How to behave after hip replacement: general recommendations. Life with a new hip Limitations after hip replacement
Hip arthroplasty is the replacement of a damaged element of the joint. For this purpose, special implants are used. Endoprostheses may be required for a variety of reasons (injuries and diseases of the hip joint). After hip replacement, certain recommendations must be followed.
Reasons for prosthetics
The most common reasons why endoprostheses may be required are:
- Advanced and severe stages of rheumatoid arthritis.
- Femoral neck injuries (most often fractures).
- Development of hip dysplasia.
- The presence of aseptic necrosis of the head, which is called avascular necrosis.
- Severe stages of coxarthrosis.
The need for an endoprosthesis may arise due to post-traumatic consequences (for example, arthrosis).
The life of a patient after endoprosthetics, as a rule, changes: a number of recommendations appear that the patient must strictly follow. After endoprosthetics, some restrictions arise, the patient needs special therapeutic exercises.
At first, the patient is forced to walk on crutches. How long will it take to recover?
The postoperative period and complete recovery depend on the patient’s age, his general condition and many other factors. In order to avoid complications after hip replacement, it is necessary to follow all the recommendations of the attending physician.
Exercises after hip reconstruction surgery should be performed strictly under the supervision of a qualified specialist. Living with a new regime will speed up the recovery process. The patient will be able to walk without the help of crutches much faster.
Pain after endoprosthetics, as a rule, is pronounced. Under no circumstances should you take any measures on your own, otherwise serious complications may arise.
Features of a modern hip endoprosthesis
Today, orthopedics has made significant progress in its development. A feature of a modern endoprosthesis is its complex technical design. The prosthesis, which is cementless, contains the following elements:
- head;
- leg;
- cup;
- insert.
The difference between a cemented endoprosthesis is a solid acetabular element (cup and
). Each individual element has its own dimensions. The surgeon must select and install the size that is ideal for the patient.
The types of fixation of hip joint endoprostheses have the following differences:
- Cement fixation.
- Cementless fixation.
- Hybrid type of prosthesis fixation.
Reviews about each individual prosthesis are quite different, so it is recommended to collect as much information as possible before replacing the hip joint.
A hip joint endoprosthesis can be:
- total;
- single-pole.
The use of a particular prosthesis depends on the number of elements being replaced. The friction unit is the interaction in an artificial joint. How long can a hip replacement last? This will depend on the type and quality of the material used in the friction unit.
When does a patient need endoprosthetics?
The main indications for surgical treatment are the results of clinical and radiological studies and the symptoms that accompany the disease. The symptoms that the patient complains about are one of the most significant factors indicating the need for surgery.
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In some cases, despite the fact that coxarthrosis is at one of the last stages of development (this is evidenced by x-ray examination), the patient is practically not bothered by anything. There may be no need for surgery.
How are the operations carried out?
Hip replacement surgery is performed by two teams (operating and anesthesiological). The operating team operates under the guidance of a highly qualified operating surgeon.
On average, an operation to replace a hip joint with an endoprosthesis takes 1.5-2 hours, while the patient is under spinal anesthesia or anesthesia. In order to exclude infectious complications, intravenous administration of an antibiotic is necessary.
Rehabilitation process
After endoprosthetics, the patient remains in the intensive care unit for some time, under the close supervision of doctors. For 7 days, the patient continues to be given antibiotics and drugs that can prevent blood clotting. In order to fix a certain distance between the legs, a pillow is installed. The legs should be in an abducted position. Temperatures after hip replacement surgery are often unstable, so doctors monitor this closely.
How long will it take to recover from hip replacement? This is impossible to predict. In order to speed up the rehabilitation process, you must carefully follow all the doctor’s recommendations.
The patient is advised to move the next day. Without getting up from the pastel, the patient can sit down and even do therapeutic exercises. Exercises after hip replacement, which the patient performs in the first month after surgery, are as simple as possible.
In order to fully restore mobility, it is necessary to constantly work on the hip joint, while following all the recommendations of the attending physician. In addition to exercise therapy, the patient is prescribed breathing exercises.
In most cases, already on the third day of rehabilitation, the patient can walk, using crutches and relying on the help of a specialist. After how many days can stitches be removed? It depends on how quickly the patient recovers. On average, stitches are removed 10 to 15 days after hip replacement surgery.
How to live after being discharged from the hospital? Many people wonder: how to live after returning home? In the hospital, the patient is constantly under the supervision of medical staff, who monitor the entire rehabilitation process. Life with a hip replacement is somewhat different from normal life. As already mentioned, in order to restore mobility, you need to constantly work on the hip joint.
The patient should walk as much as possible, without allowing severe fatigue. Exercise therapy plays a major role in the rehabilitation process; all exercises must be approved by the attending physician. After discharge from the hospital, the patient can visit special centers where qualified exercise therapy instructors will work with him.
This brochure is dedicated to people undergoing hip replacement surgery. You have been diagnosed with damage to the hip joint. You have undergone conservative treatment for a long time, using all possible drugs for pain relief. You hoped that you could return to your normal lifestyle.
In reality, miracles do not happen. There comes a moment when life becomes unbearable and you cannot live without pain, walk without pain, movements in the joint are limited. You can no longer carry out everyday activities, you feel your own limitations in everyday life. This is usually accompanied by severe pain and limited mobility in the hip joint. Based on these symptoms, as well as medical examination data, doctors recommend implantation of an artificial joint. The purpose of our brochure is to familiarize you with the possibilities, features and benefits of total hip replacement surgery. We will try to help you prepare for surgery and avoid unnecessary anxiety during your hospital stay.
Of course, this information is not a substitute for consultation with your doctor, orthopedic surgeon, rehabilitation specialist or other medical personnel. If you have any questions or are unsure about anything, you should discuss this with a specialist. Remember! The result of treatment will depend on the strict implementation of all the recommendations of the attending physician and your commitment to recovery.
To better understand possible operations, let's try to imagine the anatomy of the hip joint.
So the hip joint is a ball and socket joint. It is surrounded by muscles and ligaments and allows movement of the hip and the entire lower limb in all planes. In a healthy joint, smooth cartilage covers the head of the femur and the acetabulum of the pelvic joint. With the help of surrounding muscles, you can not only support your weight while supporting your leg, but also move. In this case, the head slides easily inside the acetabulum. In a diseased joint, the affected cartilage is thinned, has defects and no longer functions as a kind of “lining”. The articular surfaces altered by the disease rub against each other during movements, stop sliding and acquire a surface like sandpaper. The altered femoral head rotates in the acetabulum with great difficulty, and pain occurs. Soon, in an effort to get rid of pain, a person begins to limit movements in the joint. This in turn leads to shortening of muscles, ligaments and even greater contracture. The pressure exerted by the muscles on the femoral head increases; over a long period of time, the weakened bone “crushes,” changes its shape, and flattens. As a result, the leg becomes shorter. Bone growths (so-called ossifications or osteophytes) form around the joint. The changed joint can no longer fully perform its function.
What is total hip replacement
Only surgery to completely replace the diseased joint or total hip replacement can radically interrupt this entire chain of painful processes.
In principle, total arthroplasty is the replacement of a damaged joint with an artificial endoprosthesis. Total endoprosthetics is one of the main achievements of this century. Many decades ago, the relatively simple design of the hip joint inspired doctors and medical technicians to create an artificial replica. Over time, research and improvement in surgical techniques and materials used have led to tremendous advances in the field of total hip replacement. The design of endoprostheses perfectly follows the human anatomy. The endoprosthesis consists of two main parts: a cup and a leg. The spherical head is located on the stem and inserted into the cup of the endoprosthesis. The materials used for the artificial joint are special metal alloys, heavy-duty polyethylene and ceramics, developed specifically for endoprosthetics. They provide excellent tissue compatibility, absolutely painless movement, maximum strength and durability of the endoprosthesis. Typically, the surfaces of the endoprosthesis in contact with each other include a ceramic or metal head mounted in a polyethylene cup. They can also be all metal or all ceramic. 
