Rehabilitation after hip replacement

Damage to the hip joint in 64% of cases leads to disability, is the cause of severe dysfunction of the lower extremities and spine, coupled with severe pain. Rehabilitation is required after hip replacement surgery. How it is carried out and why it is necessary - we will consider in detail in this article.

The most common lesions of the hip joint are osteoarthritis, subcapital fractures of the femoral neck. Thus, the latter give the highest rate of adverse outcomes and require joint replacement.

Endoprosthetics with modern models of endoprostheses is a highly effective method of treatment that significantly improves the quality of life - positive results are achieved in 90-98% of cases. Rehabilitation measures are necessary for 100% of patients. Rehabilitation measures for general somatic and local - that is, the restoration of the work of the limb.

Why a hip replacement is needed and what to expect from the surgery

But let's start in order before looking at how rehabilitation after a hip replacement goes. So, the hip joint is formed by the semilunar surface of the acetabulum of the pelvic bone and the articular surface of the femoral head. This is a multi-axial, powerful connection, which is the link between the lower extremities and the body. Flexion and extension, pronation and supination of the thigh, abduction and adduction, circular rotation of the thigh are carried out. Thanks to this connection, a person has the ability to stand on his feet and move around.

Diseases of the joints, namely, the hip joint, are most often manifested by the appearance of pain in the pelvic area during walking, stiffness after waking up, a decrease in the range of motion, and a crunch. The appearance of these alarming symptoms is a reason to seek qualified medical help. X-ray results will be required, possibly magnetic resonance imaging, but in most cases, only an x-ray examination is sufficient.

With the active progression of the disease, the ineffectiveness of conservative treatment, they talk about arthroplasty, hip replacement. After treatment, as noted above, the patient is waiting for the postoperative period - early recovery, late recovery, remote. The patient is restored in rehabilitation institutions, as well as at home. Forecasts largely depend on how effective the rehabilitation program is drawn up by the doctor. The efforts of the patient himself, the willingness to comply with all recommendations and focus on results are also important.

Today, orthopedic surgery offers an effective treatment that can significantly improve the quality of life. An endoprosthesis is being created using innovative technologies. As you recover from hip replacement surgery, you can gradually begin to lead an active lifestyle, play sports in a gentle mode. Rehabilitation involves strengthening muscles and ligaments.

Orthopedic surgery is a radical solution to the problem, which may be associated with the development of complications. Especially if the operations are performed on elderly patients with a burdened somatic history. Such patients represent a group of increased anesthetic risk both in terms of age and comorbidities, and in terms of the aggressiveness of such operations. The most significant factors are, first of all, trauma, massive blood loss, and the risk of fat embolism.

In order to prevent deep vein thrombosis after surgery, fraxiparine is prescribed taking into account body weight, as well as elastic bandaging of the lower extremities.

In order to prevent osteoporosis of various origins, osteo- and chondroprotective drugs are prescribed.

Duration of rehabilitation

Often the problem lies in the ignorance of the convalescents, who, before the installation of the prosthesis, are not at all interested in rehabilitation measures.

Many patients are not well aware of the issues of rehabilitation, and begin to delve into only after a hip replacement. In those cases when they think about rehabilitation measures only a few months after the operation, the condition of those operated on is much worse than those who actively, under the strict guidance of specialists, began to recover in the early postoperative period.

Do you experience severe pain after hip replacement? This is a common occurrence in cases where rehabilitation measures are neglected.

It is characteristic and quite natural that many have a fear of unnecessary movements. Those who have undergone surgery are afraid of fractures, dislocations - “suddenly the structure will not withstand the weight of the body or will shift.”

It should be understood that the efforts of specialists alone are not enough - the active participation of the patient in restoring mobility is necessary. Inaction after the operation does not allow you to return to normal life, improve the quality of life.

Why else, besides minimizing the pain syndrome, rehabilitation measures are needed? Of course, to minimize the risk of complications, restore normal motor activity, which does not differ from that in healthy people.

Rehabilitation activities involve compliance with the following key principles:

1. The start of rehabilitation activities is not late, but early is one of the keys to success.
2. The increase in physical activity is strictly gradual, taking into account the current state and the rate of progress.
3. Compliance with strict phasing.
4. Observation in dynamics by a specialist.
5. Selection of the most successful combinations of methods, a comprehensive, with an individual approach.
6. Psychological assistance, connecting relatives and friends to maintain the patient's self-confidence. To return the limbs to their former functionality, you need a strong desire to fight and receive excellent results as a reward.

