With the widespread use of artificial hip arthroplasty, post-operative rehabilitation has become increasingly important, and the best results can only be achieved by combining excellent surgical techniques with perfect post-operative rehabilitation. The purpose of postoperative rehabilitation is to promote the patient’s recovery of physical strength, increase muscle strength, increase joint mobility and restore the coordination of daily movements. The development of the rehabilitation plan must follow the three principles of individualization, gradualness and comprehensiveness.
(I) Pre-rehabilitation evaluation
Since the surgery itself directly affects the postoperative rehabilitation plan, the rehabilitation staff must understand the details of the surgery. The prosthesis should be placed in the normal anatomical position. Only by understanding the advantages and disadvantages of the prosthesis position can the patient be well guided in his activities, thus avoiding complications such as dislocation during training. The influence of the surgical approach on joint stability: the posterior approach rarely causes instability of the hip joint in internal and external rotation. The anterior approach is less likely to cause instability during hip flexion. The positive and lateral approaches, especially those with the joint capsule intact, are the most stable during hip flexion and extension activities.
(II) Rehabilitation process
1.The night after surgery
Put a soft cushion of appropriate thickness under the outer limb of the operated side, make the hip and knee joint slightly flexed, wear anti-rotation shoes to avoid external rotation of the lower limb and reduce pain.
2.Day 1 after surgery
Remove the cushion and straighten the lower limb on the operated side as much as possible to prevent hip flexion deformity.
3.Day 2 after surgery
Both functional exercises can be started. The main purpose of early exercise is to maintain joint stability and muscle tone, and prevent joint stiffness and muscle atrophy. Specific methods.
(1) Flexion and extension exercises of the ankle joint family to promote blood return to the lower limbs and reduce the chance of deep vein thrombosis.
(2) Isometric contraction exercises for the quadriceps, N cord, gluteus maximus and gluteus medius to maintain muscle tone.
(3) Deep breathing exercises.
4.Day 3 after surgery
Remove the drainage tube, take X-ray film to determine the position of the prosthesis, and start the following exercises if there are no special problems.
(1) Hip and knee flexion and extension exercises, and gradually transition from passive at first to active with assistance to fully active exercises.
(2) Hip rotation exercises, including both extension and flexion exercises. In the flexion position, pull both hands on the bed support and sway the upper body from side to side, paying attention to the hip not to leave the bed.
(3) Hip extension exercises, flexing the opposite hip and knee joint, doing active extension of the hip joint on the operated side, fully extending the hip flexors and the anterior part of the joint capsule.
(4) Isotonic exercises of the quadriceps and upper limb muscle strength exercises, with the aim of restoring upper limb strength so that the patient can use crutches better after surgery.
In the early postoperative rehabilitation process, the following points should be noted: avoid placing the hip on the operated side in an externally rotated and extended position; to prevent the patient from turning to the opposite side, the headboard should be placed on the operated side; elevate the foot of the bed on the opposite side, or maintain the abduction of the muscles on the operated side, or place a triangular pad between the legs, provided that the external rotation of the lower extremity is prevented; carry out joint mobility exercises early after surgery, otherwise it will be very difficult after the hematoma of the joint capsule is mechanized in 6~8 weeks. If the hip joint on the operated side is unstable in moderate flexion, avoid tilting the upper body to the operated side when performing hip rotation exercises in the sitting position.
5.One week after surgery
The patient’s physical strength has recovered, and patients using cemented prosthesis can already go down to the ground for functional rehabilitation exercises. Therefore, the main purpose of this stage is to restore the mobility of the joint and further improve the muscle strength. The rehabilitation exercises must be carried out under the direct supervision of the doctor, taking into account the history of the preoperative hip joint pathology, the type of prosthesis, the surgical procedure and the patient’s general condition, to selectively develop the respective rehabilitation plan. The exercise methods are as follows.
(1) Bed exercises: The best way to exercise the strength of hip flexors is to do active or active resistance hip flexion exercises in the semi-flexed position of the hip joint. Early postoperative active straight leg raising exercises are not only of little significance for hip flexor exercise; on the contrary, they often cause excessive pressure on the acetabulum, which is not conducive to the growth of bone tissue in the non-cemented acetabular prosthesis, and at the same time, the pain in the groin area on the operated side affects the patient’s rehabilitation. Seven days after surgery, if there are no special circumstances, the patient can be allowed to turn over. The correct position for turning should be: straightening the hip on the operated side, which is conducive to passive extension of the hip joint. Specific exercises include.
