A post-operative guide (Hip)

A post-operative guide (Hip) – Dr. Rahul Damle

Early Postoperative Exercises

These exercises are important for increasing circulation to your legs and feet to prevent bloodclots. They also are important to strengthen muscles and to improve your hip movement.

Ankle Pumps – Slowly push your foot up and down. Do this exercise severaltimes as often as every 5 or 10 minutes. This exercise can begin immediatelyafter surgery and continue until you are fully recovered.

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Ankle Rotations -Move your ankle inward toward your other foot and thenoutward away from your other foot. Repeat 5 times in each direction 3 or 4 times a day.

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Activity

Some patients experience back discomfort after surgery. This is caused by the generalsoreness of the hip area and partly by the prolonged lack of movement required before,during, and after surgery. Periodic change of position helps to relieve discomfort andprevents skin breakdown.

The head of your hospital bed should not be elevated more than 50 degrees during the firstfew days after surgery. Sitting up may allow the artificial ball to dislocate from the hipsocket.

There will be some precautions, mostly to prevent dislocation, which is more likely to occurthe first six to eight weeks after surgery. These precautions include:

Using 2-3 pillows between your legs and not crossing your legs

  • Not bending forward 90 degrees
  • Using a high-rise toilet seat

Initial rehabilitation

In the first few days after surgery, you will be assisted to a reclining chair, and physical therapy may begin. You will gradually begin to take steps, walk, and learn to climb stairs with the aid of a walker or crutches.

This initial rehabilitation generally takes 10 – 14 days. During this time, discomfort may be experienced while walking and exercising. Pain medication will be ordered by the doctor as needed. Most patients are relieved of their painful pre-surgical hip condition.

Therapy and rehabilitation program

Following surgery, you will work to become independent and doing exercises to improve the range of motion and strength of your hip. You will be instructed to meet your needs.

Do the home exercises two to three times a day (see home exercises section). Do your exercises indefinitely. Walking is not a substitute for exercise. If an exercise is causing pain that is lasting, reduce your intensity. If it continues to cause pain, contact your doctor.

Home Exercises

Here is a list of potential exercises you may be asked to complete. These exercises are sometimes done before surgery to help maintain the strength and range of motion of your hip.

Active Internal and External Rotation:
Begin with your legs straight and a comfortable distance apart. Roll your legs inward so that your kneecaps are facing each other. Hold for 5 seconds. Roll your legs outward and hold for 5 seconds. Progress to 20 repetitions, 3 times per day.

Range of motion exercises
Active hip and knee flexion :
Lying on your back with legs straight, toes pointed toward the ceiling; arms by your side. Keeping the heel in contact with the bed, bend your hip and knee. Return to starting position. Progress to 20 repetitions, 2 times a day.

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Active Internal and External Rotation:
Begin with your legs straight and a comfortable distance apart. Roll your legs inward so that your kneecaps are facing each other. Hold for 5 seconds. Roll your legs outward and hold for 5 seconds. Progress to 20 repetitions, 3 times per day.

Active Abduction :
Place a smooth surface (card table, plywood sheet, etc.) under your legs. Begin with your legs together, then spread them apart as far as you can. Hold them apart for 5 seconds. Return to the starting position. Progress to 20 repetitions, 3 times a day.

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Strengthening Exercises
Quadriceps Setting :
Tighten the muscles on the top of your thigh. At the same time push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds. Progress to 20 repetitions, 3 times a day.

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Gluteal Setting :
Lie either on your back with your legs straight and in contact with the bed. Tighten your buttocks in a pinching manner and hold the isometric contraction for 5 seconds, relax 5 seconds. Progress to 20 repetitions, 3 times a day.

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Hip Extension :
While lying on your stomach, raise one of your legs off the bed with the knee kept straight and the pelvis held in contact with the bed. Slowly lower the leg. Repeat 10 times. Avoid hyperextending the back. Repeat procedure for other leg. Progress to 10 repetitions each leg, 3 times a day.

Activities of Daily Living 
Do’s and Don’ts
Your new hip is designed to eliminate pain and increase function. There are certain movements that place undue stress on your new hip. For your safety, these should be avoided. This is especially true during the first few months after your surgery.
DO NOT move your operated hip toward your chest (flexion) or your operated leg towards the chest any more than a right angle. This is 90 degrees.

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DO NOT sit on chairs without arms.

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DO grasp chair arms to help you rise safely to standing position. Place extra pillow(s) or cushion(s) in your chair so that you do not bend your hip more than 90 degrees.

DO NOT get up like this. Keep your involved leg in front while getting up.

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DO use a chair with arms. Place your operated leg in front and your uninvolved leg well under.

DO NOT sit low on toilet or chair.

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DO get up from the toilet as directed by your therapist. Use the elevated toilet seat if we have given you one.

DO NOT pull blankets up like this.

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DO use a long-handled reacher to pull up sheets or blankets or do as directed by therapist.

DO NOT bend way over.

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DO NOT turn your knee cap inward when sitting, standing, or lying down.

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DO NOT try to put on your own shoes or stockings in the usual way. By doing this improperly you could bend or cross your operated leg too far.
DO these activities as directed by your therapist.

DO NOT cross your operated leg across the midline of your body (in toward your other leg).

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DO NOT lie without pillow between legs

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DO keep a pillow between your legs when you roll onto your “good” side. This is to keep your operated leg from crossing the midline.

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