Rehabilitation after a hip replacement

Rehabilitation for this operation starts long before the operation date itself.

At the pre-operative assessment the physiotherapist will give you exercises to maintain the muscle strength and ranges of movement in the hip.

Your walking pattern will be corrected if necessary and the correct walking aids prescribed and their use demonstrated. Information leaflets given will also prepare you for the operation and increase the chances of you having a quick recovery.

When you are admitted for the operation you may be seen by the ward physiotherapist to check any problems, look at your walking ability, answer questions and remind you of the exercises to be done while you are recovering in the 24-48 hours after operation.

The day following the operation

The physiotherapist may assess your breathing ability and check that your legs muscles are working properly. If you have an epidural in place your legs may feel numb and be difficult to move to some extent. The physiotherapist will ask you to perform a few exercises:

1. Take a few deep breaths every hour and have a cough to clear any phlegm which may develop after the anaesthetic
2. Move your feet up and down at the ankle 20 times every hour to encourage the circulation in the legs
3. Tighten up the thigh muscles at the knees and hold for a few seconds. Do 10 times hourly
4. Squeeze the buttock muscles together gently 5 times hourly

Getting going

People with hip replacements often get up and start walking on the first day after operation, although it may be the second day for specific reasons or if your medical condition dictates. The physiotherapist will come and see you with an assistant.

They will check the operation instructions and assess how you are now the operation is over. You will get out of bed as shown and stand by the side of the bed. If you do not feel dizzy you will be given the crutches and taught to walk.

How much weight you can put through your hip depends on many factors and the physiotherapist will instruct you accordingly. You will be able to sit out in a chair when your surgeon permits it.

Onwards and out…

From now on you will concentrate on improving the skills you have already started to work on. These include the exercises, getting off and back onto the bed, walking independently with the crutches, managing the toilet and washing and sitting out in the chair.

When you are fit enough you will be instructed in the safe way to dress, bathe and manage functional activities by the occupational therapist.

Discharge

When you have mastered the ability to get about and care for yourself independently you can be discharged home. This can happen very early after the operation but is most likely around 5 to 7 days post-operatively. If you are older or not so able to look after yourself your discharge may be delayed or you may be discharged to another hospital for a convalescent period.

Longer term

You will be reviewed by your surgeon at regular intervals and he or she will guide you as to how much weight-bearing to put through your hip and what functional activities you may resume.

As a general rule exercise is not indicated for people with hip replacement so it is unlikely you will be encouraged to attend physiotherapy or a gym. Appropriate weight-bearing activities may be the most useful way of improving muscle power and gait pattern.

Keeping safe at home

In general it is a good idea to keep up the precautions you have been taught to prevent the possibility of dislocation. It takes about 12 weeks for the new fibrous bag to form around the hip joint which helps hold it in place, and by this time the risk of dislocation has fallen by 95% from the time of operation.

Eventually it will become automatic for you to observe the necessary care with your hip. The new hip is not like the original and stressful sports and heavy work are unwise.

Falls can be a problem, although this may be partly due to being elderly and not just after an operation. The decreased visual ability and balance of elderly people renders them at risk.

Tips for accident prevention can be useful such as having good lighting at home, avoiding rugs and thick carpets and having a clear and lit route from the bed to the bathroom. People may fall at night whilst going to the toilet as they may not be fully alert.

Getting on with life

This is what hip replacement is all about, restoring a person’s functional ability to do the normal things in life. Once the pain has gone and a ‘normal’ joint has been restored, all normal day to day management tasks such as sleeping, walking, sitting, climbing stairs, personal hygiene and housekeeping should be possible.

Many people do not stop there and go on to take up or resume recreational activities they enjoy. This is entirely reasonable as long as sensible limits are observed. The new hip is not an exact copy of the original either in anatomical or functional terms.

Examples of sensible activities for someone with a hip replacement to perform are:using a static bicycle, swimming, walking, bowls, cross-country skiing and ballroom dancing.

Activities to be avoided may include high-impact sports such as jogging, tennis, squash, downhill skiing, extreme walking, football, rugby and basketball. A person may have the ability to perform these activities with a new hip but it is not wise to do so.