Can I return to normal back and leg activities after a hip replacement (THA)?
After THA, patients can basically return to their normal level of activity through rehabilitation, i.e. they can do all kinds of activities in their life. However, there are certain prerequisites to achieve such an effect.
1, the disease that causes the patient to replace the hip joint is not some special disease. If the patient needs hip replacement because of rheumatoid arthritis, ankylosing crestitis and other diseases, then even after the joint replacement, the patient may have multiple joint deformities because these diseases existed before the surgery or continue to develop, and some patients may even have crest deformities, such as anterior arch of the crest, retroflexion and scoliosis. And these crestal and joint deformities will to a certain extent affect the use of artificial hip joints, which in turn will prevent the patient from returning to the level of normal human activities.
2, If the hip joint lesion is caused by common femoral head necrosis, femoral neck fracture and other diseases, these patients should ensure that no hip dislocation occurs within six weeks after the artificial hip replacement. Once hip dislocation occurs, timely reset and restriction of activities are required, and if repeated dislocation is also considered, such as secondary revision, even after rehabilitation training, it will take longer to recover to reach the level of normal human activities.
For the above two prerequisites, the first point cannot be changed by the patient after surgery because of the nature of the disease, so there is nothing that can be done. However, for the second point, the patient is capable of doing so. To prevent artificial hip dislocation, patients should try not to sit on a low stool or a shorter sofa until six weeks after surgery, although they can do such movements as sitting and standing. In addition, do not do stilts or cross-legged movements within six weeks, and every time you turn over, you need to hold a pillow between your legs if the affected side is on top. For squatting, it is generally recommended to do it after three months or six months after surgery, and especially not within six weeks after surgery.
In addition, there are certain requirements for the time that patients can walk after surgery: within six weeks after surgery, patients can walk slowly with a walker three times a day, morning, noon and night, but each time they only need to walk for about 15-20 minutes before they need to sit down and rest; after six weeks after surgery, this time can be extended to about half an hour each time. If the patient walks for too long each time, the pressure on the artificial hip joint will increase in a short time. It is also easy to develop edema in the affected limb and may cause muscle aches and pains due to prolonged activity, which may affect the recovery process after surgery.
Post-operative rehabilitation of artificial hip joint replacement (THA): six weeks is the dividing line
Do not rush into rehab after a hip arthroplasty. Because the hip joint is a ball and socket joint, it has a stabilization process when fitted with an artificial hip joint. In order to prevent dislocation of the artificial hip joint, in principle, do not do too many activities within six weeks after surgery, and the real rehabilitation exercises should start after six weeks after surgery.
So do you lie still within six weeks after surgery? Of course not. The rehabilitation that patients need to do within six weeks after surgery includes
How to prevent blood clots within six weeks after surgery?
1. Use of a plantar IV pump (usually done in the hospital): Generally, you can start using a plantar IV pump on the second day after surgery and insist on it for a week to effectively prevent blood clots. Because although patients can go down to the ground soon after surgery, they still need to restrict their activities, and when they do not go down to the ground, the plantar vein pump can help patients do contraction activities to squeeze the veins and increase blood return, thus preventing blood clots, which can be said to be a kind of passive contraction training.
2, calf muscle contraction training to promote blood circulation. The specific training method is: the affected limb is placed on the bed as straight as possible, the toes are stretched to the head side back to the maximum, the muscles on the leg are tensed as much as possible, insist on 5~10 seconds, then relax, and then continue the exercise, 20 groups are performed each time, 2~3 groups are performed every day. This is an active contraction training to prevent blood clots.
3, flexion and extension activity training of the axis, mainly including active bedside sitting gravity natural dip and passive CPM machine assisted training, etc.
Six weeks after surgery, how to rehabilitate
Waiting for six weeks after the surgery, the real rehabilitation training begins. Patients need to do abductor training, which is the most important training after hip arthroplasty. The abductor muscles of the hip joint mainly include the vastus lateralis, gluteus medius and gluteus minimus. These muscles can not only abduct the hip joint, but also play a stabilizing role in weight-bearing sports, especially when walking to stabilize the pelvis and maintain body balance.
