Guidelines for post-operative rehabilitation after total hip replacement

  Total hip arthroplasty is one of the main surgeries for hip function reconstruction, mainly used for those who are over 50 years old with the following indications, total hip replacement is feasible, and caution should be exercised for those under 50 years old. Heavy damage or obvious degeneration of the acetabulum, heavy pain and limitation of joint movement, which seriously affects life and work;. Rheumatoid hip arthritis, joint ankylosis, stable lesions, but good knee movement; aseptic necrosis of the femoral head and old femoral neck fracture complicated by femoral head necrosis with severe deformation, collapse and secondary hip osteoarthritis; femoral head replacement, hemi-hip replacement and hip fusion failure.  The degree of recovery of hip function after hip replacement depends on two main aspects: the perfection of the surgeon’s surgery and the level of rehabilitation training of the rehabilitation therapist. Once the surgery is completed, the degree of recovery of function is entirely determined by the level of rehabilitation. The rehabilitation after total hip replacement in our department was carried out very early in China, and we have accumulated a lot of clinical experience and have the leading level of rehabilitation treatment in China.  Postoperative time 1~day 2: Absolute bed rest, wearing thong shoes to prevent lower limb rotation, while the affected limb is abducted 15~30 degrees, and cold compresses are applied with pressure for 15 minutes every 2 hours to reduce swelling and exudation.  Postoperative day 2~week 2: The main contents of rehabilitation training include ankle pump, static contraction of quadriceps muscle, straight leg raising exercise, hip abduction exercise, hip posterior extension exercise, hip flexion and hip flexion exercise in bed, with hip flexion angle between 0~90 degrees, and hip inversion exercise is strictly prohibited to prevent prosthesis dislocation. After total hip replacement with bone cement fixation, you can stand with weight after 48 hours after surgery, but avoid excessive hip flexion angle. Cold compresses must be applied after the completion of rehabilitation training to eliminate the swelling and pain caused by the training. The goal of this phase of rehabilitation is 75~90 degrees of mobility, eliminating postoperative reactions and reducing the degree of muscle atrophy.  Postoperative week 2~4: The main contents of rehabilitation training are ankle pump, quadriceps static contraction, straight leg raising exercise, quadriceps training, calf raising exercise, ball clenching exercise, hip abduction exercise, hip posterior extension exercise, skateboarding exercise, power carriage exercise, and hip flexion angle between 0~100 degrees. Cold compresses must be applied after the rehabilitation training is completed to eliminate swelling and pain from the training. The rehabilitation goal of this phase is 90~100 degrees of mobility, strengthening the muscle strength of the hip and the limb below the hip, and increasing the stability around the hip joint.  Postoperative week 4~8: The main contents of rehabilitation training are straight leg raising exercise, calf raising exercise, quadriceps training, adductor training, hip abduction exercise, hip posterior extension exercise, skateboarding exercise, power bike exercise, gait training, balance and proprioceptive training, etc. The hip flexion angle is between 0~120 degrees. After the rehabilitation training is completed, cold compresses must be applied to eliminate swelling and pain caused by the training. The goal of this phase of rehabilitation is to achieve 110-120 degrees of mobility, the overall muscle strength of the affected limb should reach the level of the healthy limb, and the gait should be at or near normal.  More than 8 weeks post-operative: The rehabilitation goal is to achieve a mobility of 120 degrees or more, the overall muscle strength of the affected limb should reach the level of the healthy limb, and the gait should be at or close to normal. The function of fast walking and jogging should be completed.  The above is the general rehabilitation process and rehabilitation goals after total hip replacement. While implementing the overall plan, the training progress should be increased or slowed down appropriately according to each patient’s own situation. The patient must follow the rehabilitation plan to the letter.