REHABILITATION AFTER TOTAL HIP REPLACEMENT
On the day of surgery, the patient performs deep-breathing and coughing exercises and isometric gluteus and quadriceps-setting exercises. Calf-pumping exercises are initiated to decrease the risk of thrombophlebitis. Lower limbs are maintained in position with an abduction splint. Active-assisted to mild resistive exercises are prescribed for unaffected joints and limbs. On the first postoperative day, the patient begins active-assisted range of motion of the affected hip and knee in all planes, with hip flexion limited to 80 degrees and extension limited to neutral. The patient is instructed in proper transfer techniques and is assisted in getting out of bed to stand for 15-minute periods.
On the second and third postoperative days, the patient adds short-arc quadriceps-strengthening exercises and begins progressive standing, transfers, and ambulation. Initial gait training in the parallel bars or walker assistive device provides proprioceptive feedback with partial weight bearing. During ambulation, the patient is evaluated for limb-length discrepancy. The patient advances from partial weight bearing to full weight bearing as tolerated per surgeon preference and technique. The abduction wedge is removed, but it is used at night for 6 weeks after surgery.
Physical and occupation exercises continue after the third postoperative day, and then active hip flexion, extension, and abduction are added. Progressive ambulation continues until the patient achieves independent ambulation with assistive devices. Then, the patient may use supportive devices to walk without supervision. After the third postoperative day, this is often continued in a skilled rehabilitation facility until the patient is safe to be at home. Until discharge from the hospital or rehabilitation facility, the patient continues the strengthening and range-of-motion exercises and learns to negotiate steps and curbs. Hip abductor and quadriceps femoris exercises are advanced per surgeon preference to progressive resistive exercises. Instruction is given in the use of assistive devices for dressing and other activities of life. At the time of discharge, the patient is provided with written instructions to be followed at home and with adaptive equipment to compensate for the limited hip flexion (e.g., bathtub seat, elevated toilet seat, long shoehorn). When the patient is pain free, isometric exercises to increase hip muscle strength are added. The only proscribed activities are extreme hip flexion, internal rotation, adduction past neutral, and lifting weights more than 50 lb. However, applying excessive athletic stress to the prosthesis is not recommended in most cases. During the first 6 to 8 weeks after discharge, the patient normally uses a cane in the oppo-site hand to protect the joint. Active hip extension exercises are added after 6 to 8 weeks.