The first days after surgery are the most important. Your body is weakened by the operation, you have not yet fully recovered from anesthesia, but in the first hours after waking up, try to remember more often about the operated leg and monitor its position. As a rule, immediately after surgery, the operated leg is placed in an abducted position. A special pillow is placed between the patient’s legs to ensure moderate separation. You need to remember that:
- In the first days after surgery, you should only sleep on your back.
- You can only turn on the “non-operated” side, and then no earlier than 3 days after the operation. Turning onto the healthy side must be performed very carefully, with the help of relatives or medical staff, constantly holding the operated leg in a state of abduction. To protect against dislocation, we recommend placing a special pillow between your legs.
- You can sleep on the “non-operated” side no earlier than 2 weeks after the operation,
- In the first days, large ranges of motion in the operated joint, sharp turns of the leg, and rotation in the hip joint should be avoided.
- When sitting in bed or visiting the toilet in the first days after surgery, you must strictly ensure that there is no excessive flexion in the operated joint (more than 90 degrees). When you sit on a chair, it should be high. A regular chair should be cushioned to increase its height. Low, soft seats should be avoided.
- After surgery, it is strictly forbidden to squat, sit cross-legged, or “cross” the operated leg over the other.
- Try to devote all your free time to physical therapy exercises.
The first goal of physical therapy is to improve blood circulation in the operated leg. This is very important to prevent blood stagnation, reduce swelling, and speed up the healing of the postoperative wound. The next important task of physical therapy is restoring muscle strength in the operated limb and restoring normal range of motion in the joints and support for the entire leg. Remember that in the operated joint the friction force is minimal. It is a hinge joint with ideal gliding, so all problems with limited range of motion in the joint are solved not through its passive development like rocking, but through active training of the muscles surrounding the joint.
In the first 2-3 weeks after surgery, physical therapy is performed while lying in bed. All exercises must be performed smoothly, slowly, avoiding sudden movements and excessive muscle tension. During physical therapy exercises, proper breathing is also of great importance - inhalation usually coincides with muscle tension, exhalation with muscle relaxation.
First day: the first exercise is for the calf muscles. Bend your feet toward and away from you with slight tension. The exercise should be performed with both legs for several minutes up to 5 times within an hour. You can start this exercise immediately after waking up from anesthesia.
The following exercises are added on the second day after surgery.
The second exercise is for the thigh muscles. Press the back of your knee joint into the bed and hold this tension for 5-6 seconds, then slowly relax.
The third exercise is to slide your foot along the surface of the bed, lift your thigh towards you, bending your leg at the hip and knee joints. Then slowly slide your leg back to the starting position. When performing this exercise, you can help yourself with a towel or elastic band at the beginning. Remember that the angle of flexion in the hip and knee joints should not exceed 120 degrees!
Fourth exercise - placing a small pillow (no higher than 10-12 centimeters) under your knee, try to slowly tense your thigh muscles and straighten your leg at the knee joint. Hold the straightened leg for 5-6 seconds, and then also slowly lower it to the starting position.
All of the above exercises must be done throughout the day for a few minutes 5-6 times per hour.
On the 2nd day after surgery, provided there are no complications, you can sit up in bed, leaning on your hands. On the third day, you need to start sitting up in bed, lowering your legs from the bed under the supervision of staff. This should be done towards the non-operated leg, gradually abducting the healthy leg and pulling the operated leg towards it. In this case, it is necessary to maintain a moderately apart position of the legs (use a special pillow). When moving the operated leg to the side, keep your body straight and make sure that there is no external rotation of the foot. No earlier than 4-5 days it is allowed to get up from the bed under the supervision of medical personnel. Sit on the edge of the bed, keeping your operated leg straight and in front. Slowly place both feet on the floor.
FIRST STEPS
The goal of this rehabilitation period is to learn how to get out of bed, stand, sit and walk so that you can do this safely yourself.
