I. What is a joint? A joint is made up of two or more bone ends and a variety of tissues that join together. For example, the knee joint is made up of the tibia (lower leg bone) and the femur (thigh bone). The hip joint, also known as the “ball and socket joint,” is made up of the femoral head (ball), the upper end of the femur, and the acetabulum (socket), part of the pelvis. The surface of the bony end of the joint is covered with a smooth layer of cartilage. The presence of articular cartilage under normal conditions allows the joint to move in a painless and frictionless manner. However, when the articular cartilage is damaged by a disease such as arthritis, the joint becomes stiff and painful. The joint is surrounded by fibrous tissue – the joint capsule – which has a smooth “lining” – the synovial membrane. The synovial membrane produces synovial fluid, which reduces the wear and tear caused by joint movement. The normal human hip joint: The hip joint is the largest weight-bearing joint in the body. It consists of two main parts: the spherical portion of the proximal femur – the head of the femur is contained within the acetabulum over the pelvis. There is a ligament – the round ligament – that connects the acetabulum to the femoral head providing the stability of the joint. The bony surfaces of both the femoral head and the acetabulum are covered with smooth articular cartilage as a “cushion” that allows for greater flexibility of movement between them. The surface of the joint is covered by a thin, smooth layer of synovial tissue. In a normal hip joint, the synovial tissue secretes a small amount of fluid, which lubricates the hip joint to reduce wear between the femoral head and the acetabulum. All of these mechanisms ensure that your hip joint can move freely and painlessly under normal circumstances. Common causes of hip pain and dysfunction: The most common cause of chronic pain and instability in the hip joint is arthritis. Examples include: osteoarthritis, rheumatoid arthritis, and traumatic osteoarthritis. Osteoarthritis: Often occurs in patients over 50 years of age and has a tendency to run in families. In this disease, the cartilage cushion of the hip joint is lost and direct wear and tear occurs between the femoral head and the acetabular bone, resulting in pain or stiffness of the hip joint. Rheumatoid arthritis: A disease of the synovial membrane in which inflammation of the synovial membrane produces large amounts of synovial fluid and destroys the cartilage of the joint, leading to pain and stiffness. Traumatic osteoarthritis: This is secondary to a severe trauma or fracture of the hip joint. Hip fracture can cause the familiar ischemic necrosis of the femoral head, which eventually leads to pain and stiffness of the hip joint. Second, what is artificial joint replacement? Artificial joint replacement is an operation to replace the damaged joint with an artificial joint, to solve the pain, deformity and dysfunction, and to restore and improve the joint movement. Why do I need an artificial hip joint replacement? The purpose of artificial joint replacement is: 1) to relieve pain; 2) to restore and improve joint function; 3) to correct deformity. What kind of patients need artificial hip replacement? 1.The function of the hip joint is obviously affected, such as the inability to sit on a low stool, the difficulty in going to the toilet and up and down the stairs, the inability to wear socks, cut toenails, etc.; 2.It is accompanied by moderate to severe persistent joint pain, which can only be relieved by long-term painkillers; 3.Non-surgical treatment, i.e. physiotherapy, acupuncture or oral Chinese and Western medicines, etc., cannot relieve the pain; 4.There are signs of joint destruction by X-ray examination; the purpose of surgery is to solve your pain and return your normal life. The purpose of surgery is to solve your pain and give you a normal life. The following actions should be avoided as much as possible, otherwise the chance of your artificial hip joint loosening will be greatly increased. Do not sit on a low stool (about 20cm), including squatting; avoid jumping from a height with straight legs; avoid strenuous exercise; avoid falling; do not rotate your hip outward in either lying or walking position; do not lie on the side of the operation. V. In order to make you complete the training easily and happily, we have formulated the following training plan for you: (a) 1~3 days after surgery: The training in this period is aimed at restoring muscle strength and promoting blood flow in the lower limbs to prevent thrombosis. However, do not move the hip joint for the time being. 1. Flexion and extension of the ankle joint: slowly hook the toe upward, then extend it farther to make the foot surface tense. You can practice several times every 5~10 minutes; start immediately after surgery until you fully recover. 