The Hip Joint

Physiotherapy for Your New Hip

You will wake up from the anaesthetic with a tube draining your operated hip joint and a pillow between your legs.

Post-operative treatments following total hip replacement.

After a general anaesthetic, it is necessary to do regular deep breathing and coughing exercises to ensure that any phlegm secretions remaining in your lungs and airways are cleared.

Foot and Ankle Exercises

In order to reduce the risk of clots forming in the deep veins of your calf, it is necessary to both wriggle your toes and do full range ankle movements such as pulling your toes up towards your nose and then pointing them towards the floor. Both the toe and ankle exercises should be done 5 minutes every hour during the daytime while you are awake.

Knee Exercises

While you are resting in bed, tense and straighten your knees (of both the operated and non-operated legs). If you are doing the exercise correctly, your heels will raise off the bed when your knees are tensed. If you do this exercise first on the non-operated side, where there is no pain, it should make it easier to start up the exercise with your operated leg. Tense your knees while slowly counting to 5 (in other words, for five full seconds). In that five seconds, keep on trying to tighten the knees even more. Do this whenever you can as it will strengthen your muscles. It is best to build up and release the tension in your knees slowly and in a controlled manner. Doing it too quickly is poor technique.

Active Hip and Knee Bending and Straightening

For the first few days after surgery, these exercises are done with the assistance of a qualified physiotherapist. These exercises should be done every hour.

Keeping the kneecaps facing straight up to the ceiling, and the knees straight, move your leg out to the side and back. Your non-operated leg can move as far as you like and should not need assistance. However, your therapist will support the leg on your operated side at the knee and ankle. This movement does not have to be over a large range. Caution: the leg must not roll inwards so that the kneecap is facing the other leg. This could cause the hip to dislocate.

Getting Out of Bed

You will need assistance with getting out of bed for the first few times. To avoid dislocation, always get out of bed on your non-affected side and get into bed on your affected side. For example, if your right hip had the surgery, get out on the left side of your bed and then get into the right side of your bed.

As you slide out of bed, be careful not to bend too far forwards or to twist at the waist towards your operated leg. It is also very important that you don't cross your legs (left over right or right over left). Any of these movements can cause your hip to dislocate.

Depending on the type of artificial hip that you have, you may be allowed to put full weight on it immediately after surgery or you may only be allowed to partially load it that soon. For this reason, and for reasons of comfort, you will be given a walking frame when you begin to walk. Because you can lean on this frame you should not need to limp. If the muscles feel stiff and sore when standing on your operated side, you simply lean harder on the frame to decrease the leg discomfort. This makes it easier to step through with the other leg slowly and in a controlled fashion. Step timing should be equal as should be step length.

Make it a habit to walk without a limp. If you start limping at the outset, you may never be able to free yourself of that bad habit. Also, limping deprives the operated leg muscles of the opportunity for proper rehabilitation. Therefore, if you find that you limp while walking without an aid you should immediately correct this by getting a walking aid.

If your walking aid is a single stick, it goes in the opposite hand to the operated side so you can put your weight on the stick when standing on the operated leg to step through with the other leg. This gives you a wider base and prevents you from leaning onto your affected side. As you regain your strength, your goal will be to re-establish a good walking pattern so that the stick, crutches, and walking frame can be abandoned.

Going Up Stairs

Your first post-operative attempt at stairs should always be done with the help of your physiotherapist.

Firstly, lead with your non-operated leg going up. If you feel the need, you can use a stick, crutches, or hold onto a rail for support but always keep your stick on the same level as your operated leg. The operated leg then follows to stand alongside the non-operated leg.

Going Down Stairs

Firstly, put the walking aid(s) on the lower stair and lean on it. Keep leaning on the stick as you put your operated leg on that stair. Your other leg follows through to stand alongside the operated leg.

Exercise is important in rehabilitation after hip replacement surgery but it must be gentle. There is evidence that hip weakness persists up to two years after surgery even with a normal walking pattern. Many studies have shown that leg weakness is a major risk factor for falls in older persons.

Value of Exercise

Hip joint weakness persists for up to two years after surgery, even for people with a normal walking pattern. Many studies have shown that weakness is a major risk factor for falls in older persons. To counteract such problems, gentle exercise is important in rehabilitation after hip replacement surgery. Hydrotherapy (exercise in a pool against the resistance of water) is a good example of gentle exercise that can help to improve muscle tone and strength of the hip region.