Exercising With A Hip Replacement
Total hip replacement rehabilitation is not a complex process but it is useful for a skilled eye to be kept on the progress of the patient if the outcome is going to be optimal. The muscles around a painful joint weaken due to lack of use and this reduces the support of the joint given by them. Tightness may develop in the joints due to the restrictions in the movements which are limited by the pain and so the patient may develop an abnormality of gait to cope with the pain and tightness.
Before the operation there is much patients can do to improve their situation in preparation for the replacement with walking practice and exercise. The physiotherapist will assess the joint range of the hip and prescribe joint mobilising and strengthening exercises as required. The walking pattern will be analysed and suggested changes instructed. A poor gait may impel the physiotherapist to issue walking aids such as elbow crutches or a stick, used on the side opposite to the arthritic joint. If this does not allow a sufficiently good walking pattern then a second elbow crutch or stick may be added to do this.
Physiotherapy assessment and treatment of the patient begins on the first day after the operation with encouragement to perform hourly contractions of the major quadriceps and buttock muscles. This aids restoration of the patient's leg control and enables joint movement to be performed. Sliding the knee and heel up and down the bed allows practice of repeated hip flexion and joint control which improves the ability to mobilise both around the bed for self care and in and out of bed. Routine ankle pumping exercises are traditionally taught for the same reason and to improve circulation but the effect of this may be small.
Hourly contractions and gentle movements of the hip will get the joint moving and restore some confidence in the patient that they can independently move their leg around, which initially feels very heavy. The physiotherapist and an assistant will mobilise the patient as their condition allows, using crutches or a frame. Early sitting out in a chair is encouraged with a seat high enough to prevent too much hip flexion. As the side of the thigh has been operated this can limit the amount of knee bend so patients are encouraged to regularly slide their feet back towards themselves in sitting.
Initially mobilisation should produce a safe and acceptable walking pattern and after the initial period the physiotherapist will progress to teaching as close to a normal gait as possible. Once the patient has achieved a step-through gait and are walking well their gait pattern should be very close to normal with the addition of a pair of crutches the only clue they have had an operation. Muscle activation is normalised by the natural rhythm of an automatic activity such as walking and a correct sequence of muscle activity lowers the energy requirements for walking and increases muscle strength.
Specific exercises can be added to the patient's regime if a significant weakness in one or more muscles is identified. Standing and holding on to a firm object in front is the best position to start with from a balance and safety point of view. The exercises consists of three movements: raising the knee up in front so the thigh eventually is close to horizontal; abducting the leg to the side whilst kept straight; maintaining an upright posture whilst moving the straight leg behind the body. These exercises strengthen the major moving and stabilising muscles around the hip and pelvis and can easily be performed even by elderly and less strong patients.
In some cases these exercises will need to be supplemented by harder ones or by prescribing hydrotherapy. Pool therapy is very useful for patients after their joint replacement as they feel supported and in control of the leg but the water gives significant resistance to muscular activity. Resistance can be increased by using floats attached to the foot and the water resists the practice of the gait pattern, resisting the whole process. Care must be taken not to exercise hip replacements unduly or this can loosen the cement-bone interface and reduce the life expectancy of the replacement.