I. Considerations for rehabilitation exercise
1) Elements
Confidence: Rehabilitation exercise is hard, especially at the beginning, you must be confident in yourself.
Persistence: Rehabilitation exercises are not a temporary activity for patients after artificial joint replacement, but need to be persistent for a long time, so be persistent.
Caution: Safety is very important, and falling can sometimes have very serious consequences and undo all previous efforts. Therefore, you need to be careful when performing any rehabilitation exercises. Particular care needs to be taken when getting up early after surgery, and someone must accompany you to complete it.
2) Precautions
The proper use of your artificial joint will allow it to serve you better and longer.
The following actions should be avoided as much as possible, otherwise the chance of loosening of your artificial hip joint will be greatly increased.
◆ Don’t stagger in the morning after surgery, and don’t apply pressure while stagger.
Prohibit sitting on a low stool (about 20cm), including squatting.
Prohibit jumping from high places.
◆ Avoid doing strenuous exercise.
◆ Avoid falling to.
◆ Do not rotate your hip joint outward when lying down or walking.
Do not lie on your side when you are in the lateral position.
Rehabilitation exercises for artificial hip joint replacement
Perioperative rehabilitation exercises: mainly during the postoperative hospitalization, according to the recovery of the body after surgery can be divided into the following stages.
1. 1-3 days after surgery
On the first day after surgery, the patient is usually weak due to blood loss during surgery, and the wound pain is obvious. Therefore, the rehabilitation training at this time is aimed at restoring muscle strength and promoting blood circulation in the lower limbs to prevent and control thrombosis. The reason for not moving the hip joint is that the contraction of the lower limb muscles is like a pump that continuously squeezes blood back to the heart. The complete lack of activity of the affected limb after surgery may cause blood stasis and swelling in the lower limb, resulting in deep vein thrombosis, which may cause life-threatening pulmonary and cerebral root blockage if the thrombus is dislodged, while the complete lack of activity of the lower limb may cause the muscles and joints to lose elasticity and affect the recovery of limb and joint functions after surgery. Therefore, the lower limbs should be slightly elevated on the 1st to 3rd days after surgery to promote blood return to the lower limbs.
1) Flexion and extension of the ankle joint: slowly hook the toe upward and then extend it farther so that the surface of the foot is taut. 5-10 times every hour, each movement lasts for 3 seconds, starting immediately after surgery until you are fully recovered.
2) Rotate your ankle joint: Rotate your ankle joint from the inside out, 3-4 times a day, 5 repetitions each time.
3) Exercises on the healthy side of the limb: contract the muscles of the healthy side of the lower limb by flexing the hip and knee, and practice 1 set of 30 reps every 2 hours for 10-15 seconds each time.
Through this phase of exercise, the following should be achieved.
◆ Basic elimination of swelling of the affected limb.
◆ The affected thigh and calf muscles can make muscle stretching and contracting movements with coordinated force.
2. Postoperative day 4-7
During this period, the patient can eat normally, physical strength is gradually recovered, wound pain is reduced, blood and fluid in the joint have been drained out, drainage tubes have been removed, swelling of the affected limb has gradually subsided, and some lying hip activities can be started to restore muscle strength and gradually increase the mobility of the hip joint.
Repeat the following three exercises 3-4 times a day for 10 times each time.
1) Hip flexion and knee contact: As shown in the figure, the patient can flex and extend the hip and knee on your own so that your heel slides towards the hip and then straightens, taking care not to swing the knee to the sides.
2) Hip contraction exercise: Lie flat so that the hip muscles are held tight for 5 seconds.
3) Abduction contact: straighten the leg in the flat position and spread it out to the sides as far as possible, then recover it, taking care not to bring it completely together.
4) Quadriceps contraction exercises: keep the muscles in front of your thigh taut by pressing down and straightening the knee joint as much as possible, hold for 10-15 seconds, practice 10 times every 10 minutes until you feel a little fatigue in your thigh muscles.
5) Straight leg raise exercise: your front thigh muscles tense, try to straighten the knee joint, raise the lower limb (10cm from the bed), hold for 5-10 seconds, slowly lower, repeat the exercise, you will feel a little fatigue of thigh muscles.
(6) Hip straightening exercises: active straightening action of the hip joint on the operated side or a pillow under the hip, which can stretch the hip flexors and the anterior part of the joint capsule.
3. Postoperative day 8-14
Continue the previous phase of exercises according to the recovery situation, and further increase the exercises in sitting and standing positions to restore normal hip joint activities and increase muscle strength at the same time. Most patients at this period can already partially weight-bearing the artificial hip joint (patients using non-cemented prosthesis should delay the weight-bearing time appropriately, please follow your doctor’s instruction for the specific method), and carry out the following rehabilitation training contents.
