Total Hip Replacement

The rehabilitation after surgery is relatively simple. Getting out of bed right after surgery and taking the first few steps are a challenge, but after that it gets easier. Patients who have hip replacements recover with remarkable little physical therapy. A therapist will help while you are in the hospital, but you will usually not need to go to physical therapy after leaving the hospital. The most important activity or exercise in the recovery process is walking. In the hospital you will learn how to walk with crutches. Depending on whether you have a cementless total hip or cemented total hip, you will be instructed in either partial or full weight bearing. If your new hip is cementless, it is important to limit the amount of stress on the hip until bone grows into the prosthesis. It is for this purpose that you are instructed to limit the amount of weight you put on that leg to 50% (one-half) of your body weight. The physical therapist will show you how this is done while you are in the hospital. You should continue always using two crutches or a walker for six weeks. At that time you will visit Dr. Bertin for a checkup and an X-ray. Your rehabilitation will then be advanced as outlined in a later section.

If your new hip was either partially or fully cemented, you should start walking with two crutches or a walker. You will be able to put as much weight as you desire on that leg while walking. You can advance to a cane held in the hand opposite to the replaced hip as soon as you feel stronger. You should continue using either crutches or a cane for six weeks. At that time you should see Dr. Bertin for an X-ray, and your rehabilitation will be progressed.

Twice each day you should devote fifteen to twenty minutes to an exercise period. Three exercises should be completed up to thirty times each. They are all performed standing while holding onto a chair, walker or something sturdy for support.

1. Your weight is applied to the unoperated leg, and the leg that had surgery is lifted forward about forty degrees and then brought back to a neutral position. This is repeated as many times as possible, working up to thirty repetitions.
2. The operated leg is elevated to the side about forty degrees and returned to neutral. This, likewise, is repeated and the number of repetitions is increased to thirty.
3. The same sequence is repeated lifting the leg backwards twenty to thirty degrees.

During the hip replacement operation, the ligaments and muscles around the hip are separated to allow exposure of the joint. After the operation, these are all sewn back very securely to the appropriate place and the healing begins. However, there is the possibility the ball can come out of the socket until this healing is complete. This is called dislocation. It is very uncommon for this to occur and can be prevented by observing some simple precautions for three months after surgery. Thereafter, dislocation is almost unheard of except in major trauma. The following preventative suggestions should be easy to follow:

1. Do not cross your legs. This includes while sitting and lying down. To assist while asleep in bed, you should keep a pillow between your knees. Either the pillow you brought home from the hospital which straps to your legs, or a regular, larger pillow will work while you are in bed.

2. Do not flex or bend the hip past a right angle (90^o). The easiest way to remember this is to keep the level of your knee below the level of your hip while sitting. You should not sit in a low, soft chair, sofa, or love seat. Choose a higher, firm chair to sit in. One with arms is especially good. If your favorite chair is a little too low, build the seat up with folded blankets or a pillow so you do not sit so low. In the bathroom, use an extension on the toilet seat every time.

3. Do not bend over to reach things. This might flex the hip too much. This includes reaching your feet to put socks on or to clip your toe nails, as well as picking up something you may have dropped. Use the "reach extender" you received in the hospital if you need to grab something.

Again, these precautions are only necessary for the first three months. After that, the hip is healed, and dislocation should not be a problem.

1. TO GET UP OR SIT DOWN
First, put the foot of your operated leg out in front.
Then use your hands and get up. Your crutches or walker should be in hand.
2. SITTING
· Use a chair that is firm, high, and has arms. · Keep the level of your knees below the level of your hips.
3. TO PICK UP SOMETHING FROM THE FLOOR
· Method 1 Use a reacher. You should have received one in the hospital
· Method 2 Support your body with one arm
and either
Kneel on the knee of your total hip leg.
or
Extend your operated leg behind you.
4. TO REACH YOUR FOOT
· Only attempt to reach your foot after two months from surgery. · Initially before your hip limbers up, you may need to reach your foot under the opposite knee.
· Getting to your foot by hip external rotation and abduction is also possible.

5. REMEMBER TO KEEP YOUR KNEES APART, AND EITHER KNEEL ON THE KNEE OF YOUR TOTAL HIP LEG OR EXTEND YOUR OPERATED LEG BEHIND YOU.