At this time, you still feel weak, so in the first days someone must help you, supporting you (you may feel slightly dizzy). Remember, the faster you get up, the faster you will begin to walk. The medical staff can only help you, but nothing more. Progress is entirely up to you. So, you should get out of bed in the direction of the non-operated leg. Sit on the edge of the bed, keeping your operated leg straight and in front. Before standing up, check that the floor is not slippery and that there are no rugs on it! Place both feet on the floor. Using crutches and your non-operated leg, try to stand up. Caring relatives or medical staff should help you in the first days. Using your healthy leg, move your two crutches forward. Then bring the operated leg to the level of the crutches, slightly bending it in all joints. Leaning on the crutches and transferring your body weight to them, move your healthy leg forward. Repeat all movements in the same order.
When walking in the first 10-14 days, you can only touch the floor with your operated leg. Then slightly increase the load on your leg, trying to step on it with a force equal to the weight of your leg. You can walk for as long as your well-being and the condition of your leg allow, without reducing the time of therapeutic exercises. If you don’t do gymnastics enough, incorrectly, or overuse walking, the swelling of your legs will increase by the end of the day. In this case, consult your doctor for clarification. Concomitant diseases can maintain leg swelling.
After you have learned to confidently stand and walk without assistance, physical therapy should be expanded with the following exercises performed in a standing position.
Knee Raise
Slowly bend the operated leg at the hip and knee joints at an angle not exceeding 90 degrees, while raising your foot above the floor to a height of 20-30 cm. Try to hold the raised leg for a few seconds, then also slowly lower your foot to the floor.
Taking the leg to the side
Standing on your healthy leg and holding the headboard securely, slowly move your operated leg to the side. Make sure your hip, knee and foot are facing inward. Maintaining the same position, slowly return your leg to the starting position.
Taking the leg back
Using your healthy leg, slowly move your operated leg back, placing one hand on the back of your lower back and making sure that your lower back does not arch. Slowly return to the starting position.
We recommend doing the exercises listed above up to 10 times a day for several minutes. They will help you significantly speed up the rehabilitation period and quickly start walking without assistance.
Almost every patient needs to walk up stairs. Let's try to give some tips: when moving up, you should start the lift with the non-operated leg. Using crutches, move your non-operated leg to a higher step. Shift your body weight to your non-operated leg on the step above. Then the operated leg moves - lift it and place it on the same step. The crutches move last or simultaneously with the operated leg. When going down stairs, place your crutches and your operated leg on the step below first, then your non-operated leg. Leaning on crutches, bend the non-operated leg at the joints and, maintaining balance, place it next to the operated leg.
If possible, use a handrail instead of one crutch. So, let us repeat once again the general rules for moving up the stairs - the healthy leg is always on the upper step, the sore leg is always below, on the lower step. The crutches remain for support on the same step as the sore leg.
Postoperative complications
Despite all the measures taken to prevent complications, there is still a risk of their occurrence. They can develop due to incomplete preoperative examination of the patient or errors by the operating doctor. However, more often, improper postoperative care and non-compliance with the physical activity regimen outside the hospital are to blame for the occurrence of complications.
One of the most common complications is dislocation of the implant head. It is characterized by pain that intensifies with movement, muscle spasm around the hip joint, and forced positioning of the operated leg. Characteristic symptoms of this complication after hip replacement are lameness and shortening of the affected limb.
In the presence of an untreated chronic inflammatory process in the patient’s body, there is a possibility of developing paraprosthetic infection in the tissues surrounding the endoprosthesis. In the future, it can lead to the formation of a purulent fistula and the development of osteomyelitis. The inflammatory process is characterized by severe pain, swelling and redness in the area of the operated joint. The skin becomes hot to the touch, and the patient develops a fever.
Severe complications include periprosthetic fracture of the femur. It is characterized by acute, sharp pain, rapidly increasing swelling, redness, crunching when moving and palpating the operated area, deformation of the leg and the impossibility of active movements.
During the operation, there is a risk of damage to the fibular nerve, resulting in the development of neuropathy. It is characterized by intermittent pain of various localizations, weakness of the ankle joint, and a feeling of numbness in the toes and feet.
The most dangerous complication is pulmonary embolism, when a blood clot that breaks off during surgery clogs its lumen. The patient suddenly develops shortness of breath, weakness, and suffocation. The patient loses consciousness. If urgent resuscitation measures are not provided, death occurs. This complication is quite rare.