(2) Sling-assisted exercises: the pulley device on the through-body bed frame, relying on the upward traction force of the rope and thigh sling, while making active-assisted hip flexion exercises, resistance hip extension exercises, active knee extension exercises and hip abduction and adduction exercises.
(3) Supine and prone hip internal and external rotation exercises: when exercising, it is necessary to keep both lower limbs abducted, and avoid external rotation hip exercises if there is an unstable hip extension and external rotation position during surgery.
(4) Sitting exercises: unless special needs, it is generally not advisable to sit for a long time after surgery, otherwise it is easy to make the hip flexion deformity also cannot be well corrected. Within 6~8 weeks after surgery, patients should mainly lie, stand or walk, and sit for as short a time as possible. It is worth emphasizing that compared with the standing and lying position, the sitting position is the position where the hip joint is most likely to be dislocated or semi-dislocated. If the patient has poor intraoperative stability, the following exercises should be abandoned for the functional exercises of the seat.
(5) Hip extension exercises: sit on the bedside, brace your hands back and take the initiative to straighten the hip and knee joints.
(6) Hip flexion exercises: pay attention to the appropriate hip abduction and place it in the rotation neutral position.
(7) Hip flexion position selection exercise: feet apart, knees together, for practicing hip internal rotation; conversely, for hip external rotation exercise.
(8) Three-dimensional exercise: it is suitable for patients who start to move down to the ground. The exercises include
(9) Hip extension exercises: posterior extension of the lower limb on the operated side, half flexion of the hip and knee on the opposite side, head up and chest up, make anterior pelvic movement, stretch the anterior hip joint capsule and contracted hip flexor muscle groups.
(10) Left and right pelvic swaying exercise: it can be used to practice hip joint adduction and abduction. Straighten the lower limbs and sway the pelvis from side to side to make the bilateral hip joints alternately abduct and adduct. If the patient fixes both shoulders and feet against the wall, the exercise will be more effective. The common deformity is the contracture of the hip joint in the inversion position, therefore, more exercises should be targeted to the hip joint abduction movement.
(11) Hip inversion deformity correction exercises: straighten the lower limb of the healthy side, appropriate padding, while the affected limb directly on the ground. This can keep the affected limb in an external position. It is mostly used for patients with preoperative hip adduction deformity.
(12) Hip flexion exercise: elevate the affected limb, rest on a stool of a certain height, lean forward with your upper body and increase hip flexion. Adjust the height of the stool to control the degree of hip flexion of the affected side.
(13) Rotation exercise: fix the lower limb on the operated side, and practice the internal rotation of the operated hip by moving the lower limb on the opposite side back and forth.
(14) Walking exercises: when to start walking after surgery is affected by the type of surgical prosthesis, surgical operation and the patient’s physical recovery. If a cemented prosthesis is used, and it is the first hip replacement, and there is no bone graft or fracture during surgery, the patient can walk on the third day after surgery. In the case of biologic prostheses, walking exercises should not be started until at least 6 weeks after surgery. In patients with a large trochanteric osteotomy and intraoperative femoral fracture, walking exercises should be postponed until at least 2 months after surgery, depending on the radiographs. Walk with the aid of a walker first, and then switch to bilateral tucking canes when the center of gravity is stable and confidence is adequate. For walking exercises, the lower limb of the operated side should carry at least 20~30kg of weight.
(15) Treadmill exercise: Treadmill exercise starts after the patient’s walking exercise, generally 2~3 weeks after surgery. It can also be adjusted according to the patient’s specific situation. At the beginning, push slightly and maintain a speed of 20 km/h.
During hospitalization the patient is usually able to receive step-by-step rehabilitation treatment under the guidance of a physician and according to a rehabilitation program developed for each patient. However, most people have a very limited length of stay in the hospital, and post-operative hospitalization in artificial hip and knee arthroplasty cases is usually 2 to 3 weeks. For first-time artificial hip replacement patients, it is required that at discharge they arrive at.
① be able to walk independently with the aid of a double crutch and be able to sit up independently, whether these two movements can be completed directly affects the patient’s ability to take care of himself after discharge.
② absence of any signs of early postoperative complications.
③Patients and family members have mastered or understood the post-discharge rehabilitation plan and can implement it well.