To exercise the abductor muscles, mainly rely on side leg raising exercises, lying on the side in bed or standing position can be. The specific method is: the patient lies on his side, the affected limb is on top, first of all, the affected limb is abducted, that is, the leg is lifted, the ankle and toe are hooked upwards, and the other leg is at 45 degrees, on this basis, then the affected limb is stretched to the back side, insist on 10 seconds, then relax for 10 seconds, and then continue the training. Daily 10-20 times in the morning and 10-20 times in the afternoon. Generally after 6 weeks of training, there will be significant pain relief and walking limp can be improved. At the beginning of the training, if the strength of the abductor muscle is very poor, you can only train standing first, lifting the leg to the side; after training for a period of time, the muscle strength will increase, and then gradually switch to lateral recumbent exercises.
It is worth noting that after knee replacement, patients are often asked to do quadriceps exercises for straightening and raising the leg, but such exercises are not recommended after hip replacement because they tend to put a lot of pressure on the hip joint. Straightening and lifting the leg requires the thighs to exert force, so the raised leg is equivalent to a prying lever, using the weight of the whole leg to pry the newly replaced hip joint, which is very dangerous. Therefore, it is not recommended to do straightening and leg lifting after artificial hip replacement, and just do the exercise of hooking the foot without lifting the leg when lying flat on the bed.
3, rehabilitation training pain two conditions are normal
Rehabilitation training after artificial hip arthroplasty helps patients to resume normal activities as soon as possible, however, pain will inevitably occur in the rehabilitation training, then the emergence of pain is necessary to terminate the training?
In fact, no matter what kind of training a patient does at home after surgery, the intensity of the training will basically lead to leg pain or wound pain. If the pain disappears after stopping training, you can resume training. The intensity of training should be the same as before, do not reduce the intensity of training because of pain. However, it is worth noting that if the pain does not disappear after stopping training, but continues, it is necessary to seek medical attention.
In addition, after artificial hip replacement, many patients have similar experiences: the bones hurt when they walk a little. In fact, it is quite normal to experience this phenomenon within three months after surgery. This is because patients with artificial hip replacements do not start training their muscles until six weeks after surgery, which often results in the patient’s muscles not being as strong as they could be. A joint without muscle protection is like losing a lubricant, and two hard objects can come together, causing a sensation of collision and sometimes pain. Therefore, after the replacement of the artificial hip joint, patients often have the feeling that “the bones hurt when they walk around”.
However, if the pain is not relieved after more than three months, it is necessary to go to the hospital to check the blood sedimentation, C-reactive protein and other items to consider whether there are other problems.
4.After hip replacement, what kind of movement is considered moderate?
After artificial hip replacement, some patients do not pay attention to the protection of the new joint and think that they can rest easy after the joint is replaced; some patients are overly concerned about the new joint and are cautious about everything they do. So, after artificial hip surgery, what kind of exercise and diet is “moderate”, let’s talk about it.
Within six weeks after surgery, it is not recommended to squat, put on shoes and socks; after six weeks of surgery, wearing shoes and socks, walking, jogging and swimming can be done. If some patients are unsure and think that six weeks is too early after surgery, it can be postponed until three months later.
After the artificial hip replacement, it is not completely impossible to “stilt” or cross-legged. It is just that these behaviors should be done only after the patient has recovered well from the surgery for three months. If you do “stilts” or cross-legged actions within six weeks after surgery, it is likely to lead to hip dislocation, which is very dangerous.
Patients should not sit for a long time after surgery, because sitting for a long time is a test for the hip joint and lumbar spine. Generally speaking, this “long time” refers to more than 30~40 minutes. In other words, it is recommended that patients sit for 30~40 minutes and then stand and walk for a period of time.
When going up and down the stairs after surgery, patients should pay attention to “good up and bad down”, that is, the leg on the healthy side goes up first when going upstairs and the leg on the operated side goes down first when going downstairs. In addition, within three months after surgery, patients should try to hold the handrail when going up and down the stairs. On one hand, the joint may not be very stable after hip replacement; on the other hand, patients may fall after surgery due to muscle weakness. However, after three months of surgery, if the patient has recovered better through side leg raising exercises, there is no need to be so careful.
If the head of the femur is necrotic due to alcohol consumption and thus requires hip replacement, such patients are still advised to stop or reduce alcohol consumption even after the new joint is replaced. This is because continued alcohol consumption after surgery may lead to necrosis of the femoral head on the opposite (good) side and may also cause damage to the liver and kidneys.
There are not many precautions in diet after artificial hip replacement, and there is no need to avoid eating because of the surgery.
5.After the artificial hip replacement, you will be taught how to sleep
For patients who have only one side of the artificial hip joint replacement, they often feel confused about whether they can sleep on their side after the joint replacement. Will sleeping on your side “crush” the new hip joint?