AT HOME
While at home, you need to continue doing therapeutic exercises and follow the recommendations of your doctor. It is also necessary to monitor your health, since exacerbation of chronic diseases, acute infections, hypothermia, and overwork can lead to inflammation of the operated joint. If your body temperature increases, swelling of the operated joint, redness of the skin over it, or increased pain in the joint, you should immediately consult a doctor.
Also, take basic precautions at home. Wear low-heeled shoes, temporarily remove moving rugs and wires from the floor, walk carefully on wet surfaces, and try to prevent pets from getting under your feet. Do your homework as much as you can. Alternate the time of work, rest, and gymnastics. Try to go for walks with the help of relatives and friends.
Treatment of pain after endoprosthetics
Before prescribing treatment, the doctor sends the patient for a computed tomography scan and a laboratory blood test. If everything is fine with the endoprosthesis and there is no infection in the body, then the doctor prescribes treatment directly for the pain syndrome. As a rule, this is a complex treatment that includes a number of methods.
- Taking painkillers.
- Physiotherapy (baths, electrophoresis, UHF, etc.).
- Reflexotherapy (point impact on certain areas of the body).
- Massotherapy.
- Swimming, which helps strengthen adjacent muscles, improves the functioning of the implant.
- Shock wave therapy (SWT) is a pulsed effect using a special device on the disturbing area with shock acoustic waves of a given frequency. As a result, pain decreases, inflammation and swelling are gradually relieved, and the functioning of the lymphatic system improves. Tissue nutrition improves, thereby accelerating recovery processes. This method is successfully used in the “Health Plus” medical clinics for the treatment of pain after knee and hip joint replacement.
Taking into account the patient’s condition, his age, the individual characteristics of the body and the clinical picture, the doctor prescribes a certain course of certain procedures.
SHOWER AND BATHING
For the first six weeks after surgery, it is advisable to avoid bathing and prefer to wash in a warm shower. In this case, it is advisable to have someone nearby until you feel confident. If a bath cannot be avoided, then we advise you to adhere to some simple rules that make taking it as safe as possible. Firstly, avoid hot baths for up to 6 - 8 weeks - this is not at all related to the possible heating of your new joint, as patients mistakenly think. Rather, it is caused by the dangerous effect of hot water on the possibility of blood clots forming in the operated leg. Secondly, when entering the bathroom, always sit on the edge, holding the tub firmly with your hands. The legs are transferred one by one to the bathroom, while the entire load should be transferred to the hands, with which you must hold firmly. After this, you can carefully immerse yourself in the water, while the entire load should be transferred to the slightly bent healthy leg, and it is better to keep the patient straight.
You should also carefully exit the bath, again concentrating all the stress on your arms and healthy leg. The sore leg moves smoothly out of the bath, remaining in a straight position.
It is strictly forbidden to visit a bath or sauna during the first 1.5 - 3 months (due to thromboembolic complications).
We remind you once again that during this period:
- It is advisable to sleep on a high bed.
- After surgery, you should sit in high chairs (like bar stools). A regular chair should be cushioned to increase its height. Low, soft seats should be avoided. It is important to observe all of the above when visiting the toilet,
- It is strictly forbidden to squat, sit cross-legged, or “cross” the operated leg over the other.
- get rid of the habit of picking up fallen objects from the floor - you should do this with the help of any devices that exclude bending and squatting.
General recommendations for the rehabilitation period
- In a hospital, a person must acquire the skills to move safely and adopt body positions that do not harm the prosthesis. Thus, you should not cross your legs, draw your legs close to your body during sleep, lean on your sore leg, bring your knees together while sitting, or make rotational and flexion movements in the area of the endoprosthesis.
- You cannot bend the hip in the operated joint more than 90°. This poses a risk of dislocation.
- You cannot sit in one position for more than 20 minutes. When sitting, the hip joints should be above the knees or at level. It is not recommended to sit on very soft chairs. The chair should be hard, durable, with a back and armrests, on which you need to stand.
- You need to lie down in bed as follows: sit on the bed, then raise your legs and turn them along with your torso towards the middle of the bed.
- It is better to sleep on your back, and abduct the operated leg 20°, this will relax the muscles.
- To prevent unwanted movements and rotations during sleep, you should place a pillow or bolster between your thighs.