There are mainly three types of fixation of endoprostheses:
Endoprosthesis with cementless fixation y, in which both the cup and the leg of the endoprosthesis are fixed in the bone without the use of bone cement. Long-term fixation is achieved by ingrowth of the surrounding bone tissue into the surface of the endoprosthesis.
Endoprosthesis with cement fixation, in which both the cup and the stem are fixed using special bone cement.
Hybrid (combined) endoprosthesis, in which the cup has a cementless fixation, and the leg has a cemented fixation (i.e., it is fixed in the bone using special bone cement.) There is a very wide range of models for all types of endoprostheses, produced in the required range of sizes. The choice of the required type of endoprosthesis is determined by the physiological characteristics, medical indications, as well as the age, weight and degree of physical activity of the patient. The correct choice greatly contributes to the success of the operation. An orthopedic traumatologist will conduct preoperative planning, during which the required size, model of the endoprosthesis and the location of its parts will be determined. However, during the operation he should be able to install an endoprosthesis of a different size, making changes to the original plan. (This depends on the individual characteristics of the patient, the structure and density of the bone substance, the specific conditions and objectives of the operation performed.)
Before surgery
The decision to undergo surgery lies primarily with the patient. In many cases, severe pain and taking huge amounts of analgesics (painkillers) make a person's life so unbearable that surgery becomes vital. The exact time of the operation must be discussed taking into account all the necessary factors and features. It is necessary to properly prepare for implantation of an endoprosthesis. Before surgery, you can contribute to a favorable course of the postoperative period, namely:
Stop smoking.
Normalize your own weight. If you are severely obese, your doctor may delay surgery to give you time to lose weight (a body mass index greater than 35 is a relative contraindication for arthroplasty due to the high risk of postoperative complications).
Sanitation of the oral cavity and other possible foci of chronic infection is necessary. Such preliminary preparation will reduce the risk of wound infection that accompanies any surgical intervention.
If you have any chronic diseases, be sure to undergo all the necessary additional examinations so that there is time to correct their treatment.
During total hip replacement surgery, there is always some loss of some blood. This may require a transfusion. In order to prevent immunological conflict or infection, it is advisable to prepare your own blood for transfusion during surgery. You should discuss this possibility with your doctor and he will give you the necessary advice.
Currently, the quality of artificial joints and surgical techniques have reached a very high level and have significantly reduced the risk of various postoperative complications. But, despite this, certain complications associated with inflammation of the tissues around the joint or early loosening of the elements of the endoprosthesis are always possible. Strict adherence to the doctor’s recommendations will reduce the risk of complications.
Day of surgery
The operation can be performed under general, combined or regional anesthesia (pain relief). Regional anesthesia of the lower limb affects the general condition to a lesser extent and is therefore preferable. In addition to the anesthesia, you will be given a sedative (calming agent). During the operation you will not experience any pain.
The day before your surgery, your doctor will visit you to discuss anesthesia and the procedure. He will then select the medications you can tolerate best and the most appropriate method of surgery. During the operation, the affected joint will be removed and replaced with an artificial one. Implantation will require a skin incision about 15 cm in length. This way, the surgeon can approach the hip joint, remove the affected femoral head and damaged acetabulum, and replace them with an artificial cup and stem with a ball-and-socket head. After installing the cup and stem, the artificial joint is checked for mobility, and then the surgical wound is sutured. A drain introduced into the wound prevents the accumulation of leaking blood. After the operation, a pressure bandage is applied and the first control x-ray is taken.
The entire operation usually takes 1.0-1.5 hours.
The artificial joint implantation procedure is a common operation. For this reason, the following information about possible complications should not be a cause for concern and should only be considered as general information for patients. The possible complications described below relate specifically to the artificial joint implantation procedure. The general risk that exists with any operation is not mentioned here.
Hematomas (bruises)
They may appear after surgery and usually go away within a few days. The previously mentioned drains are installed to prevent major hemorrhages, i.e. for evacuation of blood.
Thrombosis
Thrombosis (blood clots) can result from increased blood clotting (blood clots can obstruct the flow of blood in the veins of the extremities), which can lead to pulmonary embolism (when the blood clot reaches the lungs). To reduce the risk of thrombosis, special medications are prescribed, in the form of tablets or injections, before and after surgery, as well as elastic stockings or tight bandaging of the lower leg and foot, and physical therapy.
Infection
Infection at the site of a surgical wound is a fairly rare complication and can usually be successfully treated with antibiotics. However, deep infection can lead to loss of the endoprosthesis and the need for reoperation. For this reason, special attention is paid to sterility and protection against bacteria. In addition, antibiotics are prescribed before and after surgery.
Dislocation (displacement), dislocation
They occur quite rarely (mostly in the early postoperative period while the soft tissue has not healed) and usually occur only in cases of extreme mobility or falls. As a rule, in this case, the doctor adjusts the displaced endoprosthesis under anesthesia. The doctor should accurately inform you about the amount of movement that is acceptable at different times during rehabilitation.
Allergy
In very rare cases, tissue reactions may develop upon contact with an artificial joint. This reaction may be caused by a chrome-nickel allergy. By using modern alloys available today, the risk of allergies is reduced to a minimum.
After surgery
When you wake up, you need to perform several exercises that reduce swelling of the limb and prevent the formation of blood clots in the blood vessels. They need to be performed while lying in bed.
Breathing exercises. Raise your hands up, take a deep breath. Lower your arms down to your sides and take a deep, energetic exhalation. This exercise must be repeated 5-6 times a day
Foot pump. When you're lying in bed (or later when you're sitting in a chair), slowly move your feet up and down. Do this exercise several times every 5 or 10 minutes.
The first days after surgery are the most important. Your body is weakened by the operation, you have not yet fully recovered from anesthesia, but in the first hours after waking up, try to remember more often about the operated leg and monitor its position. As a rule, immediately after surgery, the operated leg is placed in an abducted position. A pillow is placed between the patient's legs to ensure moderate separation. The first day you will lie in bed. If any medical procedures or examinations are required, you will be transported on a gurney. You will need to wear compression stockings (elastic bandages or compression stockings) for 6-8 weeks after surgery. You also need to remember that:
In the first days after surgery, you should sleep only on your back, preferably with a pillow or cushion between your legs
You can only turn on your operated side, but not earlier than 7 days after surgery.
When turning in bed, place a pillow between your legs
To reduce the risk of dislocation of the endoprosthesis, you should not bend the operated leg at the hip joint more than 90 degrees, or rotate the leg in the operated joint, turning its toe in and out. That is, to you FORBIDDEN:
Sit on low chairs, armchairs or beds
Squat down
Bend below waist level, pick up objects from the floor
Pulling the blanket over your feet in bed
Put on clothes (socks, stockings, shoes), bending towards your feet
Sleep on your healthy side without a pillow between your legs
Sit cross-legged, cross your legs
Turn your body to the side without simultaneously turning your legs
When sitting in bed or going to the toilet after surgery, you need to strictly ensure that there is no excessive flexion in the operated joint. When you sit on a chair, it should be high. A regular chair should be cushioned to increase its height. Low, soft seats should be avoided.
In some patients with an advanced process, certain difficulties persist when putting on socks. We recommend using a simple device in the form of a stick with a clothespin at the end, or a special clamp sold in prosthetic and orthopedic enterprises.
Wear shoes using a horn with a long handle; try to buy shoes without laces
Place the blanket next to you or use a blanket puller.
Wash in the shower on a non-slip mat using a long-handled washcloth and flexible shower head.
Devote most of your free time to physical therapy exercises.
The first goal of physical therapy is to improve blood circulation in the operated leg. This is very important to prevent blood stagnation, reduce swelling, and speed up the healing of the postoperative wound. The next important task of physical therapy is restoring the strength of the muscles of the operated limb and restoring the normal range of motion in the joints and the support of the entire leg. Remember that in the operated joint the friction force is minimal. It is a hinge joint with ideal gliding, so all problems with limited range of motion in the joint are solved not through its passive development like rocking, but through active training of the muscles surrounding the joint.