Rehabilitation measures can be divided into 3 periods, namely: early post-surgical, late post-surgical, separated post-surgical. In general, recovery can take a year or a little less than a year:

1. The duration of early post-surgical is the first two weeks. Moreover, in the first 3-7 days, the load should be minimal. Starting from the second week, the load gradually increases, invigorating exercises are connected.
2. Late post-surgical is usually divided into early and late. Accordingly, the first lasts up to one and a half months, and the second - up to three months.
3. As for the remote post-surgical, it can last, as noted above, for about a year. During this period, one should actively engage in so-called adaptive measures for maximum functional recovery.

Thus, restorative measures should be started directly in the hospital, where the operated patients stay for 2-3 weeks. When the patient has already been discharged, classes continue - with a specialist or at home. But in both cases, control by a specialist, correction of classes is necessary. The key to success is regularity and correct execution.

Today, many honey. institutions offer rehabilitation centers - using their services, operated, as a rule, receive better therapeutic results. Therapeutic physical culture is a mandatory item of the program. This is necessary to restore muscle tone.

By refusing rehabilitation, the operated person risks increasing the likelihood of developing complications, including:

• the appearance of lameness;
• dislocations;
• neuritis;
• displacement of the prosthesis, and all this is due to a weakening of muscle tone. Trained muscles serve as a kind of corset.

Unfortunately, many operated patients are sure that after orthopedic surgery all problems are solved, and there is no point in contacting the appropriate specialists. Doctors leading the operated patients also rarely insist on the inclusion of comprehensive recovery measures. Because of this, the adaptation processes are slowed down. In some cases, repeated surgery may be required to replace the endoprosthesis.

Thus, qualified specialists in the field of rehabilitation will help to significantly improve the condition after implantation. In this article, we will consider practical recommendations for physical therapy, important aspects and nuances.

Recovery: stages

So, we figured out that rehabilitation is necessary for the fastest and most comfortable recovery. However, it should be understood that each stage of recovery involves its own characteristics. That is why it is necessary to prepare for restorative measures even before the actual replacement of the hip joint.

Let's start with an overview of the early, late and late stages, and then move on to recommendations.

Early recovery phase

For the first few days, the operated patients lie only on their backs. Early recovery time is about 14 days. Experts give the following general recommendations:

1. As noted above, the first few days of the operation lie exclusively on their backs - this is very important.
2. Also, in the early days, if necessary, it is possible to roll over to the other side only with the help of medical personnel. They turn over exclusively to the side that was not operated on.
3. Movements must be slow. Turn, rise, move the hip area gently, gradually.
4. The leg on the operated side should not bend at a right angle or more.
5. You should not completely connect or cross your legs while lying or sitting - a roller is fixed between the legs.
6. Already at this stage, it is necessary to start the most gentle exercises, perform them regularly and in accordance with the instructions of the specialist. Particular attention is recommended to be paid to the angle at which the leg is relative to the hip joint during classes.

In the case of elderly patients, it should not be expected that the operated patient will begin rehabilitation measures as soon as possible. This group of patients needs inspiration, special support and care of relatives and, of course, help in recovery.

So, the early recovery stage is designed to:

1. Improve blood circulation, tissue trophism, thereby preventing the development of various complications, including thrombosis.
2. Learn to lie and sit properly.
3. Learn to stand up correctly.
4. Reduce swelling and pain intensity.

It is especially important to learn how to climb stairs correctly.

Late and distant stage

When the initial rehabilitation is over, the following activities can become the main directions of recovery.

With the help of methods of therapeutic physical culture, it is necessary to form a muscle corset that stabilizes the movements of the operated joint. Exercises are directed to the number and duration of holding the leg in the allotted state. Dosed walking with a small support on the operated leg is also required. In this case, a cane is used for one and a half months.

The stereotype of walking is corrected in order to reduce the asymmetry of walking. Apply, for example, electrical stimulation of the muscles that surround the hip joint.

In order to improve tissue trophism, remove puffiness, low-frequency magnetotherapy can be prescribed.

To improve the general somatic condition, eliminate hypoxic phenomena, vasospasm in the ischemic zone, improve the blood flow of small vessels, as well as accelerate osseointegration, a course of hyperbaric oxygenation is recommended.

Extraction is usually carried out on the 12th day. In the next 3 months, massages, therapeutic physical culture, and electrical stimulation are recommended.

