Postoperative rehabilitation after total hip arthroplasty

  This rehabilitation plan should be modified according to the patient’s condition. 1. After the operation, the affected limb should be abducted 15°-30°, and after 6 hours, the patient can perform passive activities of dorsiflexion and plantarflexion of the ankle joint, 10 times/minute, 10-20 minutes at a time, 6 times a day, to promote blood flow back to the lower limb and reduce the chance of deep vein thrombosis, and teach the patient deep breathing exercises.  2. On the 1st postoperative day, the bed is shaken up to 30°, do active ankle flexion and extension exercises, isometric contraction of quadriceps and biceps gluteus maximus joint, maintain contraction for 10 seconds, relax for 5 seconds, 10/group, 3-5 groups/time, 3 times/day to maintain muscle tone and passive movement of hip and knee joint. Start hip and knee flexion with an early range of motion of 25° for the hip and 40° for the knee (2 flexions/group, 4 sets/day for 3-5 days postoperatively) and encourage the patient according to the complexity of the surgery and the patient’s tolerance level. Gradually increase the number of activities.  3. On the second postoperative day, the bed was shaken up to 60°, and the hip and knee flexion and extension exercises transitioned from passive at first to active plus assisted to fully active. Assisted straight leg raising exercises for the affected leg to increase venous return and prevent atrophy of the quadriceps. And the bed was swung up to 90° for sitting exercises. It is not easy to sit for too long, otherwise the hip joint will be easily fatigued. Patients can also sit on the edge of the bed, brace their hands back, take the initiative to straighten the hip joint, fully extend the hip flexors and the front part of the joint 10/group, 3-5 groups/time.  4, according to the patient’s own condition after surgery in the 3rd and 4th day can start to carry out the training from sitting to standing position. The method is: the patient pulls the bed brace with both hands, so that the whole person moves to the bedside of the healthy side, the center of gravity is on the healthy side, the healthy leg is flexed and stirred hard on the bed, the healthy elbow supports the bed, while keeping the affected leg outside the booth (the posterior lateral incision to prevent internal rotation and internal retraction, the anterior lateral incision to prevent excessive abduction and external rotation) to sit up, and then stand up by double crutch support (non-marrow mud can not weight-bearing marrow mud can be weight-bearing). The method is: the patient holds the backrest of the chair with both hands, slightly posteriorly extends the affected lower limb, stretches the anterior hip capsule and contracted hip flexor muscles and posteriorly extends the healthy lower limb, and gradually moves the weight to the affected limb on the front side. Adhere to the above exercise every day, and gradually increase the amount of exercise.  5.After the 5th or 6th day of surgery, the affected limb is carried out basically without weight-bearing, the affected leg opens the step first, the center of gravity shifts forward, the weight of the person is distributed in the crutches and the healthy leg, and the healthy leg follows. If the prosthesis is non-bone cement fixation, the bone tissue grows into the prosthesis needs some time and a stable interface environment, premature weight bearing on the ground, so that the fibrous pseudomembrane between the prosthesis and the bone due to relative activity. Therefore, the postoperative weight-bearing situation is generally 6 weeks, but the doctor must see the film and decide whether to walk with weight.  6, after total hip replacement, patients should not do internal rotation, abduction and external rotation of the hip joint and excessive flexion of the hip joint for 3-6 months after surgery (such as placing the affected leg on the healthy leg, etc.), and should also pay attention to the “three no’s” in their daily life: do not sit on a short stool or soft sofa; do not stilt “two-legged “Do not bend sideways or bend forward excessively to avoid complications such as joint dislocation.  7, home after total hip arthroplasty should gradually increase the amount of exercise for muscle strength exercises and joint mobility: (1) quadriceps method: sitting legs down, add a sandbag (weight of 2.5-5 kg) at the ankle joint for knee extension and flexion exercises, slow knee extension and flexion exercises, 150 times / group, 6 groups / day, and then gradually increase the amount of exercise.  (2) Hip muscle strength exercises, no weight standing position for thigh posterior extension movements (also add a sandbag at the ankle joint 2.5-5 kg) 150 times / group, 6 groups / day.  (3) abductor muscle group exercise method: abduction 30-35 °, maintain 10 seconds, do 30-50 / group, 6 groups / day, and then gradually increase the amount of exercise joint mobility method: lying flat on the bed for active flexion and extension of the knee joint.  8, three months after the exercise is mainly the above-mentioned muscle strength exercises and joint mobility exercises, 6 months after surgery to avoid hip flexion more than 90 °, avoid sudden squatting movement and more intense exercise. Generally, the range of motion and squatting can be gradually increased after 6 months postoperatively. In the future, attention should be paid to protecting the joint and avoiding impact sports such as running and jumping (e.g. playing blue ball, jogging, dancing, etc.), and the best exercises are walking and swimming, etc.