In the first days after surgery, physical therapy is performed while lying in bed. All exercises must be performed smoothly, slowly, avoiding sudden movements and excessive muscle tension. During physical therapy exercises, proper breathing is important - inhalation usually coincides with muscle tension, exhalation - with their relaxation.
The first exercise is for the calf muscles. You have already used this exercise on the day of surgery. Bend your feet toward and away from you with slight tension. The exercise should be performed with both legs for several minutes up to 4-5 times within an hour.
Rotation at the ankle joint: Rotate the foot of the operated leg first clockwise, then in the opposite direction. Rotation is carried out only through the ankle joint, not the knee! Repeat the exercise 5 times in each direction. 
Exercise for the quadriceps femoris muscle: Tighten the muscle on the front of your thigh and try to straighten your knee while pressing the back of your leg into the bed. Hold in tension for 5 - 10 seconds. 
Repeat this exercise 10 times for each leg (not just the operated one) 
Knee flexion with heel support: Move your heel toward your buttocks by bending your knee and touching your heel to the surface of the bed. Don't let your knee rotate toward your other leg and don't flex your hip more than 90 degrees. Repeat this exercise 10 times. 
If at first it is difficult for you to perform the exercise described above on the first day after surgery, then you can hold off on doing it. If you continue to have difficulty later, you can use tape or a folded sheet to help tighten your foot.
Contractions of the buttocks: Squeeze your butt muscles and hold them tight for 5 seconds. Repeat the exercise at least 10 times.
Abduction exercise: Move the operated leg as far as possible to the side and return it back. Repeat this exercise 10 times. If at first it is difficult for you to perform this exercise on the first day after surgery, then you can hold off on doing it. Very often this exercise fails in the first days after surgery. 
Straight leg raise: Tighten your thigh muscles so that the knee of your leg lying on the bed is fully straightened. After this, raise your leg a few centimeters from the surface of the bed. Repeat this exercise 10 times for each leg. If at first it is difficult for you to perform this exercise on the first day after surgery, then you can hold off on doing it. Like the previous one, very often this exercise does not work out in the first days after surgery.
Continue all these exercises later, on the subsequent second, third, and so on days after hip replacement surgery.
First steps
In the first days after surgery, you should learn to get out of bed, stand, sit and walk so that you can do this safely yourself. We hope that our simple tips will help you with this.
You must immediately remember that before sitting down or standing up, you must bandage your legs with elastic bandages or wear special elastic stockings to prevent thrombosis of the veins of the lower extremities!!!
How to get out of bed
As a rule, you are allowed to get up on the third day after surgery. A physical therapy instructor or attending physician will help you get back on your feet for the first time. At this time, you still feel weak, so during the first few days someone must help you, supporting you. You may feel a little dizzy, but try to rely on your strength as much as possible. Remember, the faster you get up, the faster you will begin to walk. The medical staff can only help you, but nothing more. Progress is entirely up to you. 
So, you should get out of bed in the direction of the operated leg. Sit on the edge of the bed, keeping your operated leg straight and in front. Before standing up, check if the floor is slippery. Place both feet on the floor. You can also stand on the side of your healthy leg, provided that you do not bend the operated hip more than 90 degrees and do not bring it to the midline of the body. Using crutches and your non-operated leg, try to stand up.
If you want to go to bed, all steps are performed in the reverse order: first you need to put the healthy leg on the bed, then the operated leg.
How to use crutches correctly
It is necessary to stand up and place the crutches forward at the length of a step and towards the toes. Keep your elbow slightly bent and keep your hips as straight as possible. When walking, firmly hold the handles of your crutches. When walking, you need to touch the floor with your operated leg. Then increase the load on your leg, trying to step on it with a force equal to the weight of your leg or 20% of your body weight. The load can be determined using ordinary scales, on which you need to stand with the operated leg with the required load. Remember the feeling and try to step on your foot with this load when walking.
Attention: the main weight should be supported by the palms, not the armpits!
If you are allowed to use only one crutch, then the crutch should be on the side of your healthy leg. 
How to sit down and stand up correctly
To sit down, walk towards the chair with your back turned until you feel its edge. Move both crutches towards your healthy leg. Sit on a chair, leaning on the armrests and extending your operated leg.
Bend your legs at a slight angle and sit up straight. To get up from a chair, slide forward. Grab the armrests of the chair with your hands to stand on your healthy leg, slightly extending your still operated leg. Then use the crutches with both hands to stand on your operated leg.
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HOW TO GO UP AND DOWN STAIRS
Warning: Do not take your first steps up the stairs on your own!
4-5 days after the operation you need to learn to walk up the stairs. Climbing stairs requires both joint mobility and muscle strength, so if possible, it should be avoided until complete recovery. But for many of us this is not possible, because even to the elevator in many houses you need to climb the stairs. If you have to use stairs, you may need assistance. Always use the hand opposite the operated joint to rest on the railing when climbing stairs and take one step at a time.
Climbing stairs:
1. Step up with your healthy leg. 
2. Then move your operated leg up one step.
3. Finally, move your crutch and/or cane to the same step.
Descending the stairs, everything in reverse order:
1. Place your crutch and/or cane on the step below.
2. Take a step down with your operated leg.
3. Finally, move your healthy leg down.
Remember the basic rule: THE HEALTHY LEG IS ALWAYS ABOVE THE SICK LEG!
When you learn to get up and stand steadily, you can expand the complex of physical therapy. When performing these exercises in a standing position, hold on to reliable support (headboard, table, wall or sturdy chair). Repeat each exercise 10 times during each session 3 times a day.
Standing Knee Raise: Raise the knee of the operated leg. Do not raise your knee above waist level. Hold your leg for two seconds and lower it on the count of three. 
Straightening the hip joint in a standing position: Slowly move your operated leg back. Try to keep your back straight. Hold your leg for 2 or 3 seconds, then return it back to the floor. 
Leg abduction in a standing position: Make sure your hip, knee, and foot are pointing straight ahead. Keep your body straight. Keeping your knee pointed forward at all times, move your leg to the side. Then slowly lower your leg back so that your foot is back on the floor. 
AFTER DISCHARGE
Following your doctor’s instructions is very important for a speedy recovery:
If you will use a walker or crutches to walk, ask your doctor how much weight you can put on your operated leg. Do not forget that, most likely, you will get tired faster than before. You should include 30 – 60 minute rest periods throughout the day.
It is easier and safer to sit down and get up from a chair, putting the main weight on your hands. It is unacceptable to sit on low and soft chairs or beds. To sit at a sufficient height, you can add sofa or sleeping pillows.
A sufficiently high toilet seat will help reduce the stress on the hip and knee joints when standing up and sitting on the toilet.
A shelf screwed into the shower at chest level will help eliminate the need to bend over to reach toiletries when showering.
A seat (bench) in the bathroom will allow you to take a bath safely and comfortably in a sitting position.
To wash the lower parts of your legs, use a long-handled washcloth. Women use a special razor extension to shave their legs.
You cannot sweep, wash or vacuum the floor. To wash high or low-lying objects, you can use a mop with a long handle.
Traveling in a car is not prohibited, but instructions must be followed when getting in and out of the vehicle. To increase the height of the seat, you can place a pillow on it. When traveling, try to move the seat back as far as possible, taking a semi-reclining position.
Most likely, your doctor will prescribe you painkillers. Be sure to follow your doctor's instructions for taking these medications.
A slight swelling of the tissue around the postoperative wound is not a deviation. Therefore, to prevent pressure on the wound, you should wear comfortable and loose clothing. Ask your doctor or other qualified health care provider about how to clean your surgical wound.