2. Rotate your ankle joint: rotate your ankle joint from inside to outside; repeat 5 times each time 3~4 times a day. (2) 3 days to 2 weeks after surgery: During this period, you can start some lying hip activities to restore muscle strength and gradually increase the mobility of the hip joint. 1, use passive joint mobilizer (CPM): the use of CPM in the early postoperative period can make the newly replaced artificial joint enter the role in advance, effectively prevent the surrounding soft tissue adhesions and play a role in the prevention of deep vein thrombosis in the lower limbs. 120°. 2, 3 to 4 times a day, each time 10 repetitions of the following three exercises: 1) Flexion and extension of the knee joint: flex the knee joint as shown in the figure so that your heel slides towards the hip, and then straighten. Be careful not to swing the knee to the sides. 2) Hip contraction: Lie flat on your back so that your hip muscles are tense and hold for 5 seconds. 3) Abduction exercise: straighten the leg in the flat position and spread it out to the sides as far as possible, then retract it, taking care not to bring it completely together. 3) Quadriceps contraction: 1) Tense your front thigh muscles (quadriceps), straighten the knee joint as much as possible, hold for 5-10 seconds, practice 10 times every 10 minutes or until you feel a little fatigue in your thigh muscles. 2) Straight Leg Raise: Tense your front thigh muscles, straighten your knee as much as possible, raise your lower leg (10cm from the bed), hold for 5-10 seconds and slowly lower it. Repeat the exercise, you will feel a little fatigue in your thigh muscles. (iii) 2 weeks after surgery: This period is aimed at restoring normal hip mobility and enhancing muscle strength. If your artificial hip is cemented, you can start to sit up gradually and practice standing and walking. However, please make sure you carry out the following rehabilitation training under the guidance of your doctor. 1.Sit on the edge of the bed and sit on the chair at 14~21 days. When you stand up from the chair, first move your body to the edge of the chair, put the affected limb in front, let the healthy leg bear most of the body weight, take the initiative to carry out hip flexion and knee flexion, hip extension and limb extension exercises, and you can continue to use the passive joint movers. 2.From 22 days onwards, the doctor should hold the patient’s hands flat and practice walking on flat ground, 100~300 steps each time, 2~3 times/day. Walk not in more, but to walk correctly, at the same time practice equal steps up and down the stairs, when going up the stairs first step healthy leg, when going down the stairs first step affected leg. Do not rotate the foot externally or internally when walking, do not drag the step, do not skip the step, do not limp, and be bold enough to let the affected hip bear the weight. Remember to avoid accidental falls. Generally do not use crutches to avoid delaying the independent walking period. From the 4th week onwards, practice squatting, standing and stepping at the same time. 3. Standing exercises: You will be able to get out of bed and stand up soon after surgery. You may feel dizzy at first, so it is important that you have someone with you to help you. Until you have enough strength to stand. You must hold on to a handrail next to the bed or on the wall when you stand. 3~4 times a day, 10 times each time. 4.Standing leg lift exercise: hold the handrail with both hands and lift your affected limb, pay attention to the knee joint not to exceed the waist when lifting the leg. 2~3 times each time. 5.Standing abduction exercise: keep your lower limb straight and lift it outward, and slowly retract it. 2~3 times each time. 6.Standing back extension exercise: extend the affected limb slowly backwards, pay attention to keep your upper body upright, 2~3 times each time. (iv) Walking and early activities: Soon after surgery, you can walk around the ward and do some light daily activities. This will be very helpful for your recovery of hip strength and movement. Begin walking with a cane until you feel you have adequate balance. At first, walk for 5-10 minutes 3-4 times a day; then gradually increase to 20-30 minutes 2-3 times a day. After full recovery, you should keep walking 3~4 times a day for 20~30 minutes each time. Walking helps you maintain the strength of the muscles around the hip joint. (e) How to use crutches? Crutches can help with early post-operative rehabilitation for patients whose prosthesis is not yet healed and for patients with inadequate lower extremity support. Not all patients must use crutches after surgery, and some patients will not benefit from using crutches after surgery, so it is important to follow your doctor’s advice. If you need to use must carefully follow the doctor’s instructions, otherwise you will get half the result with twice the effort! The principles of using crutches: 1, do not fall down! At the beginning of the use of crutches must be helped; slippery ground should avoid walking on crutches; frail elderly and poor balance, prone to falls, post-operative crutches should not be used, it is appropriate to use a wheelchair. 