Hip Replacement Rehabilitation
The Hip
Replacement Rehabilitation protocols
mentioned here for are general and should be tailored to specific patients. For
example, weight bearing should be limited to toe touch in osteotomy of the femur.
Expansion osteotomies allow the insertion of a larger prosthesis, and reduction
osteotomies allow narrowing of the proximal femur normally. In patients with
these osteotomies, weight-bearing should be delayed until some union is
present. These patients should avoid SLR (straight leg raise) and
side-leg-lifting until, surgeon agrees that it is safe to do so.
Treatment
may also have to be adjusted according to difficulty of initial
fixation. In revision surgery, a stable press-fit acetabular component may
be difficult to achieve and multiple-screw fixation may be required. Caution
should be exercised in rehabilitation in these circumstanses.
Hip Replacement Rehabilitation might
also have to be adjusted because of stability. Abduction brace may
be used to prevent adduction and flexion of more than 80 degrees for upto 6 months
in case of recurrent dislocations. Similarly, leg shortening through a hip at
the time of revision with or without a constrained socket should be protected
with an abduction brace until the soft tissues tighten up.
Hip Replacement
Rehabilitation Protocol- Posterior Approach
Goals of Hip
Replacement Rehabilitation
- Guard against dislocation of the implant.
- Obtain pain free range of motion within safe
limits.
- Gain functional strength.
- Strengthen hip and knee musculature.
- Teach transfers and ambulation independently or
with assistive devices.
- Prevent bedrest hazards (eg. pneumonia, decubitus
ulcer, pulmonary embolism, thrombophlebitis).
Rehabilitation
Considerations in Cemented and Cementless Techniques
In cemented total hip Weight
Bearing To Tolerance (WBTT) with walker should be started
immediately after surgery.
Preoperative Instructions
- Instruct
on precautions for hip dislocation (mentioned later).
- Provide
instructions for transfers in and out of bed and chair.
- Avoid
deep chairs. Also instruct the patient to look at the ceiling as they sit
down to minimize trunk flexion.
- Avoid
crossing legs while sitting.
- While
rising from a chair scoot to the edge of the chair and then rise.
- Use
elevated commode seat. Elevated seat is placed on commode at a slant, with
higher part at the back, to aid in rising.
- For
ambulation instruct on use of anticipated assistive device.
Postoperative Hip
Replacement Rehabilitation Regimen
Patient should be made to come out of
bed in stroke chair twice a day with assistance within
1 or 2 days postoperatively. Chair should not be of low height. Begin
ambulation with assistive device (walker) twice a day.
Weight bearing
recommendations in Hip Replacement Rehabilitation
Cemented Prosthesis:
Weight bearing as tolerated with walker for at least 6 weeks, then use cane in
the contra-lateral hand for 4-6 months.
Cementless Prosthesis:
Touch down weight bearing with walker for 6-8 weeks, then use a cane in
contra-lateral hand for 6 months. Wheelchair must be used for long distances
with careful avoidance of excessive hip flexion greater than 80 degrees while
in wheelchair, this can be achieved by placing a cushion in the wheelchair seat
with highest cushion point posterior.
Isometric and bed
Exercises (Hip Replacement Rehabilitation)
- Straight Leg Raise (SLR)-
Tighten knee and lift leg off the bed, keeping the knee straight. Flex the
opposite knee to aid this exercise.
- Ankle Pumps- Pump
ankle up and down repeatedly.
- Quadriceps Sets-
Tighten quadriceps muscles
by pushing knee down and holding for a count of 5.
- Gluteal Sets-
Squeeze buttocks together
and hold for a count of 5.
- Isometric hip abduction with
self resistance while lying.
- Hip abduction adduction-
(Prevent initially if patient had a trochanteric osteotomy). While lying
on the back patient can slide the leg to the side. In standing this can be
done by moving the leg out to the side and back. Perform this exercise
while lying on one side (5-6 weeks postoperatively). The patient should be
turned 30 degree towards prone to utilize gluteus maximus and medius
muscles. Most patients would otherwise tend to rotate towards the supine
position, thus abducting with the tensor fascia femoris.
ROM and Stretching
Exercises (Hip Replacement Rehabilitation)
- 1 to 2 days postoperative, begin Thomas
stretch to avoid flexion contracture of the hip. Pull the
uninvolved leg to the chest while lying supine on the bed. At the same
time, push the involved leg against the bed. This stretches the anterior
capsule and the hip flexors of the involved leg. Perform this stretch 5
times per session, 5-6 times a day.
