Hip replacement surgery is usually the last resort for pain management in patients experiencing hip arthritis. While there are many things one may do to stave off a hip replacement, oftentimes a replacement is inevitable to maintain function and improve pain levels. Hip replacement, or total hip arthroplasty (THA) is a fairly common surgery with around 450,000 THA’s performed each year in the US alone. A full recovery from hip surgery typically takes a full year, however within 2-3 months, most people are functioning well with minimal pain. Full recovery can take up to a year as the muscles of the involved hip take prolonged lengths of time to adapt to the new hip, and the increased levels of activity that can follow a total hip replacement. Hip replacement surgeries have one of the highest success rates of major elective orthopedic surgeries. It has been found that more than 95% of patients who undergo a THA will experience pain relief from pain following the surgery. Current technologies, and surgical techniques allow for the hip replacement to last up to 10-15 years, however this number is constantly improving, and some hip replacements have proven to last up to 20 years without indications of failure.
Successful hip replacements require planning, and dedication to a set rehabilitation plan. The first tip for a successful surgery is to meet with a physical therapist prior to the surgery. In doing this, the therapist can help you to determine some goals to work toward prior to the surgery, and set the stage for post operative rehabilitation. This will also allow the therapist to get to know you and help answer any questions regarding your surgery. Setting up preoperative physical therapy appointments will hopefully alleviate any anxiety about the surgery. A mobile physical therapist will be able to assess the patient’s home situation, and any durable medical equipment they may have prior to the surgery in order to ease the transition back home from the surgery center.
Following the hip replacement surgery, it is important for the patient to follow any post operative protocols.
Common Post Operative Protocols
Movement restrictions to prevent hip dislocation
Anterior approach - limit hip extension and external rotation
Posterior approach - limit hip flexion past 90 degrees, limit hip internal rotation, and hip adduction. (No twisting, or crossing legs)
Blood clot prevention
Pain medications
Adherence to Post Operative Exercises
Ice
Following the protocols set by both the surgeons and the physical therapist will help to expedite the recovery process while protecting the healing hip.
Weeks 1-4 Following your hip replacement
Activities of daily living will start to feel easier and pain will start to subside. The patient may even find themselves ditching that walker or cane! Although things are starting to feel easier, it is important to know that the hip is still healing, and can easily be damaged. It is important to follow the hip movement precautions for up to 12 weeks (every surgeon sets different protocols, so be sure to follow up with the operating surgeon) in order to prevent the hip from dislocating. These weeks are the most critical for rehabilitation, so do not skip out on these exercises.
Things to focus on
Gait Mechanics
Normalizing your walking may be a difficult challenge following surgery. Ensuring you have proper gait mechanics is an important factor of a full recovery from a THA. When you are walking with the walker, or cane, ensure that you are walking without any gait deviations. This may take some practice.
Exercise
Functional Strength
Minimize Pain
Weeks 4-10 following your hip replacement
By this point, you are starting to feel pretty good, you are experiencing less pain and are able to do a lot more things. By now, you should feel comfortable with your prescribed exercise, and have a set exercise routine. By the end of these weeks, you will be in full strengthening mode, successfully returning to your previous strength and functional level.
Things to focus on
Gait
By this time, you should have graduated from your assistive device unless you are in unfamiliar spaces, or uneven terrain. You should have a more normalized gait with minimal gait deviations. A final goal will be to normalize gait without an assistive device over uneven surfaces, however this will likely happen over the next year as your hip continues to heal.
Strengthening
Range of Motion
Balance
Weeks 10+
Congratulations! You are making strides to a full recovery. By this time, you should feel comfortable with your exercises and stretches. Pain should be relatively low at this point of rehabilitation. You should be returning to your hobbies and extra curricular activities. During this phase of rehabilitation, you should be comfortable with all your exercises, and have a good exercise regimen in place. While you will likely be discharged from physical therapy at this point, it is important to maintain good physical activity in order to continue the healing and recovery process for the hip. Premature cessation of rehabilitation can lead to adverse health outcomes, which may result in persistent pain, or decreased longevity of the prosthesis.
Things to focus on
Return to work and recreational activities
Remember you underwent a serious surgery, and your hip is still healing. When returning to higher level activities, make sure to slowly return to the activity. Too much too soon may cause increased pain and a setback in function.
Return to full strength
Avoid lifetime restrictions
Ensuring that you have taken the correct precautions, and have followed a proper rehabilitation program will expedite your recovery time, while building confidence in your new hip. Remember that the whole process can take up to a year, so be patient and try not to rush the recovery. Enjoy the new hip, and the freedom of painless mobility!
Comments