Rehabilitation after hip replacement

Rehabilitation after hip replacement is divided into three postoperative periods: early, late and long-term:

Early period – hospital, first two weeks. In the hospital, the patient does simple gymnastics, learns to move with crutches, and take the correct positions.
Late – up to two months after surgery. The patient does rehabilitation independently at home and attends classes. During this period, efforts are aimed at restoring muscles and acquiring skills in solving everyday problems.
Long-term – up to six months after surgery. Work continues with a rehabilitation specialist and physiotherapist. The patient engages in exercise therapy, restores the functionality of his leg, and learns to walk without support.

Let's take a closer look at the rehabilitation process.

How is the recovery course developed?

The primary rehabilitation program is usually developed by the doctor who monitors the patient in the postoperative period. After discharge it is corrected. Any classes or exercises should be carried out only according to the program prescribed by the doctor. Before this, the patient must be examined, X-rays and MRI results are studied.

There is no standard rehabilitation course for everyone. The program is always compiled strictly individually, for each patient.

In medical centers for rehabilitation, drug and non-drug recovery methods are used. To prevent complications after surgery, anti-inflammatory drugs, antibiotics, and painkillers are prescribed.

The main part of the rehabilitation course is exercise therapy and therapy. The rehabilitator conducts training that begins with simple exercises with a gradual increase in load. The patient moves from simple movements to exercise machines and other sports equipment.

Therapy includes many techniques, the most effective of which are physiotherapy, massage, acupuncture, and reflexology. All this is aimed at relieving muscle tension, accelerating recovery processes, relieving pain, normalizing sleep and preventing complications.

The hip joint is one of the largest supporting joints. When replacing it, the ligaments are removed, the muscles that will hold the endoprosthesis are cut and re-sutured. In order for muscles to cope with their function, they need to be trained and strengthened. Otherwise, the prosthesis may shift, which will lead to bad consequences.

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.

Joint endoprosthetics, what complications can there be?

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In many cases, joint replacement surgery is the last resort that a sick person can rely on. But, like any operation, replacement surgery has its risks. These risks are higher with revision (repeated) surgical interventions.

Therefore, before deciding to undergo joint replacement surgery, you need to carefully weigh all the pros and cons of this choice.

Among European orthopedists there is an expression that arthroplasty of a joint is identical to internal amputation of this joint. And this is in a sense legitimate. After all, during endoprosthetics, quite a lot of your own bone tissue is removed, which is not restored.

Possible complications after joint replacement include:

Infectious process (paraendoprosthetic infection)

Infection in the area of the endoprosthesis (suppuration) is a serious complication. Its treatment is complex, lengthy and expensive.

The risk of developing a paraendoprosthetic infection is especially increased in patients with concomitant diseases such as rheumatoid arthritis who are taking hormonal drugs.

Infectious complications are manifested by pain, swelling, redness at the site of infection, and a sharp impairment of the supporting and motor function of the limb. Septic instability of the endoprosthesis develops. When the purulent process enters the chronic phase, a fistula is formed, from which pus is constantly or periodically released.

Conservative treatment is practically ineffective. Chronic postoperative osteomyelitis (purulent inflammation of the bone in the area of the endoprosthesis) is formed. In most such cases, you have to do a second operation - removal of the endoprosthesis. After this, instead of the expected appearance of a new joint, the person in this area does not even have the patient’s joint, only an “empty space”, and even a chronic purulent focus. The supporting and motor function of the limb is severely affected, and the limb is shortened. As a result, the patient remains severely disabled.

As can be seen in the above x-ray, after removal of the endoprosthesis, an “empty space” remains in the area of the former hip joint.

The components of the removed endoprosthesis were colored green at the points of contact with pus.

Recently, it has become possible to more successfully combat paraprosthetic infection through the use of so-called articulating spacers (joint spacers). These are temporary endoprostheses made from bone cement (polymethyl methacrylate) with the addition of antibiotics. Installation of a spacer followed by its removal and replacement with a full-fledged endoprosthesis will require at least 2 more extensive operations on the joint.

With repeated attempts to replace the joint, even years after the purulent-inflammatory process has subsided, a relapse is possible.

Dislocation of the endoprosthesis

Because An artificial joint is not a complete replacement for a real joint, then its functionality is correspondingly lower. Some careless movements in the joint may cause dislocation of the endoprosthesis. As with dislocations in natural joints, it is believed that the distal component of the prosthesis is dislocated in relation to the proximal one (for example, in a hip endoprosthesis, the head of the endoprosthesis is dislocated).

Therefore, after hip replacement surgery, it is strictly not recommended to bend the leg at the hip joint more than 90°, or to rotate the leg inward.

A dislocation can also occur from a fall.

If a dislocation occurs, it is adjusted under anesthesia. After this, the leg is immobilized. After the end of the acute period, the risk of repeated dislocations always remains. If it is not possible to reduce the dislocation by closed means, an open reduction of the dislocation is performed.

Endoprosthesis fracture

The leg or neck of the endoprosthesis may break. This is due to the so-called “fatigue” of the metal, which develops as a result of constant loads on the metal structure.

Even prostheses made from the strongest alloys are not immune to such complications.

Instability of endoprosthesis components (aseptic instability, loosening of the endoprosthesis)

When standing or walking, a large load is placed on the endoprosthesis; micromovements occur in the connection between the bone and the endoprosthesis. As a result, the endoprosthesis becomes loose. Both the stem (femoral component) and the cup (acetabular component) of the prosthesis may become loose. The endoprosthetic leg can destroy the bone wall in which it is located - a periprosthetic (paraprosthetic) fracture .

