Post-operative hip replacement rehabilitation program
Artificial hip replacement is a treatment for severe loss of hip function due to disfiguring hip disease, accompanied by severe pain that cannot be relieved by non-surgical methods. According to the structure, there are artificial femoral head and total hip replacement; according to the fixation principle, there are cemented type (mechanical fixation) and non-cemented type (biological fixation). Artificial hip replacement can relieve pain, correct deformity, rebuild joint stability, restore and improve joint motion function, and improve the quality of life. Studies have shown that post-operative hip replacement should be combined with comprehensive post-operative rehabilitation therapy to obtain the most ideal treatment effect. Moreover, the rehabilitation treatment should follow the principles of science, comprehensiveness, individualization and gradual progress. Combined with my work experience, the following is a brief description of the post-operative rehabilitation treatment plan for artificial hip replacement (this plan is a regular plan, please use it in conjunction with your own situation and consult your doctor if you have any questions).
I. Within 1 week after surgery
Specific rehabilitation measures: (Most of the following contents are shown and described with the right leg as the affected leg, some of them are marked as the left leg)
1.Positioning: In the supine position (Figure 1), the affected leg is slightly abducted, with a pillow between the legs, and a pillow is placed on the outside of the affected leg to prevent external rotation of the hip joint. In addition, a pillow or wedge-shaped cushion can be placed under the affected limb in the supine position (the pillow should be gradually raised from the N fossa to the far side in a slope shape, and the affected leg should be kept straight), in order to elevate the affected limb, promote blood circulation, and increase the comfort of the patient (Figure 2). In the lateral position (healthy side underneath, Figure 3), the affected side is kept mildly abducted with the help of an abductor pad or pillow (pillow should be fluffy enough and longer than the calf), and the affected side is avoided for 3 months after surgery.
Post-operative supine position (lower limb pad up – left affected leg)
Post-operative healthy side lying position
2.Muscle training: the affected leg is the main one, taking into account both upper limbs and the healthy side of the lower limb at the same time
2.1. Isometric muscle training in bed.
Put a thin pad at the heel, and press the heel to the thin pad
Figure 4 isometric contraction of the quadriceps
Figure 5 N cord muscle isometric contraction (training requirements as above)
Figure 6 gluteus maximus isometric contraction (training requirements as above)
2.2, seated muscle training.
Figure 7 seated knee extension
Figure 8 sitting hip flexion (the same training requirements as the left figure)
2.3. Standing hip extension (Figure 9A), abduction (Figure 9B) and knee flexion (Figure 9C) training, hold each action in the maximum position for 10 seconds, rest for 10 seconds, repeat 10-15 as a group, 2-3 groups/day.
3. Ankle pump training: perform three movements of hooked foot – taut foot – ankle loop for one training session, 20-30 times/hour. (If the individual is fatigued after surgery, only the first two movements can be performed as required.) Both legs should be performed simultaneously, slowly and in full range (Figure 10).
Ankle pump training
4.Joint mobility training: active and passive combination
4.1 Swing up the head side bed board to make the hip flexion (<90°< span="">), each swing up time is controlled within half an hour, 2-3 times/day.
4.2 Slide the heel against the bed in the supine position to flex the hip joint to <45° and hold it for 15-20 seconds, then slowly straighten it and rest for 10 seconds, repeat the action 20-30 times/2-3 hours.
4.3 Training (Figure 11): Starting on the 3rd postoperative day, ROM was gradually increased with no or minimal pain, hip flexion <90°, 2 times/day for 30 minutes/time, ice packs were applied for 15-20 minutes after training, and the hip was kept slightly out of the booth during the whole exercise.
CPM training
5. Early weight-bearing training.
5.1 The cemented prosthesis can be moved to the ground with the help of a walker on the 1st day after surgery, but not for too long.
5.2 The time to start weight-bearing after biologic prosthesis replacement should follow the doctor’s prescription: at present, it is mostly recommended to start gradual partial weight-bearing (with the help of a healthy scale) as early as possible, 5 minutes/time, 4-5 times/day. Initially, start with 10-20% of body weight and gradually reach 100% weight bearing by six weeks after surgery. If the patient has poor bone quality (severe osteoporosis) and special intraoperative management such as osteotomy, the issue of weight bearing for both types of prostheses should be carried out strictly according to medical advice. The HSS recommends that after biologic prosthesis replacement, if the patient has no relative contraindications or limitations, the patient can be encouraged to carry maximum weight as tolerated (weight-bear as tolerated,WBAT) when moving out of bed.
6.Pneumatic circulation device treatment for the affected limb (Figure 12): to reduce pain, control swelling, and prevent the occurrence of venous thrombosis in the lower limb.
Pneumatic blood circulation device treatment
7, ice: the use of chemical ice bag wrapped in a towel applied to the most obvious place of wound swelling and pain, keep 15-20 minutes, dressing thicker appropriate to extend the time, and appropriate pressure on the ice bag (such as bandage wrapping), reduce the distance between the ice bag and the tissue paste, the total time generally does not exceed half an hour. Pain and swelling can be obvious when the ice pack every 1-2 hours.
8. Instruct patients to use walkers and double-axillary crutches to practice progressive gait (gait training first with walkers, then switch to single crutches and later canes after stabilization, refer to the popular science article: walkers series for details).
9.Prohibited movements and basic daily life guidance after total hip replacement
Contraindicated movements: avoid hip flexion over 90°, internal lower extremity over the midline, and internal and external rotation over the median posture (try to keep the toe up posture) in any position within 12 weeks after surgery; do not cross your legs.
