Exercises After Hip Replacement & Resurfacing

 


It is very important to continue with physical therapy and exercises after any joint replacement or resurfacing procedure. Once patients are out of the hospital, the surgery may be finished but the physical therapy and rehabilitation are just beginning. Mobility and strength steadily improve with each passing day.

This may sound daunting to someone who is contemplating surgery and currently dealing with a painful hip, but in actuality, most patients find that the pain they have after surgery is quite different from the preoperative pain. Patients commonly remark immediately after surgery that they no longer feel the grinding, deep joint pain with weightbearing that they had previously, and that most of the discomfort after surgery is muscular pain in the area of the incision. Perhaps even more importantly, this type of discomfort steadily resolves and actually improves the more patients are up and about using their new hip.

Getting Home And Transportation

Most patients are able to go home in a regular car, and within a few days, can certainly use the car as a passenger to get to the hospital or physician's offices. Generally it works best to use a vehicle that allows you to stretch your legs out in front of you, and you should avoid any small cars or cars that are very low to the ground as this may require flexing the hips beyond 90 degrees.

Patients often ask about other transportation options. Generally, most patients are able to travel in a regular car, but those going to a rehabilitation facility may prefer use of a wheelchair car or ambulance. These services can be arranged by the discharge planner at the hospital, although most insurance companies and Medicare do not cover such transportation costs.

Generally it is best to avoid nonessential travel out of the house for about 7 to 10 days after a total hip replacement. Most of our patients are able to go for short rides or to a restaurant after about a week. Hip resurfacings can expect to mobilize somewhat quicker. Although some younger and more active patients have actually returned to office (desk) jobs for short periods after the first week, it is typically best to do the exercises / physical therapy and otherwise rest in the first few days after surgery. We generally recommend planning on taking 6 weeks off from work, and up to 10 weeks for a very physical job.

You should not take any extended car trips for 5 weeks. This is primarily because of the prolonged sitting and the increased risk of blood clots.

Driving is usually not recommended until 2 or 3 weeks after discharge, if you have good control of your right leg, and if you do not have any other medical conditions that prevent you from driving. If you have other conditions besides your hip that may impede your driving (such as low blood pressure or neurologic issues), check with your family physician before driving. Obviously, if you have lightheadedness or are still taking narcotic medications, then you should not drive.

We typically recommend that patients practice driving in an empty parking lot, such as an empty school or church parking lot on a Saturday. It is also a good idea to take a family member or friend with you, and if you BOTH feel comfortable with your ability to drive, then begin driving short distances and gradually work up to longer trips.

It is important to understand that you have to take legal responsibility for determining when you are safe to drive. If you feel you are unsafe, then wait until you feel more confident.

Getting Around On Your Own Two Feet

You should be walking at least 4 or 5 times per day, increasing your distance each time. Walking is your most important exercise after a hip replacement or resurfacing. It will increase your stamina and strength, decrease stiffness, help to prevent blood clots and constipation, and you actually will feel much better if you are mobile.

However, when you are not walking, remember your rest periods in bed with leg elevation. These breaks are important to prevent swelling. Keep the legs elevated above the level of the heart. Flex the ankles up and down whenever you think about it, which promotes circulation. You may walk frequently, but in general you should spend two hours, twice a day, in bed with the legs elevated for as long as there is persistent swelling in the leg. If your leg and calf suddenly become much more swollen, warm to the touch, and painful in the calf, it can be a sign of a blood clot and you should call the surgeon's office.

During the first week at home, you should not sit in a chair for more than 3 times a day for 30 minutes each time (usually at mealtime). After the first week, this can be relaxed if there is not significant swelling or discomfort. Sitting periods can slowly be increased to a normal routine after the first week.

Total Hip Precautions In Our Practice

Do not cross your legs or extend your hip or leg backwards during this time period. Do not cross the midline with your affected leg(s). Do not internally rotate the leg ("pigeon-toeing").

Always sit in a straight back chair (i.e., dining room chair, no couches, no low recliners, etc.) for 6 weeks following surgery.

When you sit down, slide your foot (on your operated side) out in front of you. Do not lean forward when sitting in a chair during the first few weeks, but if you must lean forward, then be sure to spread your knees apart as you do so (which places the hip replacement into a more stable position).

Do not pivot on the operated leg(s). In particular, do not plant the foot on the operated side and turn, leaving the foot planted and rotating on the hip. This can predispose to dislocation.

Hip replacement patients should not force hip flexion beyond 90-100 degrees for the first 6 weeks. Resurfacing patients who have had an anterior approach (not a posterior approach) typically can range the hip to whatever is comfortable, but should not force their range beyond the limits of comfort.


Hip precautions: DO NOT cross the legs over the midline in the first 6 weeks.

Hip Precautions: DO sleep with a pillow between the legs for the first 2 weeks

Hip Precautions: DO NOT sit with the legs crossed over the midline.

Hip Precautions: DO sit like this, with the legs apart and in a straight backed position.

Hip Precautions: DO NOT flex more than 90º in the first 4 to 6 weeks unless otherwise instructed
by your surgeon. This includes bending at the waist beyond 90º.

Hip Precautions: DO NOT pivot on the operated leg.