- Patient may start with exercising on stationary
bicycle depending on trunk stability with a high seat 4-7 day
postoperative. Until successful completion of a full arc on the bicycle,
the seat should be set as high as possible. The seat may be progressively
lowered to increase hip flexion within safe parameters.
- Perform extension stretching of the anterior
capsule in standing by extending the involved leg while the uninvolved leg
is mildly flexed at the hip and knee, supported by the walker. Slowly
thrust the pelvis forward and the shoulders backward for a sustained
stretch of the anterior capsule.
Abduction Pillow
Keep an abduction pillow between the
legs while in bed. Use the abductor pillow while asleep or resting in bed for
5-6 weeks, it may then be safely discontinued.
Bathroom Rehabilitation
Permit bathroom privileges with
assistance and an elevated commode seat. Teach bathroom transfers when the
patient is ambulating 10-20 feet outside of room. Always use elevated commode
seats.
Assistive devices used
in Hip Replacement Rehabilitation
Use "reacher" or "grabber"
to help retrieve objects on the floor. Do not bend to put on slippers. Shoe
horn and loosely fittings shoes or loafers.
Transfer Guidances
- Bed to Chair- Avoid
leaning forward to get out of chair or off bed. Slide hips forward to the
edge of the chair first, then come to standing. Do not cross legs when
pivoting from supine to bedside position. Therapist or
nurse assists until able to perform safe, secure transfers.
- Bathroom- Use elevated
toilet seat with assistance. Continue assistance until able to perform
safe, secure transfers.
Transfer to Home
- Instruct patient to travel in the back seat of
four door sedan, sitting or reclining lengthwise across the seat, leaning
on one or two pillows under the head and shoulders to
avoid sitting in a deep seat.
- Avoid sitting with hip flexed more than 90
degrees to prevent posterior dislocation.
- Urge those without a four-door sedan to sit on
two pillows with the seat reclined.
- May begin driving 6 weeks postoperative, when
agreed by the surgeon.
Stair training in Hip
Replacement Rehabilitation
- Going up stairs-
Step up first with the uninvolved leg, keeping crutches on the step below until both
feets are on the step above, then bring both crutches up on the step. If
available hold the handrail.
- Going down stairs-
Place crutches on the step below, then step down with the involved leg,
and then with the uninvolved leg. If possible, hold the rail.
Exercise Progression in
Hip Replacement Rehabilitation
- At 5-6 week, begin standing hip
abduction exercises with pulleys, sports cords or weights.
Also may perform side stepping with a sports cord
around the hips, as well as lateral step ups with a low step, if
clinically safe. Progress hip abduction exercises until the patient
exhibits a normal gait with good abductor strength.
- Perform prone lying extension exercises of the
hip to strengthen the gluteus maximus. These may be performed with the knee
flexed (to isolate the hamstrings and gluteus maximus) and with the knee
extended to strengthen the hamstrings and gluteus maximus.
- Initiate general strengthening exercises,
develop endurance and perform cardiovascular
exercises.
Instructions for Home
in Hip Replacement Rehabilitation
- Continue with the previous exercises and
ambulation activities. Continue to observe precautions.
- Install elevated toilet seat at home.
- Supply walker for home.
- Review rehab specific for home situation, like-
steps, stairways, narrow doorways.
- Ensure home
physical therapy has been arranged.
- Avoid driving for minimum 6 weeks.
- Patient should have prescription of
prophylactic antibiotics that may be needed eventually for dental or
urologic procedures.
Managing Problems After
Total Hip Replacement
1-Trendelenburg Gait (weak
hip abductors)
- Concentrate on hip abduction exercises to
strengthen abductors.
- Evaluate leg-length discrepancy.
- Make the patient stand on involved leg with
flexed opposite knee. If opposite hip drops, have patient try to lift and
hold in an effort to reeducate and work gluteus medius muscle.
2- Flexion Contracture of the Hip
- Avoid placing pillow under the knee after
surgery.
- Walking backward helps stretch flexion
contracture. Perform Thomas Stretch 30 times a days.
The above mention Hip Replacement
Rehabilitation Protocol should be tailored to individual patients need and
performed in guidance of a physical therapist.
Precautions After Total
Hip Replacement
Following points must be explained
clearly during Hip Replacement Rehabilitation. AVOID
- Crossing your legs or bringing them
together(adduction).
- Bringing the knee too close to your chest-
extreme hip flexion ( you can bend until your hand gets to your knee).
- Turning the foot in toward the other leg
(internal rotation).
Thanks for sharing nice information about toilet seat cushion stepper commode wheelchair with us. i glad to read this post.
উত্তরমুছুনThanks for sharing. INPATIENT SERVICES
উত্তরমুছুনPALLIATIVE CARE SERVICES