Replacing a worn joint has become common practice. Modern medicine has reached a level at which good results are achieved, operations have become available to a wide range of patients. Their demand in Russia reaches three hundred thousand a year. But there is one aspect that significantly affects any, even the most successful, operation - this is rehabilitation after hip replacement.
From the very first hours after it, it is important to follow all the recommendations. In the hospital, the healing of sutures is monitored, the formation of blood clots and dislocation are prevented. It is not easy to lie on your back all the time, but properly started rehabilitation will ensure a quick recovery in the future.
Unfortunately, not everyone can afford a spa or spa treatment. Most patients fulfill the rehabilitation conditions after hip replacement at home. In this regard, many questions arise: when you can lie on your stomach, sit, walk, go down and climb stairs, and many others.
Home preparation
When going to the hospital, you should prepare for your return home. After all, a serious operation is ahead and servicing yourself on your own at first will not be easy. Among such surgical interventions, the most serious is hip arthroplasty. Rehabilitation after surgery will require a set of measures. The house is adapted to the new needs of the owner: they acquire special chairs and linings on them, attach handrails, and a non-slip rug is placed in the bathroom.
Do not forget about the blanket tensioner, dry closet and crutches. You should consider comfortable shoes that do not need to be buttoned. It is good if a gym complex is installed in the apartment. After the operation, most of the free time is advised to engage in physical therapy. Thus, rehabilitation after hip replacement at home will be successful.
Observing the simple rules that can be learned in advance, the operated patients get rid of the unpleasant feeling of uncertainty, behave confidently in the circumstances, and gradually begin to recover.
Rehabilitation program after hip arthroplasty
The existing set of measures aimed at the quickest recovery of the patient consists of several phases, each of which is aimed at a specific solution to the problems:
- The first four days after surgery.
- From the fifth to the twenty first day of rehabilitation.
- One month after surgery.
First of all, remember what movements can not be done several months after replacing a joint:
- Sharp bending or extension of the legs.
- Crossing the legs.
- Limb rotation.
Even in the most favorable circumstances, it will take at least three months for complete healing of the tissues after hip replacement. Rehabilitation after surgery until complete recovery lasts an average of about a year.
In the hospital
Immediately after surgery, the patient is in intensive care. Doctors make sure that blood clots do not form. The patient lies on his back, a catheter is inserted into the bladder. The legs are in an extended position, between them put a pillow or a special roller in order to maintain the correct position of the limbs. Body turns are prohibited.
If the patient's condition is stable, there are no complications, transfer to the intensive care unit is possible. Rehabilitation begins after hip replacement: the catheter is removed, the patient is allowed to stand up and move around with a walker or other support. At first, the patient will have a high toilet and a high bed. This is necessary to ensure that the joint flexion angle is less than 90 degrees. You should sit in bed, leaning back on the pillows.
Joint rotation is limited (these are movements in which the foot deviates from the axis of the foot), it should be no more than 30 degrees.
First leg movements
It is believed that cautious movements should be started as early as possible so that rehabilitation occurs faster after hip replacement. As soon as the catheters and droppers are removed, they carefully turn over with the help of a nurse. From the fifth to the eighth day, the doctor may allow him to turn over first on his side, and then on his stomach, but be sure to keep the roller between his legs. This will prevent dangerous foot casts.
Bringing the foot is the term for the establishment of the operated leg beyond the midline. This usually happens when trying to bring the legs together. The midline is represented by continuing the line of the spine. When bringing the foot, a dislocation or a fracture is possible.
When lying on the stomach, make sure that the knee joint is maximally unbent. It can be unpleasant, even painful. However, to pay close attention to such a pose at the beginning of rehabilitation is the salvation from the inability to straighten the legs in the future.
So you can lie in the waking hours - it is believed that this position stretches the joint better. At night, you should take a position on your back with a roller between your legs apart. Rehabilitation after hip replacement in a hospital includes mandatory physical exercises to prepare the muscles for movement. They need to be repeated at home, gradually increasing their number.
Zero phase rehabilitation
This is the name of events held immediately after surgery. All actions are aimed at preventing the formation of blood clots. The patient does special exercises at a slow pace as soon as the anesthesia is removed. This will help accelerate recovery, reduce pain, develop muscles, and increase blood circulation.
Since there are no identical patients, there are no single rehabilitation exercises after hip replacement.
In the case when the joint replacement occurred due to a hip fracture, when a person did not wait for years, overcoming pain, the muscles will respond well to exercises and healing will be faster. If the disease that led to the replacement of the joint developed slowly, the person did not lean on his injured leg for years - the muscles most likely atrophied. You will have to teach them to work correctly, and this will take more time.
Only a doctor can properly coordinate a patient with appropriate exercises that are beneficial to him. Having received the complex, exercises are done three times a day.
An approximate set of exercises in the zero phase
To successfully start and undergo rehabilitation after hip replacement, do not neglect simple exercises.
- Foot pump. Imagine you are inflating a tire with your foot. Move the foot toward and away from you, as when working with a foot pump. This exercise is very useful, it should be performed until recovery for several minutes sitting, lying down, anytime. With it begins the movement of the legs in the ward.
