5 Top Tips For Hip Replacement Recovery

5-top-tips-for-hip-replacement-recovery

Modern hip replacement is a common procedure with great outcomes for the majority of people. This doesn’t mean you should treat the hip replacement recovery process as a walk in the park. Spending much of my week working as a physiotherapist with patients recovering from hip surgery, I am often tasked with helping people who are having difficulties with rehabilitation.

These problems most commonly arise around 4-12 weeks after total hip replacement surgery. In this blog, I'll be sharing my 5 top tips for hip replacement recovery after surgery - tips that will help you avoid those annoying hiccups in your post-operative recovery.

#1. Don't hurry off your crutches after a total hip replacement!

Early in my physiotherapy career, we were taught to wean patients off crutches as soon as possible, to decrease the dependency on mobility aids.  So often in clinic, I would see people getting off their crutches after hip replacement as early as 2-3 weeks post operatively.

There is a difference between being able to take weight without crutches and walking well. Most people can take weight on the operated leg within 2-3 weeks comfortably but it’s an entirely different story if you are trying to do more than 20+ steps with good effective gait. 

Think of crutches as a mobility aid - how much 'aid' you need after surgery will reduce over time. The way you use crutches will therefore change as the weeks progress after your operation.

Early after hip replacement surgery, you will be using two crutches to reduce the amount of weight you are taking through the leg, allowing you to still step through and walk with a normal, albeit heavily assisted gait.

As the weeks progress and your leg gets stronger, you can gradually reduce down to one crutch with lessening pressure or weight transferred through the hand to the crutch.

The priority after hip replacement surgery is to learn to walk with a good gait pattern again. Many people have not been walking well for a while prior to surgery, dropping down on their hip, swaying their body side to side. This is usually due to muscle weakness, fatigue and/or trying to avoid pain.

(Quick note - there is much that can be done for those with hip osteoarthritis prior to surgery. The better prepared your body is before surgery, you are likely to recover more quickly, so come in and see us for some hip physiotherapy for hip osteoarthritis. Don't just wait around for surgery!)

The goal of the crutch is to assist with achieving an optimal gait pattern -  keeping the trunk upright with good pelvic control and minimising stiff legged walking (swinging the stiff leg out to the side).

Achieving a good walking pattern is not just about looking after that new hip, but also your back, your knee ... other parts of your body that can be aggravated by compensatory movement patterns. So, don't hurry off those crutches after your hip replacement!

don't-hurry-off-your-crutches-after-a-total-hip-replacement
don't-hurry-off-your-crutches-after-a-hip-replacement

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#2. Don't start intense exercise too early after a total hip replacement

Even though you now have a 'new hip', there is still much soft-tissue recovery that needs to happen. The hip capsule and muscles and tendons around the hip may have been cut or stretched to allowed access to the deep joint, and then repaired. They need some healing time - this doesn't mean lying in bed all day! But loading needs to be gradual and the healing time respected.

It's also important to remember that even before surgery reducing activity levels due to pain and stiffness, usually mean that your muscles and tendons will have had a bit of 'holiday'. There will not be ready to jump straight into harder exercise or activity straight after surgery - we need to give them time to recover from the effects of the osteoarthritis, as well as the surgery. 

Consider your levers when exercising after hip replacement

As physiotherapists, we are always considering 'levers' and the impact on forces put across a painful or healing area. A long lever is where there is weight further away from where the movement is occurring, and a short lever is where the weight is closer to that point.

So, for actions around the hip, a long lever exercise refers to lifting a 'long leg' i.e., a leg with a straight knee. Conversely, a short lever exercise would involve lifting the leg with a bent knee, so the weight is kept closer to the hip, reducing load on the hip muscles (It's just physics! :).

Lifting a straight leg in an open-chain (foot off the ground) exercise is a much harder exercise. This means that if the muscles around the hip are weak (which they generally are in people undergoing hip replacement surgery), you will tend to over-utilise your multi-joint thigh muscles that cross the knee and the hip. These muscles, including Tensor Fascia Lata (TFL), Sartorius and Rectus Femoris should usually be your secondary helpers for hip movement.