All this is needed in order to move from crutches to a cane and then begin to walk completely independently. It is impossible to give up crutches earlier, when the muscles are not yet able to fully hold the joint, much less react to possible non-standard situations (for example, a sharp turn).
Exercises with elastic band (with resistance). These exercises should be performed in the morning, afternoon and evening 10 times. One end of the elastic band is secured around the ankle of the operated leg, the other end - to a locked door, heavy furniture or wall bars. To maintain balance, you should hold on to a chair or headboard. 
Hip flexion with resistance: Stand with your back to a wall or heavy object to which an elastic band is attached, with your operated leg slightly to the side. Raise your leg forward, keeping your knee straight. Then slowly return your leg to the starting position.
Hip extension with resistance: Stand facing a wall or heavy object to which an elastic band is attached, with your operated leg slightly to the side. Extend your leg at the hip joint, keeping your knee straight. Then slowly return your leg to the starting position. 
Leg abduction with resistance in a standing position: stand with your healthy side facing a door or heavy object to which a rubber tube is attached, and move your operated leg to the side. Slowly return your leg to the starting position. 
Walking: Use the cane until you are confident in your balance. At first, walk for 5-10 minutes 3-4 times a day. As your strength and endurance increase, you will be able to walk for 20-30 minutes 2-3 times a day. Once you are fully recovered, continue regular walks of 20-30 minutes 3-4 times a week to maintain your muscle strength. Use the cane only on the side of your healthy leg.
TIPS FOR THE FUTURE
Approximately 6-8 weeks after surgery, your doctor may allow you to drive and will talk about your driving habits. If your car is not equipped with an automatic transmission, discuss any restrictions on driving your car with your doctor. Before you drive out onto the road, you should make sure that braking your car does not cause you discomfort.
Patients often experience constipation after surgery. This is caused by low mobility and the use of painkillers. Discuss your diet with your doctor. If the doctor has no objections, then you should include fresh fruits and vegetables in the menu, and also drink eight full glasses of liquid every day.
Watch your weight - every extra kilogram will accelerate the wear and tear of your joint. Remember that there are no special diets for hip replacement patients. Your food should be rich in vitamins, all necessary proteins, and mineral salts. No one food group has priority over the others, and only together can they provide the body with complete, healthy food.
Your artificial joint is a complex structure made of metal, plastic, ceramics, so if you are going to travel by plane, take care to obtain a certificate of the operation performed, because This can be useful when going through security at the airport. On long trips, take your endoprosthesis passport with you.
Remember that your joint contains metal, so deep heating and UHF therapy on the area of the operated joint using the transverse technique are undesirable.
Usually, with complete restoration of limb function, patients have a desire to continue playing their favorite sports. But, taking into account the peculiarities of the biomechanics of an artificial joint, it is advisable to avoid those types of sports activities that involve lifting or carrying heavy objects, or sharp blows to the operated limb. Therefore, we do not recommend horse riding, running, jumping, weightlifting, etc. Walking (regular and Nordic), swimming, gentle cycling and skiing are recommended.
Avoid colds, chronic infections, hypothermia - your artificial joint may become the “weak spot” that will become inflamed.
Rehabilitation at the outpatient stage
Each patient requires an individual program taking into account concomitant pathology. The goal of rehabilitation is to form a correct gait and eliminate muscle imbalances.
Physiotherapy:
Magnetic therapy of the hip joint and lower limb
Calcium electrophoresis on the hip joint area
Electrical stimulation of the gluteal, quadriceps muscles of the thigh (DDT, SMT, Miorhythm, IFT)
Heparin phonophoresis on the area of hematomas (if any)
Hydrotherapy, swimming (after complete healing of the postoperative wound)
Heat therapy (after 6 weeks)
Massage of the operated limb (allowed from 12-14 days after removal of postoperative sutures).
Therapeutic exercise
Continue the exercises you did before.
Special gymnastics lying on your side (unoperated), on your stomach, standing with support.
Cycling training
Dosed walking
Remember that your artificial joint will not last forever. The average service life of a normal endoprosthesis is 15-20 years, in the best cases it reaches 25 years. Of course, you should not constantly think about the inevitability of repeated surgery (especially since most patients manage to avoid it). Your new joint “loves” an attentive, careful attitude. It is very important that you remember this and remain in good physical shape and on your feet at all times. Taking into account some of the precautions that we talked about above, you will be able to fully recover and return to a normal active life, to your favorite job or hobby.
WE WISH YOU HEALTH!
Content
A patient who has recently had an endoprosthesis installed requires special care and assistance. It is important to help him restore his motor functions at home as soon as possible. To do this, they perform therapeutic exercises daily and adhere to a number of rules to avoid complications.
Rehabilitation periods after hip replacement
Hip replacement surgery is prescribed for hip fracture, coxarthrosis, osteonecrosis, and rheumatoid arthritis. If previously these diseases meant disability, now, thanks to successful treatment, the patient can restore the functional activity of the joints. To speed up the rehabilitation period at home after hip replacement, you need to follow all the doctor’s recommendations and regularly perform special physical exercises for your legs. Each recovery period requires compliance with certain rules.
Early period
Immediately after hip replacement surgery, the patient will be under the supervision of a doctor. During this period, it is important to systematically monitor body temperature, change bandages on time, and monitor the functioning of the respiratory and cardiovascular systems. Swelling in the leg is relieved with an ice compress. If necessary, the doctor may prescribe a blood transfusion and medication with blood thinners (this helps prevent thrombosis). To prevent the development of complications, antibiotics are prescribed on the second day after surgery.
Pain occurs after the installation of an artificial joint. However, it is a normal consequence of the operation. As a rule, pain is relieved with painkillers or injections. Some patients have an intravenous catheter placed through which the analgesic is administered. The duration of use of painkillers and the dosage of medications are adjusted by the doctor.
During the first day after hip replacement, patients are in a supine position. To avoid dislocation, you should not bend the leg with the prosthesis more than 90 degrees. To avoid injury, patients are placed with a special cushion between their lower extremities. In addition, immediately after the operation, the patient in a supine position is recommended to move the operated leg slightly to the side. During the first period of rehabilitation, it is strictly forbidden to independently take the blanket lying at the bottom of the bed.
Late period
After early rehabilitation, the patient begins a longer recovery period, which lasts for several months. At this time, you should gradually increase the duration of walking with support. In this case, you need to keep your back straight and look ahead. The daily maximum is 30 minutes of walking. It is only allowed to increase the speed of movement and distance. For 2 months after hip replacement, you should not climb stairs higher than 1 flight.
Rehabilitation at home after hip replacement involves proper rest. It is better to lie on your back, but if you are more comfortable lying on your side, place a soft cushion or pillow between your knees. You should sleep on a hard orthopedic mattress; the height of the bed should be at least knee-high. It is better to get dressed during rehabilitation while sitting on a chair and with the help of a loved one. Putting on socks or shoes on your own is prohibited - this leads to excessive flexion of the hip joint.
Functional recovery period
Rehabilitation after hip replacement ends after three months, but the functional restoration of the leg must continue. If the specified period has passed, and the pain in the leg does not go away or there is discomfort when walking, you should use a cane. Despite the fact that a person can already return to work and drive a car, active sports are allowed only after 8-12 months.
In some cases, the rehabilitation period at home may be extended by a doctor. This decision is influenced by the patient’s age, medical history, systemic pathologies, and hypersensitivity to medications. To speed up recovery after hip replacement, exercise therapy prescribed by your doctor should be performed at home. In addition, therapeutic massage and kinesitherapy help a lot. If possible, the patient should rest at least once a year in a sanatorium or specialized medical center.