- Analgesics should not be taken during exercise therapy. The patient must adjust in advance to the pain through which all exercises will need to be performed. Otherwise, you may simply not feel when something goes wrong.
- It is not recommended to drive a car in the first 1.5-2 months.
- Do not lift or carry heavy objects.
- In the first weeks after surgery, it is important to prevent falls. You should move very carefully; it is advisable to have someone nearby at these moments to insure you.
Recommendations regarding walking:
- walk slowly, on smooth and non-slip surfaces;
- take steps of equal length, the time of support on a cane or walker is the same for each leg;
- the order of climbing the stairs: before the first step, the legs stand together, then the healthy leg, the operated leg, the support.
- descent down the stairs: support, operated leg, healthy leg.
CURRENT CONTROL
An endoprosthesis is a rather complex structure. Therefore, we strongly recommend that you do not abandon the scheme for monitoring the behavior of the new artificial joint. Before each follow-up visit to the doctor, it is necessary to take an x-ray of the operated joint, it is advisable to take blood and urine tests (especially if after the operation you had some kind of inflammation or problems with wound healing). The first follow-up examination usually occurs 3 months after surgery. During this visit, it is important to find out how the joint “stands” and whether it is possible to start putting full weight on the leg. The next control is after 6 months. At this moment, as a rule, you already walk quite confidently, fully loading the operated leg. The purpose of this examination is to determine what and how has changed in the condition of the bones and muscles surrounding the joint after normal load, whether you have osteoporosis or some other bone tissue pathology. Finally, the 3rd control - one year after joint replacement. At this time, the doctor examines the joint to see if there is a reaction from the bone tissue, how the surrounding bones and soft tissues and muscles have changed in the process of your new, higher quality life. In the future, visits to your doctor should be made as necessary, but at least once every 2 years.
REMEMBER! If pain, swelling, redness and increased skin temperature appear in the joint area, if the body temperature increases, you need to contact your doctor URGENTLY!
Consequences of endoprosthetics
It should be noted that the process of implanting a hip or knee joint endoprosthesis cannot be completely painless. During the postoperative period, the patient may experience pain and discomfort.
This is usually expressed as follows:
- aching pain in the area of the installed endoprosthesis;
- pain in areas adjacent to the implant;
- pain after physical activity;
- nagging or aching pain in the evening.
Similar symptoms occur even during a successful postoperative period, when there are no defects associated with the prosthesis itself and its installation and when infectious and inflammatory processes are excluded. Such pain is usually caused by irritation of the nerve fibers in the area of the installed endoprosthesis and tissue healing, because any operation is an intervention in the subtle and complex world of the human body, and therefore such unpleasant sensations are a natural reaction to the operation.
Prevention of complications after surgery.
Prevention of thrombosis. Follow your doctor's instructions carefully to reduce the potential risk of blood clots. These problems may especially occur in the first few weeks after surgery.
The following signs indicate the formation of blood clots:
- Pain in the leg, in the calf muscles, not associated with the incision.
- Pain, swelling, redness along the back of the leg.
- Swelling of the thigh, leg, ankle, or foot.
Indications for thromboembolism:
- Sudden difficulty breathing.
- Sudden pain in the chest, aggravated by deep breathing and coughing.
Contact your doctor immediately if these signs occur!
Prevention of infection.
The most common routes of infection after endoprosthetics are the introduction of bacteria into the bloodstream during dental procedures, urinary tract infections, and skin infections. These bacteria can infect the area around the denture.
For two years after surgery, you may need to take prophylactic antibiotics before dental procedures, including enamel cleaning, or other surgical procedures that may introduce bacteria into the bloodstream.
Be alert for the following signs of an early infection:
- Continued fever (temperature above 37°).
- Fever or chills
- Increasing redness, swelling, pain in the area of the postoperative wound.
- Discharge from a wound.
- Increased pain with exercise and at rest.
Contact your doctor immediately if these signs occur!
Prevention of falls.
A fall during the first weeks after surgery can damage the endoprosthesis and lead to the need for another operation. You need to be especially careful when walking on stairs. You should use a cane, crutches, walker, handrails or other assistive devices until the joint becomes stronger and the mobility or strength of the muscles in it is restored.
Your surgeon or physical therapist will advise you on what assistive devices you need after surgery and when you can safely stop using these devices.