your operated leg straight out. Once seated, bend your knee comfortably, or keep it straight.
  4. When getting up, scoot your operated leg out in front of you.
  5. Push up using the armrests, keeping your operated leg out in front of you.

Car Transfers: The front seat is preferable because it generally has more leg room, can be adjusted for comfort, and can allow the rider to more easily wear a seat belt.

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  1. Make sure the seat is as far back as possible. Back up to the car with your walker or crutches. Put your operated leg out in front of you.
  2. Lower yourself slowly to the seat. You may roll the window down and use the car doorframe, along with the headrest, to support yourself as you sit.
  3. Scoot back into the seat, then swing your legs into the car. If the seat is low, recline the back slightly or put a pillow on the seat to sit on.
  4. To get in the back seat in a semi-reclining position. You will need to use your arms and non-operative leg to scoot yourself back farther onto the seat.

57323_total_hip-24.jpgPutting on Underwear or Pants (if having difficulty at first few weeks)Often not needed 

  1. Sit on side of the bed or in an armchair.
  2. Use the dressing stick or reacher, and catch the waist of the underwear or pants with the hook.
  3. Slip the underwear or pant leg over your operated leg first by lowering the reacher toward the floor by your foot.
  4. Repeat for your non-operated leg.
  5. Pull the underwear or pants up over your knees.
  6. Stand with the walker or crutches and pull the pants or underwear up.
  7. When undressing, take the pants or underwear off of your non-operated leg first.

 

Putting on Socks and Stockings (often not needed) 

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    Slide the sock or stocking onto the stocking aid. Be sure that the heel is at the back end of the plastic and the toe is against the end.

  2. Secure the sock in place with a garter or with the notches on the plastic piece. Do not pull the top of the sock over the top of the plastic piece.
  3. Holding onto the cords, drop the stocking aid out in front of the operated foot.
  4. Slip your foot into the sock and pull it on.
  5. Remove the garter or release the sock from the notches on the plastic piece using your reacher.
  6. Put the other sock on your other foot in your usual manner.
  7. To take the stocking or sock off, use the reacher to hook the back on the heel and push the sock off of your foot.

Shoes

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Wear slip-on shoes or shoes with Velcro straps so that you will not have to bend over to put the shoes on and tie the laces. Use the long-handled shoe horn or reacher to put on and take off your shoes.

Walking with Crutches

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Crutch Safety

  • The pressure or weight goes on your hands and not on your armpits. Nerve damage can result if weight is placed on the armpits for a long period of time.
  • Keep your elbows close to your side to help keep the crutches against your ribs.
  • Your crutch tips should be 2 to 3 inches out to the side of your feet so you do not trip on your crutches
  • There should be a slight bend in your elbow when holding onto the crutches (15 to 20 degrees).
  • Take your time and do not try to walk too fast.
  • Keep your head up and look ahead. Do not look at your feet when walking.
  • When walking on carpet, you must pick up your crutches and injured leg more than when you walk on tile or linoleum floors.
  • Remove all throw rugs from the floor to keep from slipping and falling.

Weight Bearing As Tolerated / Full Weight Bearing

You may place as much weight on your operated leg as you can tolerate. Use the crutches to improve your balance and safety, as well as to favor the operated leg when it is painful. Stairs and Curbs: Always use a handrail if one is available.

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Going up with Handrail

  1. Place both crutches under your arm on the injured side.
  2. Grasp the handrail with your other hand, if possible.
  3. Bring your good leg up to the next step. Let the injured leg trail behind.
  4. Straighten your good leg and bring the crutches and injured leg up.

 

Going Up without Handrail

  1. Keep the crutches on the stair you are standing on.
  2. Support your weight between your crutches.
  3. Bring your good leg up to the next step. Let your injured leg trail behind.
  4. Straighten your good leg and bring the crutches and injured leg up.
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Going Down with Handrail

  1. Put the crutch on the lower step.
  2. Lower your injured leg down to the lower step.
  3. Support your weight between your crutch and handrail.
  4. Move your good foot to the lower step.

 

Going Down without Handrail

  1. Put the crutches on the lower step.
  2. Support your weight between your crutches.
  3. Bring your injured leg down to the lower step. Let your good leg trail behind.
  4. Bring your good leg down.