What rules to follow in the postoperative period
Regardless of whether the hip replacement surgery was total or partial, a person must adhere to a number of rules to quickly restore motor function:
- You can sit down and stand up on the second day after surgery (for this you need to use handrails);
- on day 5, it is allowed to climb several steps of the stairs, and the first step must be taken with the healthy leg (vice versa when descending);
- physical activity should be increased slowly, sudden movements are prohibited;
- you cannot sit at home on low chairs/armchairs or lift objects from the floor without the help of outside devices;
- you need to keep your body weight normal;
- It is allowed to sleep on your back or side with a cushion between your knees;
- Driving is allowed after at least 2 months of rehabilitation at home;
- it is necessary to adhere to a balanced diet (the amount of food with iron should be increased, drink a lot of water);
- Sexual relations can be resumed 2 months after hip replacement.
Recovery after hip replacement at home
Since most rehabilitation takes place at home, it is worth knowing what aspects are important to quickly regain motor function in your leg. Therapeutic gymnastics plays an important role. If during exercise you feel pain or severe discomfort, it is better to interrupt the exercise and consult a doctor. Every day for 3 months of rehabilitation at home you need to bandage the operated limb with an elastic bandage - this will help relieve swelling.
At first it is allowed to move around at home only with the help of crutches, later you can switch to a cane. Doctors recommend using it for six months. In this case, the cane must be placed simultaneously with the operated leg. You can’t lean forward while moving, and if it’s difficult for you otherwise, slow down and take small steps. Housework is allowed. The only condition is that you can work if there is no load on the sore limb. It is strictly prohibited to lift any weights during rehabilitation at home.
How to walk on crutches correctly
A few days after endoprosthetics, the doctor allows you to get out of bed. The first time this happens with the help of a physical therapy instructor, who explains to the patient the rules of movement and use of crutches. The walking method looks like this:
- when climbing stairs, the movement begins with the healthy leg;
- the movement is as follows: lean on crutches and move your healthy limb to the step;
- then push off the floor with your crutches and transfer your body weight to this leg;
- tighten the operated limb while moving the crutches to the upper step;
- when moving down the stairs, everything happens the other way around - first place the crutches on the step;
- leaning on them, move the sore leg down, leaving the emphasis on the healthy one;
- Place your healthy leg on the same step and lean on it.
An effective set of exercises after hip replacement
Without physical therapy, rehabilitation at home after hip replacement is impossible. There are no universal exercises for restoring the functionality of a limb: each period of rehabilitation involves performing movements of varying complexity. The training program is selected by the doctor. On the first day of rehabilitation, the patient is allowed to do the following exercises at home:
- alternately pulling your toes towards you with your legs extended;
- circular movements of the feet;
- squeezing/unclenching toes.
Later the exercises become more complicated and look like this:
- in a standing position, the prosthetic leg is moved forward 25-30 cm and returned to its original position (10-15 repetitions);
- the leg is raised with the knee bent to a height of 30 cm (10 times);
- the leg is moved to the side as much as possible and returns back, the patient holds onto a chair or handrail, stands with a straight back (6-7 times);
- raising the leg up without bending the knee (up to 10 repetitions).
Video
Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.
Found an error in the text? Select it, press Ctrl + Enter and we will fix everything!Memo for the patient
Before and after total hip replacement (endoprosthetics)
Instead of a prologue or what is endoprosthetics
Constant pain in your hip joint, which arose after an injury or disease of the joint, has recently become unbearable... It is difficult to remember at least one day when you did not feel it. All tested remedies that relieved pain before now provide only a short-term effect. Movements in the joint have become limited and painful. You began to notice that your leg cannot be fully straightened, it has become shorter. The attending physician at the clinic is less optimistic in his forecasts; he responds to persistent demands to reliably relieve you of pain either with silence or with poorly concealed irritation... What to do?
Our goal is not to scare you or throw you into panic. On the contrary, we will try to help you choose the right path for recovery.
So, all attempts to reliably get rid of pain using conservative treatment methods were unsuccessful. But even the thought of the possibility of surgical treatment seems terrible to you. Moreover, you hear a wide variety of, sometimes contradictory and frightening, opinions about the results of operations...
To better understand possible operations, let's try to imagine the anatomy of the hip joint. So, the hip joint is a ball-and-socket joint where the thigh meets the pelvic bones. It is surrounded by cartilage, muscles, and ligaments that allow it to move freely and painlessly. In a healthy joint, smooth cartilage covers the head of the femur and the acetabulum of the pelvic joint. With the help of surrounding muscles, you can not only support your weight while supporting your leg, but also move. In this case, the head slides easily inside the acetabulum.
In a diseased joint, the affected cartilage is thinned, has defects and no longer serves as a kind of “lining”. The articular surfaces altered by the disease rub against each other during movements, stop sliding and acquire a surface like sandpaper. The deformed head of the femur turns with great difficulty in the acetabulum, causing pain with every movement. Soon, in an effort to get rid of the pain, the patient begins to limit movements in the joint. This in turn leads to weakening of the surrounding muscles, “shrinking” of the ligaments, and even greater limitation of mobility. After some time, due to the “crushing” of the weakened bone of the femoral head, its shape changes, and the leg shortens. Bone growths (so-called “spikes” or “spurs”) form around the joint.
What kind of operations are used for severe joint destruction? The simplest, most reliable, but not the best is to remove the joint (resection) followed by the creation of immobility at the site of the former mobile joint (arthrodesis). Of course, by depriving a person of mobility in the hip joint, we create many problems for him in everyday life. The pelvis and spine begin to adapt to the new conditions, which sometimes leads to pain in the back, lower back, and knee joints.
Sometimes operations are used on muscles and tendons, which, when crossed, reduce pressure on the articular surfaces and, thereby, somewhat reduce pain. Some surgeons use corrective operations to expand the crushed head, thereby moving the load to undamaged areas. But all these interventions lead to a short-term effect, only for a while, reducing pain.
Only an operation to completely replace the diseased joint can radically interrupt this entire chain of painful processes. To do this, the orthopedic surgeon uses a hip replacement (artificial joint). Like a real joint, the endoprosthesis has a spherical head and an imitation of the acetabulum (“cup”), which are connected to each other and form a smooth joint with ideal gliding. A ball-shaped head, often metal or ceramic, replaces the femoral head, and a cup, often plastic, replaces the damaged acetabulum of the pelvic bone. The stem of the artificial joint is inserted into the femur and securely fixed in it. All parts of the artificial joint have polished surfaces for perfect gliding during your walking and any movements of your leg.
Of course, an artificial joint is a foreign body for your body, so there is a certain risk of inflammation after surgery. To reduce it you need:
- cure bad teeth;
- cure pustular skin diseases, minor wounds, abrasions, purulent nail diseases;
- cure foci of chronic infection and chronic inflammatory diseases, if you have them, monitor their prevention.
We remind you once again that an artificial joint is not a normal joint! But, often, having such a joint can be much better than having your own, but sick!
Currently, the quality of artificial joints and the technique of their installation have reached perfection and have reduced the risk of various postoperative complications to 0.8-1 percent. Despite this, certain complications are always possible, associated with the already described inflammation of the tissues around the joint or with early loosening of the elements of the endoprosthesis. Strict adherence to the doctor’s recommendations will reduce the likelihood of such complications to a minimum. At the same time, it is difficult to demand from the surgeon one hundred percent guarantees of the ideal functioning of the implanted joint, since its function depends on a number of reasons, for example: the advanced stage of the disease, the condition of the bone tissue at the site of the proposed operation, concomitant diseases, and previous treatment.
Typically, the service life of a high-quality imported endoprosthesis is 10-15 years. In 60 percent of patients it reaches 20 years. In recent years, a new generation of artificial joints (with the so-called metal-to-metal friction pair) has appeared, the estimated life of which should reach 25-30 years. namely the “estimated lifespan”, since the period of observation of these joints for the most part does not yet exceed 5-6 years.
There are many different designs of hip joint endoprostheses, but the correct choice of the joint you need can only be made by an orthopedic traumatologist who deals with this problem. As a rule, the cost of a modern imported endoprosthesis ranges from 1000 to 2500 US dollars. Of course, this is a lot of money. But, in our opinion, life without pain and the ability to move are sometimes worth it.
