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AFTER TOTAL HIP REPLACEMENT

This rehabilitation program is not fixed in stone and may be adapted depending on intra-operative findings, occurrences and results.

But in general:

After your total hip replacement surgery you will be allowed to move in bed with flexion of the hip and knee as much as you feel able to do. The physio will in some cases place the leg in a continuous passive motion machine on the day of surgery. Physiotherapy active mobilization will begin first thing the next morning. The emphasis will be on getting you upright and walking. The initial aim is to make sure that you have good balance and control of the affected leg. You will be instructed regarding limitations of range of movement of the affected hip with the purpose of avoiding dislocation of the joint. This is a risk for the first 3 months until the new capsule and scar tissue has consolidated. Generally you may place the leg in any position as long as the the thighs are apart. For the ladies, anything unladylike is good. For example, when getting up off the toilet or from a chair, do this with the thighs apart.

On average my patients are in the hospital 3 to 4 days. This does however depend on age and the number of comorbidities. Essentially I want you to be independent enough to get in and out of bed, go to the toilet, stand in the shower and negotiate a flight of stairs with your crutches. For those who live alone, arrangements will be made for transfer to a step down rehabilitation facility for a week or two depending.

For the first two weeks I ask only that you mobilize regularly and go for regular walks around the house or garden, and this is the only exercise that you require together with the simple movements that the physiotherapist in the ward will demonstrate and take you through while in the ward. In two weeks you will be seen in the rooms and the dressing will be removed. Methods of optimizing the scar outcome will be discussed.

From 2 weeks to 3 months the rules with respect to avoiding dislocation should be obeyed. Please see below. During this period it is a good idea to get into a pool if you have access to this. I advise submerging yourself to waist level and walking against the water resistance. Treading water and swimming with ordinary kicking is also allowable. Other exercises include learning to stand on one leg again. It is useful to practice balancing on the affected leg while for example brushing your teeth in the mornings. If you would like you can begin driving at this stage, but make sure that the range of movement rules are obeyed when getting in and out of a car seat.

These rules include the following:

  1. When standing and needing to bend down to pick something up, do so with the affected leg extended backwards. The idea is not to flex the hip more than 90° to the body.
  2. When sitting down and needing to pick something up it is best to do so with the thighs apart , the ‘unladylike’ position. Do not cross your legs.
  3. Always face what you are doing and do not twist to reach objects.
  4. When turning a corner do so as if you are on the parade ground by stepping into the direction you would like to go, again this is to avoid twisting.
  5. It is better to lie on the operated side when sleeping and you can do so as soon as you feel comfortable. If you would like to lie on the opposite side please do so with a large pillow between the legs. This is to prevent the operative leg from flopping over into a dislocatable position.
  6. Used a raised toilet seat (ask the physiotherapist about this) for up to 3 months.
  7. I advise my patients to reach for the foot in order to put on their shoes and socks by using the figure of 4 position. This will be difficult initially but it is good to begin practicing early. It is a safe position for the hip. Failing this use a long handled shoe horn.
  8.  Avoid deep seated soft couches but if you do land up in one then get up with thighs apart with the operative side leg straight and bend and push up with the good leg.
  9. Sexual activity is safe in both men and women immediately from day of discharge. Obviously one should refrain from being over enthusiastic and stay within comfort.
  10. The dressings are only shower proof and bathing should be avoided in the first 3 months because of the need to bend deeply to bet into a bath. A bar stool in the shower would be useful or take your crutches in with you.

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Avoiding dislocation
Your new artificial hip has a limited range of safe motion while it is healing. For about three months, you will need to follow special safety rules called “hip precautions” to protect your new hip while it heals. While you are in the hospital, your healthcare team will remind you often about the need to follow the hip precautions.

What if Your Hip Dislocates? (Risk is less than 1%)
Dislocation of an artificial hip is uncommon, and typically occurs within the first three months after surgery. The problem usually starts with a popping sensation or a slipping sensation. You will be unable to bear weight on the affected limb and may experience a fair amount of discomfort. You will need to contact your orthopaedic surgeon immediately and probably have someone take you to the emergency room. Putting the hip back in the socket will probably require medication or anaesthetic , given by I.V. to relax the muscles and allow your surgeon to put the hip back into place. You must get up on your feet again as soon as possible and don’t repeat the move that caused the dislocation in the first place.

Other Post operative normal occurrences.

Often the operated leg will tend to swell up, and this may continue for 6 – 8 weeks. This is because of the increased blood flow to the limb for healing and sometimes the veins and lymphatics do not cope enough to keep the leg normal. With this swelling will be the feeling of stiffness. This is normal as long as there is not an accompanying escalation in pain, especially at rest. If this is the case then contact the rooms ASAP.

Blood from the surgery site may often track down the leg along the tissue plains and become visible as a bruising behind the knee. this is mostly normal.

Following surgery you may well feel more fatigued than normal. Again, this is expected as the body is using a lot of resources to recover from surgery. Take the time to rest regularly, especially in the first 6 weeks after surgery as this is the usual time it takes to recovery physiologically. Mechanically your hip implant is able to take your weight from immediately after the operation, the rest of you however needs to recover and heal, so do not be tempted to do too much in the 1st 6 weeks other than an a normal sensible daily routine. Out patient physiotherapy is only really indicated after this period as too much activity may in fact set you back.

Long term rehabilitation.
It is important to remember that the process of developing wear and tear arthritis in the hip is one which takes a long time. During this time the muscles atrophy ( waste away). It will take a dedicated exercise regime to build up your muscles over time and often you may find that your muscles fatigue a lot, especially in the beginning. If you are not an exercise fanatic then I suggest at least an accumulative 45mins of walking a day.
The technique that I use does not disrupt any of the major muscles needed for movement of the hip. The posterior approach demands release of the small external rotators of the hip, but these are repaired and return to full function at 6 weeks, after which there are no excuses not to go for regular walks, or to increase your exercises.

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