In the future, it is also necessary to correct coordination, expand complex training with new exercises, massage and other methods.

The effectiveness of the rehabilitation program is assessed, taking into account the range of motion before hip replacement and after surgery at different recovery times. Pain syndrome, refusal of support during movement, muscle tone, elimination of venolymphostasis and, finally, restoration of working capacity are also taken into account.

Let us consider separately, in more detail, the late and remote stages of recovery.

late stage

Late restorative measures begin about a month after the installation of the endoprosthesis and continue for the next several months. The duration, of course, depends on the general condition, individual characteristics, and the age of the operated.

At this long, but no less important than the early stage, it is necessary to continue to strengthen the muscular corset, as well as gradually restore the previous motor activity, improve the functional state of the joints.

We will move on to the consideration of complex exercises a little later, but now we note that you can actively use simulators. An excellent option is an exercise bike. There is no shock load during training.

Good results are said in the case when the operated person easily sits down on his own, walks with support.

remote period

The length of the long-term recovery period varies depending on the condition, and can last 3-12 months. If adequate rehabilitation measures are carried out, then this interval will be sufficient to fully restore functionality with the lowest risk of complications.

First of all, I would like to note the pool - regular exercises in the water are very useful. It is recommended to visit at least once a week.

As you recover and adapt to more strenuous physical activity, you can move on to cross-country skiing,

In the absence of contraindications, more complex workouts are connected, long walks, etc. are possible.

Exercise after hip replacement

In order not to complicate your task, it is advisable to contact a specialized center before the operation, where the operated person will undergo rehabilitation. Much will depend on the will of the patient himself - great efforts are required from him to comply with all the recommendations of the specialist. The specialist, in turn, supervises and controls the patient at different stages.

Where to apply? You can undergo spa treatment - undergo rehabilitation after hip replacement in a sanatorium, go to a rehabilitation clinic. It is important that the medical facility provides a complete package of services specifically for those who have had an artificial hip joint. Drawing up a rehabilitation program is a purely individual matter. Each exercise, each procedure is selected taking into account the state of the body. Of course, young people recover much faster than older people, this is also taken into account. And older people, as a rule, need more motivation. Therefore, one cannot do without the support of loved ones and the help of attentive medical staff.

If we talk about foreign centers, then the most popular are Czech, Polish, German, Israeli clinics. Particular confidence in European and Israeli medical institutions is associated with the experience of foreign specialists and the availability of the necessary specialized equipment.

Within a year after the end of rehabilitation measures, you should be more careful, monitor your condition.

So, now let's move on to physical activity. Before we talk about exercises, here are some general guidelines:

1. Is not in a sitting position for a long time. Change position every 20 minutes.
2. If there is a desire to cross your legs during rest, then you should unlearn this habit, the most dangerous after hip arthroplasty.
3. Don't move abruptly.
4. Try to be constantly in motion - first in a passive way. Of course, try not to overdo it, but even minor movements are designed to tone the muscles as soon as possible.

Where to start? Waking up, you can start with the following exercise:

• starting position - lying on your back;
• very slowly understand and lower the feet, while not raising the legs;
• every movement is neat and thoughtful;
• perform for a couple of minutes, after 40 minutes repeat again.

Another exercise is similar, and it is also required to perform:

• starting position - lying down, better - sitting;
• gently and slowly rotate the foot clockwise and counterclockwise;
• during the day, repeat the exercise for a couple of minutes.

Having worked the feet, we move on to working out the larger muscles. For the first time after the operation, the exercise is performed only in the prone position: it is enough to strain the quadriceps muscle for 15 seconds, rest a little and strain again. About 10 repetitions at a time, and 4 repetitions per day can be performed.

Next, you need to proceed to flexion and extension of the knee, while it is extremely important to remember that an angle of less than 90 degrees should be obtained, as we mentioned above. Starting position - lying on your back. Raise slowly and carefully. The foot is in contact with the support. Repeat several times. Rise - no more than fifteen. Important: the foot should slide easily on the support.

Of course, in the early days, such exercises can be difficult for the operated person. If painful sensations bring tangible discomfort, then the specialist will recommend postponing the set of exercises for several days.

Another exercise that does not require active action, and is ideal for the first recovery stage, is the buttock contraction. Starting position - lying down. It is necessary to tighten the muscles for a few seconds. Repeat 7-8 times. Gradually, the duration of the voltage increases, but you should not force it. When difficulties arise - it is not possible to strain the muscles in isolation, you can raise the pelvis during the exercise, but not much.

