Following the best rehabilitation programme after having a total hip replacement can be the difference between a successful recovery and an inadequate one.
In this article, I will discuss the first three weeks of my enhanced rehabilitation programme, which I teach all my patients after surgery.
Introduction
Total Hip Replacement (THR) surgeries are performed routinely the world over, but having the surgery is only the first part of the journey.
Effective rehabilitation strategies post-surgery can help you get the most out of your new joint and also reduce the risks of post-surgical complications.
It is important to remember that a THR represents a major orthopaedic operation, and therefore, it can take its toll on the body.
Make sure that you stay hydrated, eat enough calories and get enough rest to help your body recover adequately.
Precautions
Your doctor will have provided you with some precautions to be aware of once you have had your surgery. These can vary depending on the type of approach that the surgeon has used to replace your hip. These approaches are anterior, lateral and posterior. These approaches are where the surgeon accesses the hip. This can affect which muscles are involved and what the recovery and potential complications can be.
Thankfully, there are some general precautions for the first few weeks which affect all approaches:
- Avoid Crossing your Legs
- Avoid Pivoting on the Operated Leg
- Avoid lying on the operated leg
- Avoid bending the hip beyond 90 degrees
Be sure to check with your surgeon which precautions apply to you
Rehabilitation Plan (Weeks 1-3)
During the first few weeks post-surgery, the emphasis is on recovering from the trauma of the surgery itself.
What does this entail?
It means three things:
- Getting enough rest for recovery to happen
- Exercising enough to promote recovery
- Pain management strategies to enable rest and exercise to occur efficiently
The Exercises
Lying Quad Squeeze
Lie on your back on your bed with the affected leg straight out in front of you.
Tense the quadriceps muscle (the one at the front of the thigh) by pushing your knee down.
Hold the contraction for 3-5 seconds.
Repeat 10 times. 3 times a day.
Lying Glute Squeeze
Lie on your back on your bed with both legs straight out in front of you.
Squeeze your buttocks.
Your buttocks may lift off the bed slightly whilst performing this.
Hold the contraction for 3-5 seconds.
Repeat 10 times. 3 times a day.
Lying Hip Flexion
Lie on your back with both legs straight out in front of you.
Bend the affected leg so that you slide the heel up the bed towards you.
You could place a plastic bag under your heel to reduce the friction, making the exercise more efficient.
Do not lift the foot off the bed, and stop the movement if you feel that you are about to do this.
Repeat 10 times. 3 times a day.
Lying Inner Range Quads
Lie on your back on your bed with your legs straight out in front of you.
Place a rolled-up large towel or pillow underneath the knee of the affected leg.
Push the back of the knee into the towel/pillow so your heel lifts off the bed.
Hold for 3-5 seconds.
Repeat 10 times. 3 times per day.
Lying Hip Abduction
Lie on your bed with both legs straight out in front of you.
Whilst keeping the kneecap facing up towards the ceiling, slide the heel of the affected leg out to the side as far as comfort allows.
You could place a plastic bag under your heel to reduce the friction, making the exercise more efficient.
Bring the leg back to the starting position.
Repeat 10 times. 3 times per day.
Standing Calf Raise
In a standing position, both hands against a wall for support.
Lift both heels off the ground at the same time.
Hold for 1-2 seconds at the top of the movement.
Slowly lower back to the starting position.
Repeat 10 times. 3 times per day.
Mini Squat
In standing, holding onto a table or wall for support and with your feet at hip width apart.
Slowly bend the knees.
Try and keep your weight 50:50 through both feet. Bend the knees as comfort allows, making sure not to get beyond 90 degrees of hip flexion.
Drive back up through the heels to a standing position.
Repeat 10 times. 3 times a day.
Standing Weight Transfer/March on Spot
In a standing position with both feet hip-width apart and holding onto a table or wall for support.
Rock yourself onto your right foot. Hold the position for 1 second. Transfer your weight onto your left foot. Hold for 1 second.
Place as much of your body weight onto the affected leg as you can tolerate.
If this is too difficult, you could try a standing march instead.
Repeat 10 times. 3 times a day.
Hip Extension
In a standing position with your feet hip-width apart. Hold onto a table or wall for support.
Leading with the heel of the affected leg, take the heel behind you with a straight leg as far as comfort allows.
When you get to the end of the movement, squeeze your buttock and hold the position for 1 second.
Return the leg to the starting position.
Repeat 10 times. 3 times a day.
The Plan
Complete the above exercises 3 times per day.
During the first three weeks of recovery, you will be using walking aids such as a frame or crutches. This is appropriate, and as you start to feel stronger, you may wish to wean yourself off these.
Make sure to take the advice of your medical professional before doing so.
You can start using your furniture in your house to accomplish small walks without walking aids, using the furniture as support as you walk.
Start doing these short walks regularly throughout the day.
As you progress through the days and your legs start to feel stronger and your pain is well managed, you can increase these distances.
Continue to use your walking aids outside the house in the first three weeks post-surgery.
Conclusion
This plan represents an ideal approach to the first 3 weeks of your rehabilitation post-total hip replacement.
To get the most from your new hip, you will need to be determined and diligent with your rehab. Make sure that you are also getting adequate rest and that your pain is well managed with the pain relief that you will be given on discharge. This will enable you to power through with the exercises!
Good luck!