2, step by step The use of crutches requires learning and adaptation, even for healthy people are not very easy, for postoperative patients need to be patient practice. Start with simple movements, and practice one movement well before practicing the next to avoid injury and affect the outcome of the surgery. Also be confident and make unremitting efforts for better recovery! 3.Avoid dependence When you can better control your walking, squatting, standing, and turning, and the prosthesis has been firmly healed, you should abandon the crutches. Steps from prone position to crutch use: 1. Flex the affected side of the hip outward. 2. Move the affected leg out to the bedside and bend the knee. 3.Support the body with the elbow on the affected side and move the leg on the healthy side to the side of the bed and sit up with the upper body. 4.Sit up with the edge of the bed and move the calf on the side of the bed, after the calf moves freely, then prepare to put on shoes and get up. 5.Grip the crutches with the hand on the healthy side and support the bed with the other hand, and land on the leg on the healthy side. 6, the affected side of the hand and then hold the crutches from the bed, holding the crutches to stand. 7, first move forward one foot distance from the crutches, the leg on the healthy side to the ground → shift the center of gravity until the center of gravity crosses the line of the crutches → the foot on the healthy side to move forward to cross the line of the crutches 20-30 cm. Alternate this way. Walking with a cane and crutches: For the first few weeks after surgery you will often need a walker to help balance your body to avoid falls. You can then use a cane or crutches to help you walk until you are fully recovered. After you are fully balanced and stable without a walker, you should use a cane or crutches on your healthy side. When you are discharged from the hospital, you may also perform the exercises described below on top of those described above, but you are expected to do so within your limits and with someone with you if possible. (vi) Home rehabilitation training Home rehabilitation training considerations 1. In the beginning, each exercise can be performed 3 to 5 times, then gradually increase the intensity by 1 times each time until you can perform 15 times each exercise. If you feel difficult to carry out a certain exercise, do not force, you can try to carry out this training after a week of rest. 2, breathing: pay attention to your breathing rhythm! You should keep breathing evenly, do not hold your breath. You can try this exercise, when you bend the leg squatting exhale, stretch the leg upright when inhale, how does it feel ? You can of course inhale as you bend your legs to squat and exhale as you extend your legs to stand up. Find a method that works best for you. When you finish one exercise and before you start the next one, breathe in through your nose 3 times and breathe out slowly through your mouth. 3, away from pain: in the process of all exercises, you should feel relaxed and happy and should not have the feeling of pain. If any exercise makes you feel bad, you should give it up. If you feel pain, apply a cold pack to your hip with ice. Elevate your legs as often as possible. You can take a break at any time without feeling guilty or uncomfortable. The break can even be for several days. When you start again, start with simple exercises and slowly and gradually increase the difficulty. 4. Preparation: You may need a slightly larger rug, a pillow and a small stool to help with rehabilitation. Supine Exercise: You can also use a stool or chair to prepare for the supine exercise. First extend the affected limb backward, then bend the other leg downward and bend the backward leg downward, while supporting both hands on the stool. Put the stool aside, support both hands on the floor, and then lie on the floor with forearm support. Finally turn over into a supine position. During the turning process, care should be taken to ensure that the surgical side of the leg is not pressed, regardless of which side it falls to. If the exercise is completed, do the above steps in reverse order and allow yourself to stand up slowly. 1) Full body tension You start with your back relaxed and lying flat, with your upper limbs on each side of your body, palms facing up. Both lower limbs are straight and flat, slightly outwardly apart. In each exercise you should first tense your body, that is, extend your shoulders as far down as possible, tense your chest and abdomen, and keep your hips close to the mat. Now hook your toes up and bring the back of your knees to the mat – tense your whole body. Slowly loosen your whole body to achieve complete relaxation. 2) Exercise 1: Tense your whole body, keep your right leg straight and bend and straighten your left leg on the mat as much as possible. Alternate between left and right legs, keeping the left leg straight and bending and straightening the right leg as much as possible. If you want to go faster, you can slowly increase the speed of the exercise. 