Next, move on to hip abduction. Perform the exercise very carefully and carefully. Starting position - lying down. The leg is retracted slowly. Do not start on the operated side. Do 5-10 leads, repeat 3 times, and that will be enough. For greater stability, slightly bend the other leg at the knee. Strongly lift should not be.

The next mandatory exercise is lifting the straightened leg. Starting position - lying down again. While lifting the leg, strain the calves. It should not be raised high - a few centimeters are enough. Then - slowly lower, in no case do not throw. Repeat 5-15 times, then more. And hold the leg in a raised position for a few seconds, then also increase the duration.

The performance of each exercise will be monitored by a specialist, correct if there are performance errors. At this stage, classes are mainly held in a lying position, but soon the operated person will be able to start walking, swimming, exercising on simulators, etc.

Even if the patient was discharged a week later, it does not mean at all that the rehabilitation is over.

It is extremely important to seek qualified medical assistance in a timely manner, not to postpone the operation, not to rely on ineffective methods of treatment, especially on the methods of the so-called. folk medicine. If you had experienced discomfort for a long time before the operation, limped heavily, then it will be harder to recover.

Important: no matter how long and difficult the recovery process is, with the proper approach, it will certainly give brilliant results. All this - provided that the doctor's instructions are followed and the operated person is set up for productive work.

The full functioning of the endoprosthesis, getting rid of lameness and discomfort, eliminating pain, returning to normal life, reducing the risk of complications - all this is achieved due to the well-coordinated work of the endoprosthesis and its own muscle structures.

Having noted good results, rehabilitation measures should not be stopped. On the contrary, it is necessary to continue to engage in physical education, and regularly.

It would seem that arthroplasty in itself solves all the problems of the patient, however, refusing to work with a rehabilitation specialist, you can harm yourself and extend the recovery time. It is categorically not recommended to draw up a training program on your own, engage in simulators, determine the intensity of loads and the duration of classes. So operated will significantly increase the likelihood of re-operation!

The essence of restorative measures

Although joint arthroplasty is a complex operation that requires high skill of specialists, the operated person also plays a significant role in the end result. Much depends on motivation, the desire to return to normal life as soon as possible and restore the previous functionality as much as possible.

The essence of the restoration measures is as follows:

1. Speed ​​up the regeneration process.
2. Reduce the degree of puffiness.
3. Strengthening of the muscular corset.
4. Restoration of habitual motor activity.

Important! If the choice fell on rest and recovery in a sanatorium, then when choosing a direction, one should take into account the specifics of concomitant diseases. So, if there are aggravating somatic diseases - cardiovascular, for example, or dysmetabolic (common diabetes mellitus), etc., then an individual, flexible approach is needed to draw up a plan of medical procedures in a sanatorium.

If there are no contraindications, then physiotherapy courses are quite useful - balneotherapy, laser therapy. You can connect the mud treatment.

When the operated person has recovered from the operation and returned to his usual life, he should in no case stop engaging in active physical activity. Even if we are talking about older people, you should connect a feasible load - Nordic walking, for example.

Gymnastic exercises in the system, regular, albeit short, walks are not additional measures, but key ones. They allow you to keep the joints and muscles in an acceptable condition.

early recovery

In the most difficult period, when the operation has just passed and the operated person is adapting to a new life with an endoprosthesis, one should not give up, do not relax, strictly follow the doctor's recommendations. Do not be afraid to move on your own, but consider the instructions of a specialist - how to sit, move correctly.

The restrictions that the patient faces in the first days should not be demoralizing - they will soon be gone. So, already three days after the operation, you can roll over on your side and even sit down.

What not to do during the early recovery phase:

• squat down;
• cross your legs;
• get on your knees.

In addition, the most conscious control of all movements is necessary, not only during passive exercises, but also during normal movements. You should not take large steps, sudden movements.

It should be remembered that crossing the legs and bending the knees is prohibited. Use a special pillow that is fixed between the legs. So, it will help prevent injury due to improper positioning of the joint and relax. The pillow is fixed so that the patient can roll over with it, but at this stage - only on the healthy side.

Although movements should be as careful and thoughtful as possible, complete immobility should be avoided, and even more so - be afraid to move. The latter also leads to negative consequences.