In fact, patients can sleep without any worries one to two days after the surgery, not necessarily six weeks or three months after the surgery. The body has natural “protective measures” such as muscles and synovial fluid around the joint, which protect the joint at all times. In addition, a hip replacement should be fixed very firmly during surgery. If the hip is not fixed properly, it can go wrong even if you do not press on the joint. On the other hand, if the hip joint is firmly fixed, it is very unlikely that you will have any problems with it even if you press on it. It is important to know that after hip replacement, the artificial joint will be used for 20-30 years or even longer, so it is impossible for the doctor to let the joint get loose after a sleep.
However, it is worth noting that within six weeks after the artificial hip replacement, if the patient sleeps on his or her side, he or she must add a pillow between his or her legs if the affected side is on top, so that the two legs do not come together; while the affected side is on the bottom, instead of adding a pillow, he or she can sleep without any worries.
So, what is the use of adding a pillow? First of all, when doing hip dislocation correction surgery, the doctor will put the patient in a side sleeping position, with the affected side on top, and inwardly tuck the affected side to bring the two legs together, and then take the hip joint out. Although the chances are very small and most patients have no problems after sleeping this way, it is still recommended to add a pillow between the two legs within six weeks after the surgery and when the affected side is sleeping on top, so that the legs are not together and the hip joint will be more stable. After six weeks, the joint capsule has grown strong, so there is no need for these auxiliary protection.
6, artificial hip replacement after the surgery to teach you how to pad insoles
Unlike knee replacement, hip replacement involves the length of two legs, and it is possible for one leg to be longer or shorter after surgery. If the affected leg is longer after surgery, the insole should be placed on the healthy side, and vice versa. Generally, over 90% of patients do not need insoles after surgery. In cases where the difference in length between the two limbs after surgery is within 1 cm, patients rarely experience discomfort and do not need insoles. Only in some special cases where the difference in length is greater than 1 cm, insoles are required. The reason for this is to prevent the lumbar spine from being affected by unequal limb lengths, which in turn can lead to scoliosis, lumbar degeneration, and symptoms such as bone and joint pain, lumbar pain, and leg numbness. It is important to know that once the lumbar spine disease is caused by unequal limbs, it is often very difficult to repair.
As for how high the insole actually needs to be padded, the general principle is that the difference is how much padding. The measurement method is: when the patient’s legs are not equal, take off the shoes and stand on the floor, put the paper under the bottom of the foot of the side that feels short, and then keep increasing the thickness of the paper until the patient himself feels that the feeling of the two feet on the ground is the same, the thickness of the paper is basically the thickness of the insole.
Generally speaking, the height of the insole that the patient needs is 1~3cm. However, it is worth noting that if the patient’s legs are more than 3 centimeters apart, the insole needs to be padded gradually, not 3 centimeters at once. Because these patients are in a long-term state of great difference in the length of the two legs, the lumbar spine is often already affected, if the insoles are high at once, the patient will feel that the short side of the leg has become longer, the waist can not stand. At this time, the patient needs to start with a 1 cm insole, adapt to 4-6 weeks, then increase to 2 cm, and finally gradually transition to the height of the need to pad.
As for how long the insoles need to be padded, generally speaking, the greater the difference between the length of the two legs, the longer the insole time. In other words, if the difference between the two legs within 1 ~ 2 centimeters, generally 1 year insoles, the body can accept and adapt to such a gap; the difference between the two legs 2 ~ 4 centimeters, insoles may have to pad a long time, 5 years or even longer is possible, because in a short time, the body is difficult to adapt to such a gap, only until the waist slowly compensate, to gradually adapt; if the two legs length difference of more than 5 centimeters, it is possible to need to pad longer insoles.
7, post-operative wound pain first find the cause and then treat
After artificial hip replacement, many patients reflect that although the doctor said the surgery was successful, the wound has been painful. So, is this pain caused by the surgery? What should be done?
In fact, a large incision is needed to remove the “bad bone” and put in a new joint. It is impossible to have such a large operation without any pain in the wound afterwards, but this pain should be treated differently in each case.
If the wound is painful within six weeks after surgery, the patient should not be overly stressed. Because this pain is the tissue damage caused by the surgery, causing an inflammatory response, only some non-steroidal anti-inflammatory analgesic drugs, such as fen-phen, furosemide, etc., should be used. For patients with gastric disorders, drugs such as ciloxib and meloxicam, which are less irritating to the stomach, and indomethacin suppositories, which are basically non-irritating to the gastrointestinal tract, can be considered. In addition, some blood-activating drugs can also be used appropriately. In conclusion, most pains within six weeks are aseptic inflammatory pains, and medication will solve the problem. However, if the patient thinks that it is just a minor problem and that he or she can carry it on his or her own and does not need to take medication, the untreated inflammation may further damage the patient’s joint, with unimaginable consequences.
