Early Postoperative Exercises
These exercises are important for increasing circulation to your legs and feet to prevent blood clots. They also are important to strengthen muscles and to improve your hip movement.
1. Ankle Pumps - Slowly push your foot up and down. Do this exercise several times as often as every 5 or 10 minutes. This exercise can begin immediately after surgery and continue until you are fully recovered.
2. Ankle Rotations - Move your ankle inward toward your other foot and then outward away from your other foot. Repeat 5 times in each direction 3 or 4 times a day.
Activity
Some patients experience back discomfort after surgery. This is caused by the general soreness of the hip area and partly by the prolonged lack of movement required before, during, and after surgery. Periodic change of position helps to relieve discomfort and prevents skin breakdown.
The head of your hospital bed should not be elevated more than 50 degrees during the first few days after surgery. Sitting up may allow the artificial ball to dislocate from the hip socket.
There will be some precautions, mostly to prevent dislocation, which is more likely to occur the first six to eight weeks after surgery. These precautions include:
using 2-3 pillows between your legs and not crossing your legs not bending forward 90 degrees using a high-rise toilet seat
Initial rehabilitation
In the first few days after surgery you will be assisted to a reclining chair, and physical therapy may begin. You will gradually begin to take steps, walk, and learn to climb stairs with the aid of a walker or crutches.
This initial rehabilitation generally takes 10 - 14 days. During this time, discomfort may be experienced while walking and exercising. Pain medication will be ordered by the doctor as needed. Most patients are relieved of their painful pre-surgical hip condition.
Therapy and rehabilitation program
Following surgery, you will work to become independent and doing exercises to improve the range of motion and strength of your hip. You will be instructed to meet your needs.
Do the home exercises two to three times a day (see home exercises section). Do your exercises indefinitely. Walking is not a substitute for exercise. If an exercise is causing pain that is lasting, reduce your intensity. If it continues to cause pain, contact your doctor.
Home Exercises
Here is a list of potential exercises you may be asked to complete. These exercises are sometimes done before surgery to help maintain the strength and range of motion of your hip.
Range of motion exercises
Active hip and knee flexion:
Lying on your back with legs straight, toes pointed toward the ceiling; arms by your side. Keeping the heel in contact with the bed, bend your hip and knee. Return to starting position. Progress to 20 repetitions, 2 times a day.
Active Internal and External Rotation:
Begin with your legs straight and a comfortable distance apart. Roll your legs inward so that your kneecaps are facing each other. Hold for 5 seconds. Roll your legs outward and hold for 5 seconds. Progress to 20 repetitions, 3 times per day.
Active Abduction:
Place a smooth surface (card table, plywood sheet, etc.) under your legs. Begin with your legs together, then spread them apart as far as you can. Hold them apart for 5 seconds. Return to the starting position. Progress to 20 repetitions, 3 times a day.
Strengthening Exercises
Quadriceps Setting:
Tighten the muscles on the top of your thigh. At the same time push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds. Progress to 20 repetitions, 3 times a day.
Gluteal Setting:
Lie either on your back with your legs straight and in contact with the bed. Tighten your buttocks in a pinching manner and hold the isometric contraction for 5 seconds, relax 5 seconds. Progress to 20 repetitions, 3 times a day.
Hip Extension:
While lying on your stomach, raise one of your legs off the bed with the knee kept straight and the pelvis held in contact with the bed. Slowly lower the leg. Repeat 10 times. Avoid hyperextending the back. Repeat procedure for other leg. Progress to 10 repetitions each leg, 3 times a day.
Activities of Daily Living
Do's and Don'ts
Your new hip is designed to eliminate pain and increase function. There are certain movements that place undue stress on your new hip. For your safety, these should be avoided. This is especially true during the first few months after your surgery.
DO NOT move your operated hip toward your chest (flexion) or your operated leg towards the chest any more than a right angle. This is 90 degrees.
DO NOT sit on chairs without arms.
DO grasp chair arms to help you rise safely to standing position. Place extra pillow(s) or cushion(s) in your chair so that you do not bend your hip more than 90 degrees.
