Rehabilitation after hip surgery: recovery periods, exercises, features and recommendations

In the article, we will consider how rehabilitation is carried out after surgery on the hip joint.

Restoring the patient's health should begin in the first hours after his awakening from anesthesia. This approach will achieve the best results in the shortest possible time. Rehabilitation after prosthetics of TBS (hip joint) includes a complex of various exercises, which differ depending on the recovery period. In addition, it depends on how the prosthesis was fixed, as well as on the age of the patient and his condition, the presence of concomitant pathologies. You can carry out rehabilitation after hip surgery in a sanatorium, and not just in a hospital, it can also be carried out in specialized medical centers, rehabilitation centers, or at home.

It is advisable to remain under the supervision of specialists for as long as possible, who will be able to take into account the dynamics, individual characteristics of the patient, select the permissible physical exertion, make adjustments as necessary, and monitor the correctness of the medical exercises. Rehabilitologists will ensure that recovery after arthroplasty is normal, without the development of complications, and will help the patient throughout the recovery period.

That is why surgeons recommend, after discharge from the hospital, to go to a specialized institution for rehabilitation after surgery on the hip joint. Medical centers remain preferred, however, if the patient is not able to stay in the institution for the entire recovery period, then you can visit a special sanatorium where he will also receive appropriate care.

Wherever the patient is rehabilitated, he must adhere to a plan of mandatory postoperative measures and adhere to an individually designed program.

The average duration of the rehabilitation period after surgery on the hip joint lasts up to 4 months, but it can vary depending on many factors, including the age of the patient. Elderly patients are fully restored, as a rule, over a longer period, and rehabilitation of children is faster due to the characteristics of the body, rapid tissue regeneration. Children's rehabilitation takes place similarly to an adult, but parents and medical personnel have to carefully monitor the child, especially if he is excessively mobile.

Rehabilitation after hip surgery

The rehabilitation period after replacement of TBS is divided into two postoperative periods: early and late. Each of them has different tasks, and the load on the diseased limb has a different degree of intensity. The rehabilitation of each patient is determined by many factors and always takes place at an individual pace.

Early recovery period

The main goals of the early rehabilitation period after hip replacement surgery are:

1. Prevent the development of complications.
2. Master the exercises that are performed while lying down.
3. Learn to take a sitting position and upright.
4. Master walking with crutches.

The main concerns that arise in the early period after arthroplasty are:

1. Ensuring the correct position of the diseased limb.
2. Decreased swelling, soreness.
3. Wound dressing.
4. Following a sparing diet.
5. Preventive measures aimed at preventing the development of thrombosis.

What else does rehabilitation mean after surgery on the hip joint in an adult and a child?

Requirements for movements and position of the limb:

1. In the early days, the patient is allowed to sleep lying exclusively on his back.
2. To avoid unacceptable rapprochement of the patient's legs or their crossing, a wedge-shaped cushion or pillow is placed between the limbs.
3. The patient can roll over to the healthy side 8 hours after the endoprosthetics. This can be done with the help of a nanny or a nurse. It is important to bend the legs at the knees, pinching the roller with the ankles.
4. It is unacceptable to bend the operated leg by more than 90 degrees.
5. Also, rotation of the hip joint, a sharp turn of the legs are not allowed.
   

Puffiness reduction, pain relief

No one is able to avoid the pain that occurs after hip replacement surgery. During rehabilitation, this should be taken into account.

After the end of the action of anesthesia, bouts of pain inevitably begin, which are accompanied by the development of edema. Exhausted after the operation, the patient is not able to endure it, therefore it is necessary to carry out the following measures:

1. Analgesic therapy.
2. Drainage of fluid accumulating in the joint. For this, a drainage tube is inserted into the articular cavity, which extends to the surface. They take out the tube only after the exudate ceases to accumulate in the joint cavity.
3. Cooling the affected area with ice.
4. When an infectious process occurs, the use of antibiotic medications is indicated.

Surgical Wound Dressings

1. The first ligation is carried out, as a rule, the day after the intervention.
2. The frequency of the following dressings is determined by the surgeon, however, they should be carried out at least once every two to three days.
3. Removal of sutures is performed on 10-14 days. If the wound is in satisfactory condition, then the doctor may decide on an earlier removal of the threads. If absorbable sutures were used when suturing the wound, then their removal is not required.