So, we tried to openly talk about the problem of replacing a diseased joint with an artificial one. The final choice is yours. But let you be reassured by the fact that every year more than 200 thousand patients around the world choose endoprosthetics surgery.
By choosing to have a total hip replacement, you have taken the first step in returning to the pain-free and limited mobility you lived before your illness. The next step will be a period of postoperative rehabilitation. The purpose of the brochure that you are holding in your hands is to help you take this step correctly and as successfully as possible. To do this, you will have to change some old habits and behavioral patterns, and apply certain forces to restore walking and normal movement in the joint. We hope that your family, friends, and medical workers will help you through this thorny path to recovery. We will try to help you too.
You always need to remember that an endoprosthesis, unlike a natural joint, has a limited range of safe movements and therefore requires special attention, especially in the first 6-8 weeks. Since during the operation not only altered bone structures are removed, but also altered ligaments, cartilage, and the scar capsule of the joint, the stability of the operated joint in the first days is low. Only your correct behavior will allow you to avoid the danger of dislocation and form a new normal joint capsule, which, on the one hand, will provide reliable protection against dislocation, and on the other hand, will allow you to return to normal life with full range of motion in the joint.
First days after surgery
As we just said, the first days after surgery are the most important. Your body is weakened by the operation, you have not yet fully recovered from anesthesia, but in the first hours after waking up, try to remember more often about the operated leg and monitor its position. As a rule, immediately after surgery, the operated leg is placed in an abducted position. A special pillow is placed between the patient’s legs to ensure moderate separation. You need to remember that:
- In the first days after surgery it is necessary to sleep only on your back;
- You can only turn on the operated side, and then no earlier than 5-7 days after the operation;
- when turning in bed, you must place a pillow between your legs;
- You can sleep on the non-operated side no earlier than 6 weeks after the operation; if you still cannot do without turning onto the healthy side, then it must be done very carefully, with the help of relatives or medical staff, constantly holding the operated leg in a state of abduction. To protect against dislocation, we recommend placing a large pillow between your legs.
- During the first days, you should avoid a large range of motion in the operated joint, especially strong flexion in the knee and hip joints (more than 90 degrees), internal rotation of the leg, and rotation in the hip joint.
- When sitting in bed or going to the toilet in the first days after surgery, you need to strictly ensure that there is no excessive flexion in the operated joint. When you sit on a chair, it should be high. A regular chair should be cushioned to increase its height. Low, soft seats should be avoided.
- In the first days after surgery, it is strictly forbidden to squat, sit with crossed legs, or “cross” the operated leg over the other.
- Try to devote all your free time to physical therapy exercises.
The first goal of physical therapy is to improve blood circulation in the operated leg. This is very important to prevent blood stagnation, reduce swelling, and speed up the healing of the postoperative wound. The next important task of physical therapy is restoring the strength of the muscles of the operated limb and restoring the normal range of motion in the joints and the support of the entire leg. Remember that in the operated joint the friction force is minimal. It is a hinge joint with ideal gliding, so all problems with limited range of motion in the joint are solved not through its passive development like rocking, but through active training of the muscles surrounding the joint.
In the first 2-3 weeks after surgery, physical therapy is performed while lying in bed. All exercises must be performed smoothly, slowly, avoiding sudden movements and excessive muscle tension. During physical therapy exercises, proper breathing is also important - inhalation usually coincides with muscle tension, exhalation with muscle relaxation.
First exercise- for the calf muscles. Bend your feet toward and away from you with slight tension. The exercise should be performed with both legs for several minutes up to 5-6 times within an hour. You can start this exercise immediately after waking up from anesthesia.
A day after surgery, the following exercises are added. Second exercise- for the thigh muscles. Press the back of your knee joint into the bed and hold this tension for 5-6 seconds, then slowly relax.
Third exercise- sliding your foot along the surface of the bed, lift your thigh towards you, bending your leg at the hip and knee joints. Then slowly slide your leg back to the starting position. When performing this exercise, you can first help yourself with a towel or elastic band. Remember that the angle of flexion in the hip and knee joints should not exceed 90 degrees!
Fourth exercise- placing a small pillow under your knee (no higher than 10-12 centimeters), try to slowly tense your thigh muscles and straighten your leg at the knee joint. Hold the straightened leg for 5-6 seconds, and then also slowly lower it to the starting position. All of the above exercises must be done throughout the day for a few minutes 5-6 times per hour.
Already on the first day after surgery, provided there are no complications, you can sit up in bed, leaning on your hands. On the second day, you need to start sitting up in bed, lowering your legs from the bed. This should be done towards the non-operated leg, gradually abducting the healthy leg and pulling the operated leg towards it. In this case, it is necessary to maintain a moderately apart position of the legs. To move the operated leg, you can use devices such as a towel, crutch, etc. When moving the operated leg to the side, keep your body straight and make sure that there is no external rotation of the foot. Sit on the edge of the bed, keeping your operated leg straight and in front. Slowly place both feet on the floor.
You must immediately remember that before sitting down or standing up, you must bandage your legs with elastic bandages or put on special elastic stockings to prevent thrombosis of the veins of the lower extremities!!!
First steps
The goal of this rehabilitation period is to learn how to get out of bed, stand, sit and walk so that you can do this safely yourself. We hope that our simple tips will help you with this.
As a rule, you are allowed to get up on the third day after surgery. At this time, you still feel weak, so in the first days someone must help you, supporting you. You may feel a little dizzy, but try to rely on your strength as much as possible. Remember, the faster you get up, the faster you will begin to walk. The medical staff can only help you, but nothing more. Progress is entirely up to you. So, you should get out of bed in the direction of the non-operated leg. Sit on the edge of the bed, keeping your operated leg straight and in front. Before standing up, check that the floor is not slippery and that there are no rugs on it! Place both feet on the floor. Using crutches and your non-operated leg, try to stand up. Caring relatives or medical staff should help you in the first days.
When walking in the first 7-10 days, you can only touch the floor with your operated leg. Then slightly increase the load on your leg, trying to step on it with a force equal to the weight of your leg or 20% of your body weight.
After you have learned to confidently stand and walk without assistance, physical therapy should be expanded with the following exercises performed in a standing position.
- Knee lift. Slowly bend the operated leg at the hip and knee joints at an angle not exceeding 90 degrees, while raising your foot above the floor to a height of 20-30 cm. Try to hold the raised leg for a few seconds, then also slowly lower your foot to the floor.
- Taking your leg to the side. Standing on your healthy leg and holding the headboard securely, slowly move your operated leg to the side. Make sure your hip, knee and foot are pointing forward. Maintaining the same position, slowly return your leg to the starting position.
- Taking the leg back. Leaning on your healthy leg, slowly move your operated leg back, placing one hand on the back of your lower back and then making sure that your lower back does not sag. Slowly return to the starting position.
So, you walk quite confidently on crutches around the ward and the corridor. But this is clearly not enough in everyday life. Almost every patient needs to walk up stairs. Let's try to give some advice. If you have had one joint replaced, then when moving up, you should start lifting with the non-operated leg. Then the operated leg moves. The crutches move last or simultaneously with the operated leg. When going down stairs, you should move your crutches first, then your operated leg, and finally your non-operated leg. If you have both hip joints replaced, then when you lift, the more stable leg begins to move first, then, as described earlier, the less stable leg begins to move. When descending, you should also lower your crutches first, then your weak leg, and finally your strong leg.
We remind you once again that during this period:
- It is advisable to sleep on a high bed;
- You can sleep on your healthy (non-operated) side no earlier than 6 weeks after surgery;
- You should sit in high chairs (like bar stools) for 6 weeks after surgery. A regular chair should be cushioned to increase its height. Low, soft seats should be avoided. It is important to follow all of the above when visiting the toilet.
- It is strictly forbidden to squat, sit cross-legged, or “cross” the operated leg over the other;
- get rid of the habit of picking up fallen objects from the floor - either those around you or you should do this, but always with the help of some kind of device such as a stick.
