Rehabilitation after Hip Surgery

One of the most critical factors in achieving successful total hip replacement depends upon
your diligence in physical rehabilitation. You must actively participate in the rehab process, working diligently on your own, as well as with the physical therapists, to achieve optimal results.

Your recovery program usually begins the day after surgery. The rehabilitation team will
work together to provide the care and encouragement you need during the first few days after
surgery.You may be given a device called an incentive spirometer that you inhale and exhale
into. It measures your lung capacity and assists you in taking deep breaths. These exercises
reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs
following surgery.

The physical therapists will begin as early as 1-2 days after surgery. They will teach you
simple exercises that can be performed in bed to strengthen the muscles in the hip and lower
extremity. They will also guide you through safe technique to Moving up and down in bed, Going from lying to sitting, Going from sitting to standing, Going from standing to sitting, Going from sitting to lying. Whilst these are all simple movements it is important that they are done correctly following surgery.

Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and the therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance for accident or injury. The occupational therapist will teach you how to safely perform activities of daily living, and will provide you with a list of hip precautions which are designed to protect your new hip
during the first 8-12 weeks following hip surgery. The occupational therapist will also instruct you in the proper use of various long-handled devices for activities of daily living.

At Home

Following surgery, a physical therapist may help you with your rehabilitation protocol. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regularly basis to further strengthen your hip muscles. An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to manage.
You may be asked to perform a variety of exercises, including leg lefts, ankle pumps, quadricep sets, gluteal sets, hip abduction, and knee extensions. If an exercise causes lasting pain, reduce the number of repetitions. If the pain continues, contact your physical therapist or physician. While at home, continue to walk with an assistive device unless directed by your surgeon to
discontinue use. You must also remember to strictly follow the hip precautions and weightbearing instructions during the first few months following surgery. It is recommended that you not drive unless you have been approved by your doctor.

Long-term Rehabilitation Goals

Once you have completed your rehabilitation program, you can expect to be able to perform most activities of daily living with little to no hip pain or assistance. Following total hip replacement, patients routinely are able to walk, dress, bathe, drive, garden, cook, and return to work. Although final outcomes may vary from patient to patient, hip replacement surgery
is one of the most successful procedures in modern medicine and most patients return to a full and active life.

Why are exercises important?

Due to limited movement after the operation, you will have to work hard to regain muscle power and mobility.
It is very important to do the exercises your physiotherapist teaches you, so you get the most out of your new hip. Once you understand how to do the exercises, you will be encouraged to do them on your own.

General Advice/Information

Most patients are mobilised on first day post surgery.
Patients are initially mobilised with a Zimmer frame and progressed to two sticks as assessed by the physiotherapists.
Patients are required to be able to safely negotiate stairs prior to discharge home. My average length of stay for primary hip surgery is 3 to 5 days.

For the first two weeks recovery can be slow. Patients are advised to take painkillers as is appropriate, you may find that the bruising comes out and that elevating the leg and applying frozen peas or ice pack on it help with this period. Most patients start to recover and are more active, between 2-4 weeks post surgery. Patients are followed up in outpatients at 6 weeks.

For the first 6 weeks general hip restrictions apply and patients are not allowed to bend their hip more than 90 degrees as this can interfere with the healing of soft tissues and tendons.

The insurance companies dictate that patients cannot return to driving following hip replacement surgery for six weeks.

Most patients will be allowed to return to work at 4-6 weeks post surgery depending on their employers liability insurance. Patients working on building sites and factories and certain other areas, return to work would be determined by their employers liability insurance.

As a rule of thumb, advise your employer you will be off work for three months, with the expectation that you are likely to return to work before this.

After 6 weeks you may return to full function and activity. It is important that you stretch out your scar tissue and build up your leg muscles. Exercises will be shown and explained to you to help facilitate this.

In my experience to date, most patients return to 95-98% of normal function and activity approximately 9 to 12 months following surgery.