Water, food

When a patient comes to, he may be thirsty and appetite. So the body responds to anesthesia. Eat a small amount of crackers and drink water only after 6 hours after the intervention.

In the early days, you should adhere to a special diet, which includes such products:

1. Meat broth with a small content of salt and mashed meat.
2. Mashed potatoes, oatmeal porridge.
3. Dairy products.
4. Unsweetened tea, fruit jelly.

After that, the patient can eat in the usual way or follow a diet that is shown to him in accordance with the existing chronic pathologies.

Prevention of blood clots

After surgery, there is always an increase in blood coagulation. This reaction of the body is natural, it occurs because the body directs all resources to accelerate wound regeneration. In such periods, the risk of developing thrombosis always increases, and if there is also a vein insufficiency in the patient’s history, the risk doubles.

In order to prevent thrombosis, the following measures are recommended:

1. Bandaging the legs with an elastic bandage.
2. The use of drugs based on warfarin, heparin or other anticoagulant substances.
3. Special exercises for the legs.

Modes of physical activity on the damaged side

If the joint was cemented, then:

• The initial load on the leg should begin in the early period of rehabilitation after surgery on the hip joint in children and adults, that is, in the first days after the intervention.
• Full load should start at a later period.

If the joint was fixed in a cementless manner, then:

• After 7-10 days, up to 15% of the full load can be given on the operated limb.
• Three weeks later - up to 50% of the full load.
• After 2 months - full load.

In special clinical cases - with a stroke, diseases of internal organs, oncological diseases, in old age - it is important to begin exercise therapy as soon as possible after the intervention, and the load should be full.

If the patient is worried about acute pain, you should adhere to a limited load regime, and in all rehabilitation periods.

The artificial joint has perfect mobility, but it will not move independently, it must attach to the muscles. This can only be done through active rehabilitation aimed at strengthening the muscles.

Passive exercises carried out during rehabilitation after surgery on the hip joint, on mechanical simulators are used to prevent muscle contracture, and not to strengthen the muscle corset. They can not replace physical therapy, which should be performed with the application of effort. In addition, without exercise therapy, the patient will not be able to fully recover.

What exercises are done in rehabilitation centers after hip surgery?

Exercises for the early postoperative period

The main goals of exercise therapy in the early rehabilitation period are:

1. Prevention of blood stasis, accelerated healing of surgical wounds, reduction of swelling.
2. Restoring the support function of a limb, the full range of motion.

Exercise physiotherapy exercises in the first couple of weeks should be in a supine position, but you need to get up on your feet the next day.

The set of exercises for primary gymnastics is quite simple, but it is important to follow certain requirements:

1. It is important to perform the exercises often throughout the day. The intensity should be as follows - a few minutes, five to six times in an hour. That is, an hour to complete the exercises should take up to 20 minutes.
2. The pace and nature of the exercises is slow, smooth.
3. It is important to combine all exercises with breathing according to the following scheme: with muscle tension, inhale, with relaxation, exhale.

As a rule, exercises for the gluteal, femoral, and calf muscles of each leg are included in the exercise therapy complex.

On the first day after the intervention, reciprocal successive movements with each foot should be made: pull the left foot towards yourself, the right foot away from you, then in the reverse order. The next exercise is to squeeze and unclench the fingers of both legs.

On the second day after the operation, the execution of static exercises, slides, straightening with lifting is shown.

Static exercises:

1. Five-seven-second pressure of the back of the knee to the bed and its subsequent relaxation. When performing this exercise, the femoral muscles are trained.
2. A similar pressing of the heels to the bed, allowing you to train the rear femoral and lower leg muscles.
3. Gliding the operated leg (without taking it off the bed) to the side and its subsequent return to the starting point.

Sliding, bending the legs:

1. Gliding the operated leg on the bed, bending the limb by a maximum of 90 degrees.
2. The return of the leg to the starting point. To alleviate the problem, you can use an ordinary towel or elastic tape.
   