- Foot rotation. With this movement, the knee is not involved, it remains stationary. The foot makes five circular motions, first clockwise, then counterclockwise. Also performed while sitting and lying down.
- The front surface of the thigh. Lying on the bed, try to straighten your knee. To do this, press your foot firmly against the bed. Feel the tension on the front of your thigh. Hold the position for a few seconds. It is performed 10 times for both legs.
- Knee flexion. This movement begins with the heel, which moves to the buttocks along the sheet, not looking up from it. The knee should not deviate to the side, the hip joint should not exceed a bend of 90 degrees. This exercise is repeated 10 times.
- Contraction of the buttocks. Tighten your gluteal muscles and hold for several seconds. Repeat 10 times.
The first phase of rehabilitation: four days
The goals to be conquered at this stage are as follows:
- Learn to get out of bed and go to bed without the help of a nurse.
- Learn to sit on a chair and get up from it.
- Master independent movement with crutches or walkers.
- Master the independent use of the toilet.
- Perform a set of exercises.
Those exercises that were done in the supine position are now performed in the upright position - training of the thigh muscles, gluteus muscles, work with the foot. Straighten the leg during the vertical position of the body should be fully. It is important to try not to limp, it is better to take small steps. By the end of the fourth day, a hundred-meter walk with walkers or crutches is considered the achievement of rehabilitation after hip replacement.
Second phase of rehabilitation: two weeks
Weakness after surgery disappears, the patient can take care of himself and even perform exercises. Walking is recommended with a length of not more than 150 meters up to three times a day. Everything seems to be behind. However, at this stage, overloads of a not fully healed joint, its injuries and other complications occur. There is a deceptive “self-belief” that can seriously fail.
Doctors advise: "Try to comply with the rules of movement of the operated leg. Forbidden movements are unacceptable. As before, a pillow or roller is placed between the legs, you can take anything from the nightstand only without turning the body. Muscles and ligaments after surgery are weak, do not rely on them" .
The main goal of this period is to master walking up and down stairs. This is a job for both the muscles and the joint. The first time will require outside help. Lean when moving follows the hand that is opposite to the operated leg. One step is taken at a time. Rehabilitation after hip replacement in the elderly can be delayed, in which case the stairs should be avoided until recovery.
Rules for climbing and descending stairs:
- Ascent begins with a healthy leg, descent - with the operated.
- The movement consists of three stages.
- When lifting: step with a healthy foot - raising the sore leg higher - putting a crutch on the sore foot.
- During the descent: install a crutch on the lower step - step down with a sore foot - placing a healthy leg.
Third phase of rehabilitation: a month after surgery
By the beginning of this period, the tissues had already grown together well enough to increase the load on the muscles and joint. The goal of this stage is to learn how to balance. This ensures a gradual transition from a crutch to a cane. You can’t refuse a crutch before. Standing on one leg, maintain balance. Gradually complicate the exercise, but the first attempts should be under control. Train both legs.
Exercises on simulators:
- Walking back with a treadmill. At a slow pace, the patient walks backwards, paying attention to the full extension of the legs.
- Hip extension - on a special simulator.
- Exercise bike.
- Step down.
Exercises should include resistance, which gives an elastic tape, it is attached to the ankle of a sore leg. Movement forward, backward and sideways. They are performed 3 times a day, 10 times. During the exercise, you should hold on to the back of the chair.
The essence of the exercises is stretching the fixed tape with the operated leg. So they train the correct abduction of the leg.
Walking with a cane for 5 to 10 minutes three times a day is effective. It builds muscle strength. Gradually, walks increase and maintain the habit of walking.
The fourth phase of rehabilitation: two months after surgery
This stage leads to a complete recovery. Unfortunately, many neglect the skills that are anchored in this stage. And then any non-standard situation (accident, slipping) will lead to disastrous consequences.
Goals at this stage: to go up the stairs backwards, up and down. Leaning forward, walking temporarily from a sitting position (stand up and go).
Training is useful for everyone, and even more so for people undergoing rehabilitation after total hip replacement. They doubly need to keep their muscles in good shape, and therapeutic exercises should be their companion for many years.
Full range of exercises
Exercises that are done from a supine position are suitable for all patients. They are easy to perform at home. The complex has established itself as a classic set of necessary development of the muscles surrounding the hip joint.
Feedback from those who executed the program
Reviews of rehabilitation after hip replacement are diverse. This is understandable: all people are different, the level of physical endurance, age, even heredity - everything plays a role. But one thing unites: those who overcame themselves, their laziness, and did exercises - quickly restored their health. Some took only a month and a half to fully recover.
No wonder doctors repeat: everything has its time. The gradual increase in the strength and amplitude of movements gives positive results. Unfortunately, those patients who did not begin the fourth phase of rehabilitation on the grounds that they could not do these exercises, being healthy, only began to move independently. They did not gain more confidence in the movements.
Self-putting on shoes, forgotten back pain and lameness, and if you want to sit “foot to foot” - this became possible after the operation. The walk was younger. There was optimism. When asked whether it is worth the operation, all patients as one say: worth it. The main thing is to remember that one day of surgery will entail rehabilitation measures. And it takes time.