If we want to avoid overload, and focus specifically on encouraging recovery of the local hip muscles (muscles that cross just the hip joint), it's usually better to start with shorter lever exercises.

For example, standing leaning forward on a table and lifting the leg forward with the knee staying bent, is an exercise we would recommend over a straight leg raise (lying on your back lifting a straight leg).

Keep your foot to the ground for gluteal exercise

Gluteal muscles are 'anti-gravity' muscles - they help move and hold you up against gravity when your foot is on the ground. This is their natural function and research has shown that closed-chain (foot on the ground) exercise is best for activating and applying graduated force specifically across these muscles for strengthening.

There is also a randomised controlled research trial that showed that functional performance after total hip replacement was better in those that did weightbearing exercise compared to those who did non-weightbearing exercise.

Working your glutes with your foot off the ground - lifting to the side or to the back, will work the hip muscles, but potentially not as effectively as when your foot is on the ground.  These foot-off-the-ground exercises are generally also long-lever exercises that use a lot of thigh muscles.

Instead of 'flapping your leg' to the side or back, we recommend you do exercises with your foot on the ground or bed, to better stimulate the gluteal muscles e.g., small squats and bridging - lifting your bottom off the bed a small way with the knees bent and pushing through the feet.

In weightbearing exercises, we can also work to regain your ability to control your pelvic and trunk position dynamically - something that tends to be reduced in those with hip osteoarthritis.

Stay away from those 'clams'!

Ever done or heard of the 'clam' or 'clamshell' exercise? This is a commonly prescribed exercise for gluteal strengthening (although weightbearing exercises again will usually be much more effective).

After hip replacement, particularly an anterior approach hip replacement (scar at the front), the exercise can be very provocative for the healing tissues.  We would recommend you put the clam aside, or focus on weightbearing or closed-chain exercise.

Focus on improving control around the hip and pelvis under weightbearing load. Try:

  • double leg squat with a hinge bias (fold at the hip),
  • offset squat (weight on front leg more than back - see the graphic),
  • standing on one leg with focus on pelvic control.

You can progress the squat based exercise as control and strength improves with weights into goblet squats, goblet offset squats, rear foot elevated split squat.

We recommend that you progress through your program under the guidance of an experienced hip physiotherapist, to ensure your technique is good and that your recovery is as smooth as possible.

don't-start-intense-exercise-too-early-after-a-total-hip-replacement
don't-start-intense-exercise-too-early-after-a-hip-replacement

#3. Don't forget rest, hydration and nutrition after a total hip replacement

Sleep, Hydration, Nutrition and Exercise is what I always tell my patients to prioritise after their hip replacement surgery. Why is sleep number 1 on the list? It is because that is one of the only situations in which your body can shut most other functions down, so it can focus on healing around your newly replaced hip.

Ensuring you drink enough fluids will assist in ensuring your circulatory system is functioning well.

High quality nutrition is important to provide the energy required to heal the body.

Then once you have satisfied all of the first 3, then exercise will assist with getting your hip stronger to enable you to better take weight and return to lower limb activity. 

don't-forget-rest-hydration-and-nutrition-after-a-total-hip-replacement
don't-forget-rest-hydration-and-nutrition-after-a-hip-replacement

Planning for a Hip Replacement? On your hip replacement recovery journey?

Don't do it alone! Book today, and let one of our Brisbane Hip Physios help guide you through your entire hip replacement journey, ensuring you are prepared - pre-surgery, and that you make a full recovery - post-surgery.

#4. Don't return to work too soon after a total hip replacement

More and more, we are seeing younger people undergo hip replacement surgery, because of the advanced prosthetic materials and techniques that are now available. Many people are having hip replacments well prior to retirement. So when is a good time to return to work after a hip replacement?

One of the common things I see are office workers returning to work within a month of total hip replacement. The thought comes from the fact that they feel they are sedentary in their job roles. What they don’t consider is the cognitive component of being at work 8hrs per day. This leaves them completely exhausted by the end of their work day.