Six weeks after the artificial hip replacement surgery, the wound and the joint capsule should have basically healed and functioned well. If the patient is still experiencing wound pain at this time, an active search for the cause is required. Generally, there are several reasons why pain persists beyond six weeks after surgery.
Pain due to infection. If the patient still has recurrent pain more than six weeks or three months after surgery, especially if there is significant intermittent pain and nighttime pain, infection needs to be excluded first. This is the time to actively seek medical attention, review the two indicators of blood sedimentation and C-reactive protein, and ask the attending surgeon for diagnosis and treatment.
Pain caused by muscle training. Six weeks after surgery, the patient needs to train for muscle strength. If the training is poor, the patient will feel soreness in the hip joint or soreness near the outer hip joint after walking for a little longer. This is when pain can be relieved by abductor exercises.
Other causes of pain. If there is sudden pain more than six weeks after surgery, or if there is joint locking (i.e. the joint is suddenly stuck during activities and cannot be extended or flexed, then there is usually sudden pain), you need to consider whether there is hip dislocation or fracture due to trauma, then you need to actively seek medical treatment.
8.What should I do if I have swelling after hip replacement?
After the artificial hip joint replacement, many patients will have swelling of the lower limbs for a long time. The reason for the swelling is that in the process of hip replacement, the doctor has to loosen the tissues and muscles around the hip joint so that the muscles can be relaxed to facilitate the surgery, which will inevitably hurt some small blood vessels that are not very important. When the blood vessels are affected, the blood circulation becomes poor and the venous return is not good, which will lead to swelling of the lower limbs. In particular, the hip joint is in a more important position, and the blood flow to the lower extremities has to pass through the hip joint, so the lower extremities are more likely to be swollen after surgery.
Generally, after rehabilitation, the swelling of the lower limbs will be obvious in the afternoon and evening hours, and the swelling of the limbs will disappear after a night of lying down and resting. After six weeks or three months after surgery, if swelling of the lower extremity still occurs, especially compared with the other leg, the swelling of the affected leg is more obvious, it is recommended that the patient go to the hospital for a venous ultrasound of both lower extremities to rule out the possibility of lower extremity venous thrombosis. It is important to know that the typical symptom of lower extremity venous thrombosis is swelling of the limbs, and if left untreated at this time, it may lead to pulmonary embolism due to dislodgment of the thrombus. Therefore, at this time, if there is venous thrombosis in the lower extremity, this is the time to treat the thrombosis.
If the ultrasound is done and it is determined that it is not lower extremity vein thrombosis, in order to eliminate the swelling, the patient can use some drugs that have a decongesting effect on the blood vessels, such as mai zhi ling and indomethacin suppositories. At the same time, it is necessary to moderately reduce the intensity of rehabilitation training such as walking, and elevate the affected limb to promote blood circulation, so that the venous return flow is more smooth.
9.After artificial hip joint replacement, infection is a disaster
After artificial hip replacement, patients need to be especially careful about joint infection, because once infection occurs, patients will have to face another or even multiple surgeries, which can be a catastrophic consequence. Nowadays, the lowest infection rate after artificial hip replacement is basically controlled at 1‰~2‰ worldwide; in China, the infection rate after surgery is basically between 2‰~5‰. Generally speaking, the following three groups of people are prone to infection.
Patients with poor resistance.
Patients with preoperative diseases such as diabetes and anemia, resulting in relatively poor function of other organs.
Patients with poor skin conditions and a history of trauma prior to artificial hip replacement.
Long-term use of hormones or immunosuppressive drugs.
In addition, it is worth noting that the rate of postoperative infection varies for artificial hip replacements due to different etiologies. Among them, patients who need artificial hip replacement due to inflammatory joint diseases such as rheumatoid arthritis or ankylosing crestitis have a postoperative infection rate 2.7 times higher than those due to femoral neck fracture and femoral head necrosis. Therefore, it is recommended that such patients should use antibiotics prophylactically for 1 to 2 days before surgery; use antibiotics for a slightly longer period of time after surgery; and be sure to use antibiotics to escort them if there are foci of infection in other parts of the body, such as skin infection, urinary tract infection, pneumonia, etc., more than two years after surgery.