1) How to get down to the ground
Place the walker next to the operated leg and move your body toward the bed.
Move the operated side leg under the bed to prevent external rotation of the operated side hip.
Move the able-bodied leg under the bed, turn the body and stand with the walker.
2) How to sit down
Before sitting down, prepare well, need a chair with backrest and armrest, add a cushion, back up slowly, watch the position, hold on with both hands, then sit down slowly. Hip flexion should not exceed 90 degrees, and sit in a higher chair.
3) Standing exercises
At the beginning you will feel dizzy, so be sure to have someone by your side to help you know you have enough strength to stand on your own. When doing standing exercises, you must hold on to the side of the bed or the handrail on the wall, and practice 3-4 times a day.
Standing leg lifts: Hold the handrail with both hands and lift your affected leg, being careful not to lift the knee above the waist.
Standing back extension and abduction exercises: slowly extend the affected limb backwards, lift your head and chest, stretch the hip capsule and hip flexors, pay attention to keep your upper body upright, 2-3 times each time, then straighten the lower limb and lift it outwards and slowly retract it, stretch the hip abductor and adductor muscles, 2-3 times each time.
4) How to walk with a walker-assisted stride
First use a walker to assist walking, keep the center stable and switch to a bilateral axillary cane. First place the walker 20 cm in front of the body, step the art side leg first, then the healthy side leg to follow, and so on.
In the beginning, walk for 5-10 minutes 3-4 times a day, and then increase to 20-30 minutes 2-3 times a day as you get used to it. After full recovery, you should keep walking 3-4 times a day for 20-30 minutes each time. Walking helps you maintain muscle strength around the hip joint.
Through this phase of exercise you should achieve.
◆ Active flexion of the hip joint to 90 degrees
Walk with partial weight bearing with the help of a walker
◆ Non-cemented prosthesis should extend the weight-bearing time appropriately
4. After removal of stitches and discharge from hospital
If the wound heals well and no serious surgical complications occur, the stitches are usually removed 10-14 days after surgery, and the patient can be discharged from the hospital with most of the physical condition recovered. At this time, your joint function has not reached the ideal level, so rehabilitation exercises should be continued after discharge. The hip joint is rich in muscles and recovers relatively faster than after a knee replacement. Your exercises after discharge from the hospital should mainly focus on standing exercises and walking exercises. After the soft tissues have completely healed, your hip joint can generally move freely.
1） Change from walker to double crutches for walking: first move forward one foot distance from the double crutches, land on the affected leg, move the weight forward until the weight crosses the line of the double crutches, and move the healthy foot forward 20-30 cm over the line of the double crutches, and so on alternately.
2) Continue the standing exercises during hospitalization
3) Stair climbing exercises: In most cases, you will be able to walk up and down stairs five weeks after surgery, as the soft tissues around the hip joint will have largely healed by three weeks.
When you go up the stairs, you should first move your healthy leg to the next step, then move your operated leg up the step, and when you go down the stairs, you should move your crutches to the next step, then move your operated leg down the step, and finally move your healthy leg down the step.
Once you can use the crutches to go up and down the stairs, you can switch to using the unilateral crutches to perform activities and gradually adapt until you can completely discard the crutches.
III. Notes
Through this stage of exercise, your hip joint should have returned to the normal level, but in order to use your artificial joint better, there are some details that you need to pay attention to in your daily life in the future.
1) What you need to prepare at home after surgery
◆ Install reliable handrails for your chair, toilet and stairs.
◆ Prepare a comfortable cushion for your seat with a secure backrest and armrests and a footstool for resting your affected limbs.
◆ Raise the toilet.
◆ Prepare reliable grab bars and chairs in the bathrooms.
◆ Remove all items in the area where you move around your home that may cause you to fall, such as carpets and telephone cords that can be moved.
2) Avoid squatting with your hips flexed more than 90 degrees, straighten your chest and waist when squatting, and do not bend your torso excessively.
3） When wearing shoes and socks, in order to avoid affecting the effect of surgery, you should lie down, with your feet on the bed and bend your hips to wear shoes and socks, and you should avoid crossing your lower limbs, such as stretched legs.
4） We recommend not to drive a car for 6 weeks after the surgery, because some surveys have shown that the weakened muscle response in the early post-surgery period has an impact on the safety of driving.
5) The prosthesis in your body will cause you to sound an alarm when passing through airport security. You can explain the situation to the airport security personnel, or you can ask your surgeon to issue a certificate for you.