The body is in deep energy debt after surgery, especially after something as major as a hip replacement, so every bit of energy is prioritised towards healing around the new hip. Many people then find that this fatigue makes it much harder than they thought to return to work after a few weeks.

Some people also find they might get uncomfortable sitting for long hours this soon after surgery, and have underestimated the difficulty and energy required to negotiate public transport, stairs, ramps and even moving around the workplace, manoeuvering around public toilets etc. The other consideration about an early return to work is: when does the rehab happen?

It's so important to ensure you assign adequate time for your rehab for optimal hip replacement recovery. Even if you think you'll just do your rehab programme after work, most people are so exhausted after the day's work, they have little juice left in the tank for their exercise.

If there are time pressures to return to work shortly after hip replacement, then I would suggest a part-time graduated return and work-from-home setup, if that's possible with your workplace. This will allow you to gradually build up your tolerance to the additional energy usage and also pace yourself for fatigue management.

don't-return-to-work-immediately-after-a-total-hip-replacement
don't-return-to-work-immediately-after-a-hip-replacement

#5. Don't rush into stretching your hips after a total hip replacement

To perform any type of hip replacement surgery, the hip capsule (the strong fibrous capsule around the hip joint) needs to be opened, to take out the old hip and replace it with the new one. Sometimes some muscles are also released. Surgical repair of the soft tissues occurs at the end of surgery, but healing of these tissues can take 3-4 months.

Early overstretching of the joint may stretch or damage the surgical repair and even end in dislocation of the new hip - something that is definitely best avoided!

There are a few subtleties with the different surgical approaches in total hip replacement surgery. Anterior approach hip replacement is generally deemed as the more dislocation-resistant approach, as there is less impact on the muscles.

Posterior approach hip replacement may present with more dislocation risk, as the deep rotator muscles at the back of the hip have been surgically released and then repaired. 

The general rule of thumb I have for my patients is not to stretch the front of the hip (forcing the leg into hip extension beyond the body) for anterior approach surgeries, or the back of the hip (hamstring/gluteals stretches) for posterior approach surgeries, in the first 3 months after surgery.

It is ok to be moving into the range transiently, when getting into and out of a position, but sustained stretches are best minimised in the first 3 months. This will allow adequate time for the underlying capsule that was cut and repaired to heal adequately Long term, this will ensure you have a secure capsule around your brand new hip joint.

These thoughts may be considered conservative by some, but I feel that any joint will function well in the early years but being mindful of your capsular integrity, together with undertaking adequate strengthening of the hip specific musculature is crucial for long term good functioning of your new hip.

don't-rush-into-stretching-your-hips-after-a-total-hip-replacement
don't-rush-into-stretching-your-hips-after-a-hip-replacement

I hope these tips have been helpful in guiding you through your total hip replacement recovery, but as always, consult with your physiotherapist to clarify if these pointers are applicable for your situation.

At PhysioTec our Physios have been trained by world-leading hip expert, Dr. Alison Grimaldi herself, and are able to guide you through your pre and post hip replacement journey.

Undergoing a hip replacement is a significant step, and it's important that you are prepared. Preparation plays a vital role in facilitating a smoother process and ensuring a successful recovery after surgery, as you will be better equipped to handle post-surgery rehabilitation. At PhysioTec, our team of hip physiotherapists is here to offer you the assistance and support you need throughout your hip replacement journey.

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Eric-Huang-Physio-at-Physiotec-Tarragindi-Brisbane

Author

This blog was written by Eric Huang, one of our sports, strength & conditioning, and cycling physiotherapists. Eric is also highly experienced in the management of hip conditions. He has been providing high-quality services at PhysioTec for over a decade. You can read more about Eric here.

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Hip Replacements can have a large impact on your life, and may involve many months of rehabilitation. At PhysioTec, our experienced hip physios can be by your side every step of the way, providing you with all the support you need to make a full recovery.

If you would like to book with one of our experienced Brisbane Hip Physios, please call, email or book online below:

Phone: (07) 3342 4284

Email: reception@physiotec.com.au