Leg straightening and lifting:

1. This exercise should be performed using a roller, which reaches a height of 10-12 cm. It should be placed under the knee.
2. Slowly, straining the thigh muscle, it is necessary to straighten the leg and keep it in this position for about 5 seconds. After that, it is necessary to lower the foot at the same slow pace.

The patient should perform these exercises in turn: in the first hour - one, in the second - the next.

Rules for transition to a sitting position

Begin to carefully sit down should be the next day after surgery. This must be done in compliance with several rules:

1. You should lean on your elbows or grab the frame located above the bed.
2. It is necessary to sit in the direction of the non-operated leg, first lowering it to the floor, and only then pull the operated leg to it. This can be done using an elastic bandage.
3. It is important to always keep a roller between the legs.
4. First, you should bandage the legs with an elastic bandage.
5. In the process of planting, it is important to keep the body straight, not to turn the feet out.

From the second postoperative day, it is also necessary to begin mechanotherapy of TBS.

Walking after arthroplasty

This period of rehabilitation after surgery on the hip joint in children and adults is very difficult for the patient, since too little time has passed since the operation, the wound still hurts, and the specialist is already insisting on getting up on crutches, despite the pain. The earlier the patient begins to walk, the lower the risk of developing contractures, the greater the likelihood of restoration of movements in full.

The load on the operated limb

During the first rehabilitation week, you only need to touch the floor with the operated limb. After this, the load on the sore leg can be increased to 20%, which equals the transfer of its own weight to it. That is, the patient can stand on his leg, but should not rely on it.

Up to 50% of the load increases individually for each patient. If the soreness and swelling of the legs are still preserved, it is recommended to postpone the increase in load.

Persistent swelling and soreness may indicate the development of postoperative complications, dislocation of the prosthesis, abuse of walking, improper performance of gymnastic exercises. The surgeon should understand the true reasons.

Walking stairs using crutches

Rehabilitation after surgery on the hip joint in a sanatorium involves mandatory pacing.

The walking technique is determined by how the patient moves - whether up or down. When climbing up, it is important to start the movement with a healthy leg:

1. It is necessary to lean on crutches and move a non-operated limb to a step higher.
2. Push off with crutches, transfer body weight to a healthy leg.
3. Tighten the damaged leg, at the same time rearrange the crutches one step higher.

When moving down, perform the movements in the reverse order:

1. Move crutches one step below.
2. Lean on crutches, put down your sore leg, not leaning on it.
3. Move a healthy leg one step below, lean on it.

Late rehabilitation after arthroplasty

After two months of rehabilitation after surgery to replace the hip joint, stiffness still persists, the patient steps on the operated limb uncertainly. This is evidence of incomplete recovery, that is, you must continue:

1. Homework prescribed by a doctor exercises and gymnastics based on the operated limb.
2. Classes on simulators.

An effective method to strengthen all the muscles taking part in the joint is an exercise bike.

However, it is important not to overdo it in the classroom:

1. Using the simulator is important at low speeds.
2. The height of the seat should be adjusted so that the angle of flexion of the hip joint is not more than 90 degrees, and the foot, when straightening the knee joint, barely touched the pedals.
3. The minimum rehabilitation period after hip replacement surgery is 3-4 months.

It is important to remember that the exact implementation of all medical recommendations, compliance with the rules when performing exercises, the absence of neglect of physical activity is the key to a speedy recovery.

What are the centers and sanatoriums for rehabilitation after surgery of the hip joint, we will describe below.

Where to recover?

A comprehensive recovery program after endoprosthetics, both in the early and late stages of rehabilitation, is offered by various institutions.

Specialized centers are famous for their comfortable living conditions, single and double rooms with a private bathroom. The most modern equipment and simulators are available there, and the rehabilitation program includes author's developments, in particular, innovative treatment methods (for example, according to Bubnovsky).

The patient should be observed by highly qualified doctors and instructors in exercise therapy. He can get advice from an orthopedic traumatologist, rehabilitologist, psychologist. The same services are offered in specialized orthopedic resorts. Of course, all this is not free.

Rehabilitation reviews after hip surgery

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People confirm that the sooner rehabilitation begins, the more successful it will be. On average, the entire period takes from 4 months to six months. This is an approximate time to restore full functionality.