Stairs

You may begin using stairs as soon as you feel comfortable. Some patients with good stamina and muscle strength may practice stairs at the hospital before going home; others will take a few weeks to build up their strength. The most important factor is to be safe, and always use a handrail for balance as you begin using stairs again. If you feel unsteady, then you may use a sitting position to scoot up or down the stairs.

When going up stairs, lead with the unoperated leg, and when coming down, lead with your operated leg. (If both legs have been operated on, then you can use whichever leg is more comfortable.)


When going up stairs, go UP with the nonoperated (stronger) leg first.

When going down stairs, go DOWN with the operated (weaker) leg first.

Showers and Toilets

Different surgeons may have different guidelines, but in our practice, we generally allow showering 2 days after discharge if the wound is dry. Gently towel the area dry after showering. Do not shower or get the wound wet until 2 days after the wound has become completely dry, and do not allow it to get wet if there is still some drainage.

A shower stool is a good idea for the first 6 weeks after surgery. This can be helpful to avoid slipping and falling.

Do not take tub baths for at least 6 weeks. This is primarily to avoid the motions involved with getting in and out of a tub, but generally it also is not a good idea to completely submerge the surgical site for a couple of weeks.

You may use a regular toilet unless the toilet is unusually low, or unless your surgeon instructs otherwise. For most total hip replacement patients, a raised toilet seat should be used if you find you have to flex your hips above 90 degrees getting on and off of the commode.

Sleeping at Night

Use a pillow between your legs for 2 weeks. Some patients may have more stringent instructions if they have had a dislocation in the past. Try to sleep on your back for the first few weeks to avoid laying on the operated side if possible.

Getting Dressed

Since you are not supposed to cross your legs or force hip flexion beyond 90-100 degrees for the first 6 weeks, putting on shoes and socks will be a challenge at best. Most patients find they need some assistance with this for the first few weeks, although a sock grabber and reacher instrument can be helpful. These are sometimes available from the physical therapist before going home or otherwise can be found at a medical supply store.

Ultimately, when you have healed from your surgery, the best way to practice putting on shoes and socks and clipping your toenails is to slide your foot up along the leg and rest it on the knee, keeping the hip pointed outward at about a 45 degree angle. This is a safe position. Crossing the legs with the knee going over the midline, as ladies frequently sit, is not as ideal and should be avoided for at least 6 weeks.

An anterior approach surgery has the advantage of having the incision on the front of the hip, and is therefore more comfortable when sitting than when you have had a posterior approach (with the staple or suture line on the buttock). However, some male patients have noted that the anterior incision line may chafe with briefs, and you may find boxers more comfortable.

Exercises

The exercise program after joint replacement is not temporary, but continuous. It is an important part of the ongoing management of your total hip replacement or resurfacing.

As noted above, walking is the most important exercise. You should walk at least 4 or 5 times a day, increasing the distance each time. It is better in general to walk for shorter periods with rests in between than to attempt a marathon session once or twice a day. Rest periods are helpful in between.

The walking should be at a slow, steady pace on level ground. (I often recommend going to the mall several weeks after surgery for most patients, as it is level ground and weather is not a concern.) Walking faster will not be particularly beneficial, and if you strain the muscles by walking too quickly, it is possible to have some muscle bleeding and swelling in the first week or so. A slow and steady gait, on the other hand, is very beneficial.

The following exercises are the ones we recommend in our practice, primarily with anterior approach hip surgeries. If you are reading this and have another surgeon, be sure to check with him about your exercise instructions and routine. Your physical therapist, with orders from your surgeon, may also introduce additional exercises to work on specific muscle groups tailored to your needs.

Ten sets of the following exercises should be done each day, and at least 10 repetitions of each exercise should be done during each set. The standing exercises should be done while holding on to a table or using a crutch or cane for balance. If your balance is poor or you feel unsteady, then focus on the exercises that are performed lying down or sitting until you feel more steady on your feet.

Also note that while it is not unusual for exercises to generate some discomfort, significant pain is typically a reason for caution. If a particular exercise is too uncomfortable, then focus on other exercises. If you develop any problems that prevent you from continuing, such as lightheadedness, shortness of breath, or chest pain, then it is best to stop and contact your physical therapist or surgeon.

 


Bend the hip and knee in a standing position; do not flex the hip beyond 90 degrees.

Lifting the leg out to the side (known as hip abduction). Use a table, rail, or walker for balance.

Ankle motion in circles

Knee Isometric Strengthening

Lying flat, keep the legs straight and a little apart. Try to tighten the thigh muscles and push the knee downward against the floor or bed, holding the contraction for 5 seconds. Repeat 10 times


Knee isometric strengthening. Try to push the knee downward against the floor.

Heel Slides

BLying flat, slide the operated foot up as far as you can while keeping the heel in contact
with the floor or bed, then allow it to slowly slide back. Repeat 10 times.


Heel Slides. Slide the heel back and forth, while keeping the heel in contact with the bed or floor.

Knee Range of Motion

While laying flat, place a rolled towel or round pillow under the knee, then extend the knee so
that the foot rises completely off the floor or bed. Hold it up for 5 seconds, then release. Repeat 10 times.


Knee Range of Motion. Try to extend the knee and foot completely off the floor.
Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.

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