After arriving home from the hospital, it will take a number of weeks before your strength has returned to what it was before surgery. This is very normal. You should plan on taking a nap or resting at least daily for the first two or three weeks. Adequate rest and a good diet will help your recovery.

The exercises which were prescribed in the hospital and in previous sections of this booklet should be continued. They will help you regain your strength and your desired activity level. There is an optimal amount of exercise. If you find that you are too tired or that your operated joint is too sore, it may be that you are over-exercising. If this is the case, decrease the amount of exercise and let your leg rest for a while.

If any medical problems arise during your recovery, please call Dr. Bertin immediately. If there is any problem with your incision, this is especially important. Any increasing redness, drainage, swelling, or pain in that area should be reported. If an infection is detected early, its treatment is much easier than if it progresses. If you happen to develop a sudden shortness of breath or chest pain, this would be another reason to call for immediate consultation. This could be a problem with your lungs or heart which would need to be investigated.

During your recovery, it is much better to shower than bathe. Bathing should be avoided for the first three months. A stool that sits in the shower will make it easier and eliminate the need for standing during the period of the shower. The incision should be completely healed by the time you leave the hospital. When you shower, water can just run over this area without any problem. It should not be scrubbed or thoroughly washed. Simply allow the water to run over the incision site and then blot it dry after the shower. As the small pieces of tape (steri-strips) begin to loosen, you may gently remove them.

It is important during the recovery process to allow the skin, muscle and bone adequate time to heal. The muscles need to recover their strength. If a bone ingrowth prosthesis was used, time is necessary for this process to occur. This ingrowth will not happen if the joint is over-stressed. Two crutches or a walker should be used at all times for six weeks to help with this process. You should use them whenever you arise from sitting or do any walking. After your checkup and X-rays at six weeks, the need for further crutch or walker use will be discussed.

When two or three weeks have elapsed since surgery, you may feel strong enough to go for a walk outside. This is encouraged if weather conditions are appropriate. You should use your crutches and go for a short walk. This distance can be increased daily so that by six weeks you are walking up to one-half mile a day. Travel in the car is also acceptable after about three weeks. Long trips would be discouraged for about six weeks. You must remember to protect your new joint during these unusual activities. Driving should be postponed for approximately eight weeks, especially if the operated leg is used for gas, brake, or clutch pedals.

For the first four to six weeks after surgery, you are discouraged from participating in sexual relations. Return to normal sexual activity should thereafter be gradual, and you should take the less active role for two or three months.

You should call Dr. Bertin's office to schedule an appointment three weeks after surgery. This visit will consist of a clinical and X-ray evaluation. The next phase of your rehabilitation will be outlined.

You should have just had an appointment with Dr. Bertin and had your joint examined and X-rays taken. If everything looks appropriate, he will have started you on the following advanced rehabilitation protocol to increase your strength and performance capability. You should not suddenly increase your activity level, but rather gradually advance what you are doing. If your joint or muscles are uncomfortable, you are doing too much and should cut back.

You should increase the distance you walk daily. You should work up to about a mile, and you could walk farther if you desire. You should use crutches or a cane until Dr. Bertin recommends you not to do so. Even after you stop using crutches, if you have any limp or pain, you should resume the use of a cane or walking stick to eliminate this undesirable gait pattern. As soon as the limp disappears, usually in a few weeks, you can again discontinue the use of the cane.

While standing, you can do leg "lifts" to the front, side and back. You should do about thirty repetitions of each, and as soon as this becomes easy, you can add a two- or three-pound weight to your ankle. After adding the weight, work up again to thirty repetitions.

Only one hip exercise while lying down is indicated. This is performed by lying directly on your "good" side and lifting the operated leg straight up in the air. Keep your leg straight and your toes pointed forward, not up. You should work up to thirty repetitions. Then add two or three pounds of weight to your ankle and work up to thirty repetitions with this weight.

You should ride daily for ten to fifteen minutes. The seat should be adjusted to a comfortable position, and the pedal resistance slowly increased. This can be gradually advanced to help build strength and endurance.

1. DO NOT bend your hip beyond 90^o (right angle).
2. DO NOT lean forward when sitting.
3. DO NOT cross your leg over the center or midline of your body.
4. DO NOT sit in a chair without arms
5. DO NOT reach your foot by flexing or internally rotating your hip.