After a few days, they begin feasible exercises, which is necessary to improve blood circulation, faster recovery, and relieve swelling. The program involves regular classes, is necessarily compiled by a specialist on an individual basis. In general, it may suggest the following:

1. Wiggle your fingers.
2. Move your feet in different directions, including performing “circles”.
3. Slow bending of the legs at the knees (remember the right angle!).
4. Take your legs to the sides, raise your legs.
5. Tighten and relax the buttocks, quadriceps muscles of the legs.

The repetition rate is determined individually. The result of training is a little fatigue. If pain occurs, stop exercising. As noted above, passive exercises in the first days are performed lying on your back, after a few days you can perform them sitting.

How long the rehabilitation will last after the replacement of the hip joint, only the attending physician will say, based on the condition of the operated person.

late rehabilitation

After a few weeks, daily activities become more difficult, become longer. You can connect exercises with an exercise bike. Each workout lasts at least fifteen minutes, but if fatigue sets in earlier, you should not engage in self-exhaustion. The result of training is a slight, pleasant fatigue.

The result of rehabilitation activities should be the acquisition of the following skills:

• the ability to sit on a high chair;
• independent descent and ascent of the stairs;
• confident use of crutches.

Further, the duration of daily activities, as well as walking, gradually increases. Physical therapy sessions at this stage last on average about 40 minutes. As for walking, one should gradually increase independent walking from the shortest possible time to half an hour.

Also, do not forget about a balanced diet, which we will discuss in detail below. In addition, a specialist can prescribe courses of drugs that help strengthen joint tissues and faster recovery.

Finish line - remote rehabilitation

Now that all the hard work is over, the patient who has undergone arthroplasty should return to their usual way of life. The load on the joints and muscles also increases gradually, first walking with a stick is absolutely necessary.

Do not forget about daily physical education. We repeat, all rehabilitation measures are compiled together with a specialist, taking into account every nuance. Of course, at a late recovery stage, you should not test your capabilities by exposing the body, joints in particular, to a high load.

Rehabilitation after hip replacement surgery involves the following exercises for every day:

1. Equipment - rubber harness. With its help, straight legs are abducted to the side and back.
2. Equipment - step platform. Ascents and descents, while the amplitude gradually increases.
3. Starting position - lying down. Flexion and extension of the legs.
4. Starting position - lying down. Raising the body, turning left and right.

When it comes to exercise equipment, an exercise bike is perfect. It is advisable to use a simulator with low pedals - the legs should not rise high.

A treadmill is also good for developing joints, but you need to use it in walking mode.

To reduce stiffness, make joints more mobile, pay attention to simulators with special rollers.

As noted above, you should do it exclusively under the guidance of a trainer who specializes specifically in recovery gymnastics!

The rehabilitation period after hip replacement can last more than a year - in some cases, you need to be patient.

How to organize your diet

Without rational nutrition, there is no rational treatment. Nutrition is the “background” against which other healing factors are applied. Designing a suitable diet is an important part of rehabilitation measures.

During the recovery period after hip replacement, the majority of those operated on are shown a balanced diet that takes into account individual characteristics. Thus, it is desirable for overweight people to switch to a diet with a lower energy value: excess body weight is a factor that “delays” the recovery process. The patient must understand that excess weight is a serious burden on the joints.

Therapeutic nutrition does not imply fasting. On the contrary, a constant half-starved state has nothing to do with a therapeutic diet. Even unwanted foods can be consumed, but in very small quantities. Unwanted foods and dishes include:

• smoked meats;
• sausages;
• conservation;
• roast;
• drinks containing a large amount of sugar, as well as all kinds of sweets and starchy foods.

As for meat, fatty varieties are replaced by lean ones, cooked by stewing, baking, etc.

Important: do not completely exclude, for example, fats or carbohydrates. The body must receive all the necessary nutrients. So, with a deficiency of fat, some vitamins are not absorbed. Balance and consideration of individual needs is the main criterion in the selection of a diet.

Every day, the diet should include broths, whole grains, vegetables and fruits, bran bread. Do not forget about dairy products - cottage cheese, kefir.

The daily diet is divided into 5 meals. To keep the feeling of satiety longer (which is important for losing weight), include mashed soups in the diet, as well as foods rich in fiber. For snacks, dried fruits, yogurts, cereal snacks are suitable.

Weight must be controlled: control weighings are carried out every month. Rehabilitation after hip replacement is a mandatory set of measures for the fastest restoration of mobility, elimination of swelling and reduction of the risk of complications. To return to physical activity as soon as possible, you should approach the recovery in a comprehensive manner, be persistent and follow all the recommendations of your doctor. Be healthy!