Current control
An endoprosthesis is a rather complex and “delicate” design. Therefore, we strongly recommend that you do not abandon the monitoring scheme recommended by your doctor for the behavior of the new artificial joint. Before each follow-up visit to the doctor, it is necessary to take an x-ray of the operated joint, it is advisable to take blood and urine tests (especially if after the operation you had some kind of inflammation or problems with wound healing).
The first follow-up examination usually occurs 3 months after the operation. During this visit, it is important to find out how the joint “stands”, whether there are any dislocations or subluxations in it, and whether it is possible to begin to put full weight on the leg. The next control is after 6 months. At this moment, as a rule, you already walk quite confidently, fully loading the operated leg. The purpose of this examination is to determine what and how has changed in the condition of the bones and muscles surrounding the joint after normal load, whether you have osteoporosis or some other bone tissue pathology. Finally, the 3rd control - one year after joint replacement. At this time, the doctor notes how the joint has “grown”, whether there is a reaction from the bone tissue, how the surrounding bones and soft tissues, muscles have changed in the process of your new, higher quality life. In the future, visits to your doctor should be made as necessary, but at least once every 2 years.
REMEMBER! If pain, swelling, redness and increased skin temperature appear in the joint area, if the body temperature increases, you need to contact your doctor URGENTLY!
Your artificial joint is a complex structure made of metal, plastic, ceramics, so if you are going to travel by plane, take care to obtain a certificate of the operation performed - this may be useful when going through control at the airport.
Avoid colds, chronic infections, hypothermia - your artificial joint may become the “weak spot” that will become inflamed.
Remember that your joint contains metal, so deep heating and UHF therapy on the area of the operated joint are undesirable. Watch your weight - every extra kilogram will accelerate the wear and tear of your joint. Remember that there are no special diets for hip replacement patients. Your food should be rich in vitamins, all necessary proteins, and mineral salts. No one food group has priority over the others, and only together can they provide the body with complete, healthy food.
The “failure-free” service life of your new joint largely depends on the strength of its fixation in the bone. And it, in turn, is determined by the quality of the bone tissue surrounding the joint. Unfortunately, in many patients who have undergone endoprosthetics, the quality of bone tissue leaves much to be desired due to existing osteoporosis. Osteoporosis refers to the loss of bone mechanical strength. In many ways, the development of osteoporosis depends on the age, gender of the patient, diet and lifestyle. Women over 50 years of age are especially susceptible to this disease. But regardless of gender and age, it is advisable to avoid the so-called risk factors for osteoporosis. These include a sedentary lifestyle, the use of steroid hormones, smoking, and alcohol abuse. To prevent the development of osteoporosis, we recommend that patients avoid highly carbonated drinks such as Pepsi-Cola, Fanta, etc., and be sure to include foods rich in calcium in their diet, for example: dairy products, fish, vegetables. If you have symptoms of osteoporosis, you should urgently discuss with your doctor the optimal ways to treat it.
Avoid lifting and carrying heavy weights, as well as sudden movements and jumping on the operated leg. Walking, swimming, gentle cycling and gentle skiing, bowling and tennis are recommended. Usually, with complete restoration of limb function, patients have a desire to continue playing their favorite sports. But, taking into account the peculiarities of the biomechanics of an artificial joint, it is advisable to avoid those types of sports activities that involve lifting or carrying heavy objects, or sharp blows to the operated limb. Therefore, we do not recommend sports such as horse riding, running, jumping, weightlifting, etc.
If this does not contradict your aesthetic views and does not affect the attitude of others towards you, use a cane when walking!
If you dance, do it calmly and slowly. Forget about squat dancing and rock and roll.
Normal sex is allowed 6 weeks after surgery. This period is required for the healing of the muscles and ligaments surrounding the operated joint. The following picture illustrates the recommended positions and, conversely, those that should be avoided by a patient after total hip arthroplasty.
We recommend making some simple adaptations to make your daily life easier. So, to avoid excessive hip flexion when bathing, use a sponge or washcloth with a long handle and a flexible shower. Try to buy shoes without laces. Put on your shoes using a horn with a long handle. In some patients with an advanced process, certain difficulties persist when putting on socks. For them, we recommend using a simple device in the form of a stick with a clothespin at the end when putting on socks. You need to wash the floor with a mop with a long handle.
When traveling in a car, try to move the seat back as far as possible, taking a semi-reclining position. And finally, I would like to warn against one more dangerous misconception. Remember that your artificial joint will not last forever. As a rule, the service life of a normal endoprosthesis is 12-15 years, sometimes it reaches 20-25 years. Of course, you should not constantly think about the inevitability of repeated surgery (especially since most patients will be able to avoid it). But at the same time, repeated joint replacement or, as doctors call it, revision endoprosthetics is far from a tragedy. Many patients are terrified of repeat joint surgery and try to endure the pain they experience, but do not consult a doctor, hoping for some kind of miracle. This should not be done under any circumstances. Firstly, not all pain and discomfort in the joint require mandatory surgical intervention, and the sooner the doctor becomes aware of them, the greater the chances of getting rid of them easily. Secondly, even in case of fatal loosening of the joint, the previously performed operation is much easier for the patient and the surgeon and leads to a faster recovery.
We hope that the artificial joint has relieved you of the pain and stiffness you previously experienced with your own painful joint. But the treatment does not end there. It is very important that you take proper care of your new joint and remain fit and on your feet at all times. Taking into account some of the precautions we discussed above, you can fully recover and return to your normal active life.
The image shows the affected joint, but does not show the affected muscles and ligaments, which have completely atrophied as a result of lameness. Sometimes this is noticeable visually by the size of the buttock.
Rehabilitation after hip replacement begins within 24 hours and lasts from 3 to 4 months. Medicines are prescribed only in the first days, and then massage and physiotherapeutic procedures. The duration of rehabilitation is influenced by the patient’s age, the degree of damage to the structures of the hip joint, and the patient’s compliance with all recommendations of the rehabilitation doctor.
Introductory Instructions
Rehabilitation of patients after (TBS) consists of several stages. In the early period, special attention is paid to the restoration of tissues damaged during surgery, the elimination of postoperative complications, and the prevention of complications. After 2 weeks, the late stage of rehabilitation begins. Its main tasks:
- strengthening the muscles, ligamentous-tendon apparatus, stabilizing the artificial hip joint;
- gradual strong bonding of the endoprosthesis elements with the bones due to natural tissue regeneration;
- acquisition of correct motor stereotypes, correction of posture and gait changed during illness.
A rehabilitation doctor is responsible for planning and optimizing physical activity. During rehabilitation at home, the patient is required to follow all instructions, correct dosing of loads, regularly attend scheduled examinations, and be required to contact the attending physician if their health worsens.
General principles
Rehabilitation after hip replacement is aimed at a full and comprehensive restoration of all functions of the replaced joint. The patient must recover in society within the optimal time frame, take care of himself at home, and engage in professional activities. Rehabilitation should begin as early as possible, be continuous, consistent, comprehensive and consistent. An individual approach to the recovery of each patient is practiced - therapeutic measures are carried out as planned, but if necessary, the rehabilitation doctor adjusts the previously adopted scheme.
Drug therapy
Avoiding infection of tissues whose integrity is compromised during endoprosthetics is possible not only by treating the sutures with antiseptic solutions. Patients are prescribed a course of antimicrobial drugs and antibiotics - macrolides, cephalosporins, semi-synthetic protected penicillins. The following remedies are also included in treatment regimens:
- anticoagulants, venoprotectors, preventing venous thrombus formation;
- for pain relief and;
- gastroprotectors that protect liver cells from damage due to increased pharmacological load;
- means that improve the functioning of the urinary organs.
To accelerate the restoration of bone tissue, balanced minerals are used that contain increased doses of calcium, as well as those that accelerate metabolism in bone structures.