3) Exercise 2: Tense your whole body and put your hands on your waist. Keep the right leg firmly on the mat, toes up, while spreading the left leg to the side on the mat. You should note that the knee and toes should remain in a vertical upward direction during this process. Return the left leg to its original position, then repeat the exercise with the right leg. 4) Exercise 3: Tense your whole body and put your hands back on your waist. The lower limbs are now crossed out to the sides at the same time. You should note that during this process the knees and toes should remain vertical up. Standing Exercise: Stand with your back against the wall. Spread your legs about shoulder-width apart. Heels about seven centimeters from the wall. Keep your hips, shoulders and the backs of your hands close to the wall. If you cannot stand safely on your own, you can use a cane, or you can lean your back against another object such as a table or writing desk, so that you can use your hands for support if necessary to avoid falling. 1) Tighten your body, lift your chest and head, lower your shoulders, and keep your arms and back of your hands against the wall. The buttocks are pressed against the wall, the abdomen is relaxed, the feet are fixed on the ground, the knees are slightly bent, and the toes are facing outward. This tense state is maintained for seven seconds, and then slowly relaxed 2) Exercise one full body tense. Land on one toe and slowly turn your toes, keeping your knees and hips bent. Rotate your left foot and right foot alternately. When you feel secure enough, you can speed up the frequency and shift your body weight from one leg to the other. 3) Exercise 2 Lean your back against a smooth wall, while keeping your heels seven centimeters away from the wall. Cross your legs slightly, with your knees and toes facing outward slightly. Keep your hips, shoulder joints and the backs of your hands in contact with the wall. Slowly squat down with your back against the wall while keeping your heels in full contact with the floor. Hold this position for a moment and then stand upright with your back against the wall. 4) Exercise 3 You should keep encouraging yourself by stopping for a moment during the exercise and gently pressing your legs with both hands from the knee to the hip joint. When you plan to do it again, take a few deep breaths first. You can walk around the room! Take it step by step! Muscle strength exercises: Full recovery of the hip joint may take several months. The following exercises will help you regain muscle strength in your hip joint. 10 repetitions 4 times a day. Put a leather strap around the ankle joint of the affected limb and fix the other end to a good leg or other stable furniture. Be careful to hold on to a chair or other stable object when practicing to maintain balance. 1, hip flexion: stand upright, move the affected limb forward, pay attention to keep the knee joint straight. Then return to the upright position. 2.Hip abduction: stand upright, move the affected limb to the outside, and then return to the upright position. 3, posterior hip extension: stand upright, move the affected limb backward, and then return to the upright position. Daily life precautions 1.How to squat? Straighten the chest and waist, do not bend the trunk excessively; 2, how to wear shoes and socks? Stretching the legs helps to put on shoes and socks, but it should be noted that the action must be avoided in the early postoperative period so as not to affect the effect of surgery. You should sit on the bed and put on shoes and socks with your feet on the bed in flexion and hip flexion. 3.How to go up and down the stairs? 1) You need to have enough strength and flexibility to go up and down the stairs. 2) At the beginning, you need to use the handrail of the stairs, and each step can only be one step. 3) Which leg to use to go up and down the stairs is also a matter of concern. To make it easy for you to remember, let’s use a phrase: “Healthy legs go to heaven (good legs first when going up the steps), affected legs go to hell (affected legs first when going down the steps).” It is best to be assisted by others until you feel you have enough strength and flexibility to guarantee it. 4) Going up and down stairs is a very good exercise for muscle strength and body balance. Be careful not to go up the stairs too high, each step should not exceed 25 cm. 5) Be careful to use the handrail of the stairs. After the first week of postoperative surgery, the affected limb should be bedridden and the muscles of the affected limb should be trained to be equal in length. However, you should not go up and down stairs to avoid uncontrolled falls. From week 6 to 7, the affected limb should be partially weight-bearing and walk with crutches. Prepare reliable handrails and chairs: Remove all items that may cause you to fall in the area where you move around your home, such as carpets and telephone cords that can be moved.