Exercises

The day after your surgery, the physical therapist will get you out of bed for the first time. The therapist will help you walk with a walker or crutches as you are able. You will be sitting in a chair for 15 to 30 minutes by the second day. Each day the amount of walking and time sitting in the chair will increase as you can tolerate. Before you go home the physical therapist will teach you how to climb stairs safely to protect your new knee. Your physical therapist will start you on a home exercise program on the second day after your knee surgery. Additionally you may perform isometric exercises in bed right after your surgery to help you begin to recover.

Exercise will help you regain the strength in your knee or hip and legs so you can walk more easily. These beginning exercises should be performed until you can do 3 sets of 10 repetitions very easily. An advanced set of exercises is provided for when the beginning exercises are too easy. Exercises need to be continued for at least 3 weeks when you go home. Your therapist will go over the home exercise program with you before you are discharged.

Isometric Exercises: Isometric exercises will help your muscles begin to “wake up” after surgery and will help to promote circulation in your legs to prevent blood clots from forming. They may be performed throughout the day whenever you feel your legs becoming stiff. Remember to breathe in as you tighten your muscles, and out as you relax them. Breathe normally while you hold the position.

Ankle Pumps: This strengthens your calf muscles in your lower leg.

  • 57323_total_hip-31.jpgLie on your back.
  • Bend your ankle and pull your foot and toes towards your head.
  • Push your foot back down and point your toes away from you as far as possible, like you are pushing on the brake pedal of a car.
  • Repeat with both legs 10 times every 2 hours throughout the day.

Quad Setting: This exercise helps your upper leg or thigh muscles.

  • 57323_total_hip-32.jpgTighten the muscles of your thigh.
  • Keep your knee straight. Push your knee down into the bed, having your kneecap move upward toward your hip.
  • Think about trying to raise your heel ½ inch off the bed.
  • Hold for a count of 5 and then relax.
  • Repeat with the other leg.
  • Alternate legs for 10 repetitions on each side 3 times a day.

Gluteal Setting

  • Squeeze your buttocks together. Hold for a count of
  • Relax and repeat. Perform a total of 10 repetitions 2 times a day.

Home Exercise Program (before and after hip or knee surgery)

The following three exercises should be performed at home for at least six weeks or until they become very easy to do (30 repetitions). They should be performed 2 to 3 times per day. These exercises should be performed while lying in bed or on your back.

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Heel Slides

  1. Slide your foot along the bed towards your buttocks and slowly bend your knee up, but do not bend your hip more than 90 degrees.
  2. Slide your foot away from your buttocks and slowly straighten your leg.
  3. Relax and repeat.
  4. Perform 30 repetitions, resting as needed.

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Standing or Lying Abduction

  1. Move your leg out to the side and then back.
  2. Keep your knee straight and your toes pointed ahead.
  3. Relax and repeat.
  4. Perform 30 repetitions, resting as needed.
  5. If performing this exercise is too painful, try moving your leg out to the side while standing and holding on to a walker or firm surface. Make sure to keep your toes pointed straight ahead when moving your leg to the side.

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Bridging

  1. Bend both knees up and place both feet flat on the bed.
  2. Keep your feet in place and slowly push your buttocks off of the bed only a few inches.
  3. Do not lift high enough to cause pain.
  4. Relax and repeat.
  5. Perform 30 repetitions, resting as needed.

Avoiding Problems After Surgery

Blood Clot Prevention: Follow your orthopaedic surgeon's instructions carefully to minimize the potential of blood clots which can occur during the first several weeks of your recovery. Warning signs of possible blood clots in your leg include:

  • Increasing pain in your calf.
  • Tenderness or redness above or below your knee.
  • Increasing swelling in your calf, ankle and foot.

Warning signs that a blood clot has traveled to your lung include:

  • Sudden increased shortness of breath.
  • Sudden onset of chest pain.
  • Localized chest pain with coughing.

Notify Dr. Hickman immediately if you develop any of these signs.

Preventing Infection: The most common causes of infection following total knee replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your knee replacement and cause an infection.

Following your surgery, you should take antibiotics prior to dental work or any surgical procedure that could allow bacteria to enter your bloodstream.

Warning signs of a possible knee replacement infection are:

  • Persistent fever (higher than 100 degrees orally).
  • Shaking chills.
  • Increasing redness, tenderness or swelling of the knee wound.
  • Drainage from the knee wound.
  • Increasing knee pain with both activity and rest.

Notify Dr. Hickman immediately if you develop any of these signs.