Generally speaking, joint infection after artificial hip replacement can be divided into acute infection and chronic infection. Acute infections mainly manifest as wound redness, swelling, heat and pain as well as pus flow. In the case of chronic infection, the most obvious feeling of the patient is pain, such as resting pain (i.e. the patient stays without doing anything and still feels pain in the joint), weight-bearing pain (i.e. the patient feels pain when stepping on the ground), and night pain, etc. Nowadays, most infections that occur after hip replacement are chronic infections, meaning that the bacteria are not so strong that they cause redness, swelling and heat in the patient’s wound, but only painful manifestations. When infection is suspected, patients need to seek medical attention in time and go to the hospital to do X-ray, check blood sedimentation, C-reactive protein and other items to clarify the diagnosis.
10.After total hip replacement, how long can the artificial joint be used?
How long can the new joint be used after total hip replacement is a great concern for patients and their families. In fact, with the widespread use of new technologies and materials, the service life of artificial hip joints has been greatly improved. For example, ceramic technology has evolved from the first generation to the fourth generation, and plastic polyethylene liners have evolved from ordinary polyethylene to cross-linked polyethylene, to the current use of highly cross-linked polyethylene, which is increasingly wear-resistant. The study found that the wear situation is less than 0.1 mm per decade. It is safe to say that with the use of new materials, the rate of prosthesis failure due to friction has become lower and lower.
In addition, the design of artificial hip joints is becoming more and more consistent with human anatomy and physiology. For example, technology now allows the patient’s own bones to grow inside the artificial hip joint, so that the fixation between the hip joint and the bones is more secure, ensuring the longevity of the new joint. From the latest literature, as well as many registry systems, such as the Swedish registry system, the American registry system, and the British registry system, it is found that, except for factors such as infection and trauma, the excellent rate of artificial hip joints after 15-20 years of use is 90%-95%, and the excellent rate after 20-30 years is 85%-90%. In other words, 20-30 years after the artificial hip joint is installed, 85-90 out of 100 patients can still continue to use it.
11, after hip replacement surgery, three kinds of conditions immediately seek medical attention
With the continuous development of technology and improvement of surgical techniques, the time patients need to be hospitalized after artificial hip replacement is greatly reduced, and many post-operative rehabilitation training and care are gradually transferred to be completed at home. However, patients are often hesitant to seek medical help because they are not professionals and they are afraid that they will have a big problem if they do not seek medical help, but they are afraid that it will be a false alarm. In fact, patients need to seek immediate medical attention if they experience the following symptoms.
The presence of hip dislocation. Even if it has been many years since the artificial hip joint was replaced, the hip joint may still be dislocated due to improper posture or trauma, so once the hip joint is dislocated, reset or revision should be considered.
Post-operative wound effusion. If you find that the wound is red and starts to flow pus and water after surgery, you should highly suspect infection and need to seek medical attention immediately.
Persistent pain after surgery. Patients can feel pain all the time after surgery, even if the pain increases, they also need to seek medical attention.
12.Guidelines for post-operative consultation after artificial hip replacement
For patients with artificial hip replacement, it is not easy to rest after the joint is replaced, regular review and monitoring of the joint is essential. Generally speaking, in the first year after the artificial hip replacement, you need to visit your surgeon for four times, six weeks, three months, six months and one year respectively; after one year of surgery, patients can review once a year according to their recovery situation.
The post-operative review does not require a new X-ray or other examination every time. Generally, the six-week post-operative review does not require X-ray, blood sampling, etc. This time requires patients to come to the hospital, mainly to check the healing of the wound and the presence of other uncomfortable symptoms, such as whether the wound feels painful.
And in the three reviews, three months, six months and one year after surgery, patients are required to have X-ray examinations. It is especially important to note that for patients with artificial hip joint replacement, they need to stand up for each X-ray examination in order to ensure the effect of the examination. As for blood sedimentation, C-reactive protein and other tests, it is recommended to do them when infection is suspected.
In addition, patients are advised to scan the QR code of their primary surgeon after surgery to enter the doctor’s patient association and upload relevant information such as cases. This is because after the patient scans the code and uploads the information, the doctor can quickly see the information and understand the current state of the disease the patient is in and provide timely guidance. Generally, for patients after hip replacement, uploading X-rays is the most important (not just the paper report of X-rays, but more importantly the X-rays), other things such as labs, if available, can also be considered.