DO NOT get up like this. Keep your involved leg in front while getting up.
DO use a chair with arms. Place your operated leg in front and your uninvolved leg well under.
DO NOT sit low on toilet or chair.
DO get up from toilet as directed by your therapist. Use the elevated toilet seat if we have given you one.
DO NOT pull blankets up like this.
DO use a long-handled reacher to pull up sheets or blankets or do as directed by therapist.
DO NOT bend way over.
DO NOT turn your knee cap inward when sitting, standing, or lying down.
DO NOT try to put on your own shoes or stockings in the usual way. By doing this improperly you could bend or cross your operated leg too far.
DO these activities as directed by your therapist.
DO NOT cross your operated leg across the midline of your body (in toward your other leg).
DO NOT lie without pillow between legs.
DO keep a pillow between your legs when you roll onto your "good" side. This is to keep your operated leg from crossing the midline.
Guidelines at Home
What happens after I go home?
Upon discharge from the hospital, you will have achieved some degree of independence in walking with crutches or a walker climbing a few stairs, and getting into and out of bed and chairs. Someone at home is needed to assist you for the next few weeks, or until your energy level has improved.
Medication
You will continue to take medications as prescribed by your doctor. You will be sent home on prescribed medications to control pain. Plan to take your pain medication 30 minutes before exercises. Preventing pain is easier than chasing pain. If pain control continues to be a problem, call your doctor.
Activity
Continue to walk with crutches or a walker as directed by the doctor or physical therapist. Your doctor will determine how much weight you can place on your operated leg. Walking is one of the better forms of physical therapy and for muscle strengthening.
However, walking does not replace the exercise program which you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen weakened muscles. If excess muscle aching occurs, you should cut back on your exercises.
Weightbearing
Be sure to discuss weightbearing restrictions with your doctor. Their recommendations will depend on the type of implant and other issues specific to your situation. Revision hip surgery (replacing a previously implanted prosthesis) may require an extended period of time without putting weight on the leg.
Walking and Early Activity
Soon after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity helps your recovery by helping your hip muscles regain strength and movement.
Walking with Walker — Full Weight Bearing – Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Move your walker or crutches forward a short distance. Then move forward, lifting your operated leg so that the heel of your foot will touch the floor first. As you move, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step allow your toe to lift off the floor. Move the walker again and your knee and hip will again reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor. Try to walk as smoothly as you can. Don’t hurry. As your muscle strength and endurance improve, you may spend more time walking. Gradually, you will put more and more weight on your leg.
Walking with Cane or Crutch - A walker is often used for the first several weeks to help your balance and to avoid falls. A cane or a crutch is then used for several more weeks until your full strength and balance skills have returned. Use the cane or crutch in the hand opposite the operated hip. You are ready to use a cane or single crutch when you can stand and balance without your walker, when your weight is placed fully on both feet, and when you are no longer leaning on your hands while using your walker.
Sitting
Avoid sitting more than 60 minutes at a time. DO NOT cross your legs. In fact, keep your knees 12 to 18 inches apart. Always sit in a chair with arms. The arms provide leverage to push yourself up to the standing position. A high kitchen or bar-type stool works well for kitchen activities. Avoid low chairs and overstuffed furniture because they require too much bending (flexion) in your hip in order to get up. Do not bend forward while sitting in a chair, causing more than a 90 degree bend in your hip. Use the toilet seat riser for the next eight weeks to avoid excessive bending of the hips.
Bending
For the first eight weeks, you should not bend over to pick up things from the floor. You may want to acquire a pair of slip-on shoes and a long-handled shoe horn to avoid excessive bending.
Prevention of Infection
If at any time (even years after the surgery) an infection develops such as a sore throat or pneumonia, notify your physician. Antibiotics should be administered promptly to prevent the occasional complication of distant infection localizing in the hip area. This also applies if any teeth are pulled or dental work is performed. Inform the general physician or dentist that you have had a joint replacement.
Warning signs of a possible hip 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 not relieved with analgesics.
Notify your doctor immediately if you develop any of these signs !!
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