Daily life guidance.
Keep the affected side out of bed, sit in a high chair with backrest and armrest under the bed, and make sure the hip joint flexion is <90° when standing up and sitting down.
Use a high toilet seat when using the toilet, take a shower when bathing, and pay attention to prevent slipping.
Use the lower limb on the healthy side as the axis of rotation in movement (neither do turning activities with the leg on the operated side)
Postoperative weeks 2-8
Continue to adhere to the first phase of strength and mobility training.
During this period, internal and external rotation isometric muscle contraction (Figure 13A, B) exercises can be performed with the hip in neutral position, paying attention to relevant contraindicated movements.
The supine straight leg raise (SLR) is not recommended during this period (instead of the standing leg raise) because it generates an external force equal to 3 times the body weight on the hip joint, which is more irritating to the healing joint capsule. ※
Internal and external rotation isometric contraction in neutral position (A internal rotator, B external rotator)
3. Clamshell exercise (Figure 14): Lying on the side with the affected leg on top, use the abductor pillow cushion to raise the affected leg in a slightly abducted position and perform a movement similar to the opening and closing of a clamshell, which can strengthen the gluteus medius and hip extensor muscles respectively.
Clamshell exercise
4, balance and proprioceptive training: standing position with both feet, shifting the center of gravity from side to side (Figure 15), gradually increasing the weight-bearing of the affected limb, 5 minutes/time, 4-5 times/day. At a later stage, soft pads or one-way unstable planes can be used (Figure 16A, B).
Move the center of gravity from side to side
5, heel lifting training: training should be performed without pain, adjust the intensity of training according to the patient’s condition, Figure 17.
Heel lifting training
6.Gait training: instruct the patient to use the cane or axillary cane for gait training, and gradually enable the patient to walk away from the bed without the aid.
7.Activities of daily living training: teach the patient to put on (Figure 18) and take off pants (Figure 19) correctly (the right side is the affected leg) and to pick up objects on the floor in an alternative position (Figure 20) and to put on shoes in a correct position (Figure 21).
Putting on pants (affected side first and then the healthy side)
Removing pants (healthy side first then affected side)
Picking up objects (left side is affected leg – bend knee instead of hip)
put on shoes (A correct, B wrong)
8, static squat: upper body standing against the wall, feet shoulder-width apart, feet parallel to the front, left and right legs evenly distributed weight, hip flexion knee squatting against the wall to a pain-free angle (note that hip flexion <90°). In the knee flexion to 90 ° within the pain-free and controllable maximum angle to maintain a certain time (depending on the patient's condition specific settings) for a time, slowly stand up to rest 5-10 seconds, repeat 10-15 times for a group, 2 groups / day (Figure 22).
9. Power bicycle training (Figure 23): After the patient is able to get on and off the bicycle by himself, select a bicycle with short handle (within 90 mm) and adjust the seat height to avoid hip flexion >90°. Choose medium intensity 20-30 minutes/time, 2 times/day.
Squatting
Power bike training
10.Front step-up exercise: Once the patient can walk out of bed without assistance, you can start front step-up exercise. When the patient can cross the step without pain and ensure a certain degree of linearity and control, the height of the step can be gradually increased from 10 cm, 15 cm to 20 cm (a small amount of hand weight can strengthen the thighs and peri-hip muscles in the later stage to prepare for the next step of alternating step exercises), Figure 24. Front upward step exercise
11. Assessment of hip flexor (Figure 25), quadriceps (Figure 26) and N cord muscle (Figure 27) flexibility and giving stretching exercises
Hip flexor stretching
Quadriceps stretch (left leg)
N cord muscle stretch (right leg)
12. Ice packs: as previously described
iii. Third postoperative stage (postoperative week 8-14)
1.Strengthen hip flexion exercises (you can start hip flexion over 90 degrees joint mobility exercises): supine position with a towel ring behind the knee, slowly bring the knee close to the chest, hold it in the maximum position for 3-5 minutes, slowly stretch it to the new position again and continue to hold it for 3-5 minutes, after the end of which you can apply ice to the affected area as appropriate.
2.Strengthen the progressive resistance training of the periprosthetic muscles: method as before, this period can start supine straight leg raise (SLR) exercises, 30 times/group, 2-4 groups of consecutive exercises, 60 seconds rest between groups, 2-3 exercises/day.
3.Strengthening static squat exercises: the same method as above, if the patient can maintain the stability of the alignment, then the hand weight can be increased appropriately.
4.Continue the front upward step exercise (Figure 28) and start the front downward step exercise (start from 10 cm height): the upward step exercise is gradually increased to 20 cm height. Pay attention to the lower limb force line in this period to avoid injury.
Forward downward step (10 cm) exercise
5, proprioceptive and balance training (Figure 29A, B): the focus of this phase, based on the previous phase can begin to close the eyes to stand on one leg and use multi-directional unstable plane balance exercises.
6.Power bicycle training: further increase the hip flexion angle and the same amount of training as before.
7.Activities of daily living training: encourage patients to perform daily functional activities, such as putting on and taking off shoes and socks.
This period of training mainly emphasizes muscle strength and joint stability exercises, and gradually restores most of the activities of daily living and some leisure and sports activities.
Note: This program is a regular program, please use it in conjunction with your own situation, and consult with your doctor if you have any questions.