Comprehensive physiotherapy
To normalize the functions of motor nerves and muscles, sessions of electromyostimulation, or therapeutic effects of pulsed electric currents, are performed. At the early and late stages of rehabilitation, ultraviolet irradiation of sutures, UHF therapy, electrophoresis with anesthetics, analgesics, chondroprotectors, solutions of calcium salts, and B vitamins are used.
The main goals of physiotherapy are to strengthen the muscles and ligamentous-tendon apparatus, eliminate residual pain and inflammatory swelling. Under the influence of physical factors, blood circulation in the hip joint area improves, and the damaged tissues begin to receive the nutrients necessary for their regeneration.
Rehabilitation period in a hospital setting
For 2 weeks after endoprosthetics, the patient is in a hospital. His condition is monitored by the attending physician, the surgeon who performed the operation, and junior medical staff. The main objectives of patient care are the prevention of postoperative complications and pain relief. Despite the fact that painful sensations are quite natural, they are necessarily used to relieve them. Even moderate pain seriously worsens a person’s psycho-emotional state and makes one doubt a speedy recovery.
From about day 2, a rehabilitation specialist begins to work with the patient. He shows how to breathe and cough correctly in order to prevent congestion in the lungs and not disrupt the functioning of the cardiovascular system. Physical therapy begins with performing passive exercises, including the use of mechanotherapy.
Your stitches have been removed and nothing hurts. Do you think this is the end of the treatment? In vain, a rehabilitation program awaits you ahead. Well, or he doesn’t wait, if there is no desire to recover 100%.
Preparing the home before the arrival of an operated relative
After the patient is discharged from the clinic, a long, late stage of rehabilitation begins. The patient still has difficulty moving, and some pain persists in the area of the installed endoprosthesis. In order for him to quickly adapt to new conditions, learn to walk without support on the operated leg, and master the skills of daily activity, it is necessary to furnish an apartment or house.
| Object | Necessary changes |
| Bed | It is advisable to purchase a functional bed with a height-adjustable headrest, equipped with hanging handrails to make it easier to get out of bed |
| Floors | Walking on thick carpet, laminate, or parquet can be dangerous. The best option is a thin, well-stretched covering that cannot be caught on with crutches or a cane. |
| Toilet | In the first 2 months after surgery, while sitting, the angle of flexion of the hip joint should not exceed 90 degrees. Therefore, you need to purchase an additional semi-rigid pad for the toilet seat. |
| Walls | The walls in the room should be equipped with handrails so that a person can maintain balance when bending over or trying to sit down. They should be placed near the toilet, in the hallway, in the kitchen near the dining table |
| Chairs | During the rehabilitation period, soft chairs and sofas are strictly prohibited. For seating, you will need medium-height chairs with a hard or semi-hard seat |
You will need such a device in everyday life.
Stages of rehabilitation
Due to the gradual therapeutic effect on the operated leg, complications are prevented, swelling and pain are quickly eliminated, the hip joint is developed, and the functionality of the limb is restored.
Early period
During the first week after hip replacement, the patient should maintain a gentle motor regimen.
Prevention of postoperative complications consists of diaphragmatic breathing exercises, correct positioning of the operated leg, performing gentle exercises to improve lymph and blood circulation, and strengthening the muscular frame of the limb.
Rules for the postoperative period
If blood pressure, body temperature, and heart rate are within the normal range, then the patient is allowed to get out of bed on the 2nd day after endoprosthetics. He can walk around the ward and hospital corridor using crutches.
The patient is taught proper movement on crutches, including going up and down stairs, at the stage of preoperative preparation. In the first weeks, when walking there should be only 3 points of support - crutches and a healthy leg. The operated limb does not participate in movement.
Walking on stairs has the same principle as on a flat surface - the sore leg is always between two crutches.
On day 3, you can sit on hard chairs, taking a body position in which the hip joint is bent at an angle of less than 90 degrees. At first, you can’t sit for longer than 15-20 minutes.
Maintaining an angle of no more than 90 degrees is one of the main requirements in the early recovery period.
The patient rests lying on his healthy side, placing a small thick cushion between his legs, and sleeps on his back.
Crossing your legs for the first time is prohibited - the risk of dislocation increases. There should be a cushion between the legs when changing position.
1-2 days after installation of the prosthesis, development of the leg begins. Gentle exercises are shown - sliding the feet on the bed, bending them from side to side, low-amplitude flexions of the knee and ankle joints.
Diet after surgery
In the first days after surgery, the patient receives mainly liquid and viscous nutrition - cereal porridges, milk and fruit jelly, clear broths, puree soups, well-chopped meat. He is gradually returning to his normal daily menu. The diet should consist of red meat, liver, dairy products, whole grain bread, fresh fruits and vegetables. 3-4 times a week you need to eat fatty fish (salmon, herring, horse mackerel) - the main source of polyunsaturated fatty acids and fat-soluble vitamins.
Late stage
At a later stage, the duration of walks gradually increases. By the end of the second month, the patient should be moving about 4 hours a day. During his illness, his gait and posture changed pathologically due to frequent pain, compensatory muscle tension, and destruction of the hip joint cartilage. Now it is necessary to develop motor stereotypes for the correct distribution of loads on the operated and healthy leg, as well as on all parts of the spine.
The likelihood of this happening depends on the weakness of the muscles around the implant. This "corset" doesn't work. And rehabilitation corrects this.
The limb should be fully loaded after 4-6 weeks, but only with cemented fixation of the endoprosthesis. If cementless implant installation was used, full weight bearing on the leg is possible after 2 months. Walking with a cane is indicated until lameness disappears completely, until the person begins to feel confident when moving.
Strain of the piriformis muscle of the thigh. This exercise can be performed no earlier than 3 months after surgery.
Distant phase
After about 3-4 months, the patient can freely lean on the operated leg and move without orthopedic devices. The long-term stage of rehabilitation begins. During this period, spa treatment is very useful. Mountain and sea air have a healing effect on the entire body, strengthens the immune system, and tones. In specialized medical institutions, all leg functions are restored with the help of radon, pearl, carbon dioxide, hydrogen sulfide baths, mineral waters, and therapeutic mud.
This happens rarely, and no rehabilitation, whether there was one or not, has any effect on this, so take care of yourself.
Exercises to do at home
Should be daily, with a gradual increase in dosed loads. Most often, rehabilitation doctors include the following exercises in treatment complexes:
- lie on your stomach, one at a time, and then raise your legs together, trying to touch your buttocks with your heels;
- lie on your back, bend your legs, pulling your feet as close to your body as possible;
- sit on a chair, holding onto the seat, raise your legs one by one, bend them and lower them to the floor;
- stand up, lean on a wall or chair, and do shallow lunges forward and backward.
The number of repetitions is 10-12. Movements should not be sudden or high-amplitude. Exercises should be performed smoothly, a little slowly, constantly listening to the sensations that arise.
Gymnastics on simulators
Rehabilitation centers are equipped with simulators, which allow you to recover much faster. After endoprosthetics, exercise bikes with pedaling both forward and backward are especially in demand. For walking, rehabilitation doctors recommend using treadmills, first setting the speed to about 2 km/h, and then gradually increasing it.
You can buy such a wonderful thing as a step machine. It is cheap, compact and very effective.
Possible complications
Complications after endoprosthetics develop quite rarely, since preventive measures are taken in a timely manner. Sometimes local infectious processes, thrombosis, thromboembolism, periprosthetic bone fracture, and neuropathy of the small tibial nerve occur. If the first symptoms of complications are detected, the patient should immediately report them to the attending physician.
Thrombosis is dealt with quite well, but it still affects the statistics of complications.
After restoring the functional activity of the operated leg, the person can lead a normal lifestyle, but with some restrictions. Doctors allow you to play sports, but in a gentle manner, without forceful loads on the endoprosthesis. They also recommend attending routine medical examinations, taking vitamins, chondroprotectors, and calcium supplements.