If instability of the endoprosthesis develops, a repeat operation is required—revision endoprosthetics.

In case of a periprosthetic fracture, osteosynthesis surgery will be required, followed by long-term restriction of physical activity.

Destruction of the endoprosthesis liner

The polymer insert, which is located between the metal parts of the endoprosthesis, reduces their friction against each other during movements. It can wear out, crack, dislocate.

This leads to decentration of the head of the endoprosthesis (the presented x-ray shows a displacement of the head of the endoprosthesis from the center) and dysfunction of the limb.

With such a complication, repeated surgery is required to replace the liner.

Protrusion of the acetabulum

This is the introduction of the femoral component of the prosthesis (head) into the acetabulum with perforation of its wall and exit into the pelvic cavity.

This complication sharply disrupts the function of the joint (making it virtually impossible), and is also fraught with damage to the pelvic organs.

Change in the length of the operated limb

Both shortening and lengthening of the operated limb may be observed.

A similar complication can occur if the endoprosthesis is installed incorrectly. In this case, a new operation may be required.

This complication may also be caused by weakening of the periarticular muscles. In this case, it is necessary to strengthen these muscles with physical exercise.

Contracture of the prosthetic joint (limitation of movement)

Occurs during ossification (ossification) of periarticular soft tissues.

In this case, the supporting function of the limb is preserved, but the range of movements in the prosthetic joint is sharply limited.

Postoperative neuritis (traction neuropathy)

This is an inflammation of the nerves passing near the joint due to trauma (overextension or compression) during surgery.

Deep vein thrombosis of the limb

After surgery, blood clots may form in the veins of the operated limb due to decreased movements (because with low physical activity, the muscular-venous “pump” - a pump that helps the movement of blood in the veins of the lower extremities - does not work well). At the same time, blood stagnates in the veins, the blood becomes thicker, resulting in the formation of blood clots.

Therefore, early activation of the patient is recommended, as well as prophylactic administration of anticoagulants (anticoagulants).

As a result of venous thrombosis, the most dangerous complication can develop - pulmonary embolism.

Pulmonary embolism

A fatal complication is fortunately rare (up to 0.05%). The reason for this lies in the fact that after endoprosthetics, patients’ ability to form blood clots sharply increases. If such a thrombus breaks away from the wall of a blood vessel and enters the lungs with the bloodstream, the process of oxygen supply to the body is disrupted, and the patient dies. All patients after endoprosthetics are given anticoagulants, which “thin” the blood and sharply reduce the risk of such a complication.

Life after hip replacement

Let's take a closer look at the three main periods of rehabilitation after joint replacement, as well as recovery methods.

Important! Early start of rehabilitation procedures is the key to a high quality of life, protection from complications and injuries.

Preoperative stage

Even before the operation, the patient prepares for rehabilitation after it: learns to walk with crutches and use objects for support, trains the respiratory and cardiovascular systems. It is very important to strengthen the muscles of the healthy leg, because after a joint replacement, a high load will be placed on it.

Early postoperative period

The main goal in this period is to prevent complications and improve the mobility of the prosthesis. In the first three days you can only lie down and only on your back. The operated limb is fixed in a position slightly retracted to the side using a roller. The foot should be perpendicular to the shin, the toes should “look” up. Three to four times a day, the position of the knee joint is changed for 10-20 minutes using a roller. You can turn on your side only on the healthy side; this can be done from the fourth day. From the fifth to eighth day you can lie on your stomach.

In order not to provoke vascular pathologies, in the first seven days after the operation, both legs are wrapped in elastic bandages, and then for another seven days the bandage is applied only during the daytime.

In the first weeks, the patient is gradually included in the motor mode, and he is prescribed gentle exercise therapy programs. During this period, you also need to take antibiotics, and to improve the quality of life, painkillers and, if necessary, sedatives.

Late period

The main emphasis at this stage is on increasing the strength of the leg muscles, learning to climb and descend stairs, followed by practicing technique, and strengthening gait. In the first 1.5-2 months, you need to move with crutches so that the body “accepts” the endoprosthesis.

Remote period

Three months after the operation, rehabilitation measures begin, aimed at maximizing the strength of the muscles of the operated leg and adapting the patient to normal life and daily activities.

The period of complete recovery varies from person to person. It depends on the initial pathology due to which it was necessary to change the joint, age, general condition, etc. On average, this takes a year.

Postoperative pain

In the first month after hip replacement, the patient may experience pain and discomfort. They can be concentrated in the area of the surgical wound, spreading to the knee and groin. Such pain is considered a natural response of the body to surgical trauma (skin incision, muscle dissection). To relieve them, the patient is prescribed painkillers.

Patients may often experience lower back pain after hip replacement surgery. Typically, such pain occurs during physical activity. This is associated with an exacerbation of osteochondrosis due to the restoration of the length of a previously shortened limb and an increase in the load on the spine. With proper rehabilitation measures, back pain after hip replacement goes away over time.

Rehabilitation methods used in the recovery process

Drug therapy - antibiotics to prevent infection in the early period, painkillers, anti-inflammatory drugs. After this - vitamin complexes, calcium supplements, immunostimulating drugs.
Physiotherapy – techniques for improving blood circulation, stimulating metabolic processes, reducing pain and increasing muscle tone.
Hydrokinesitherapy – water exercises to develop the joint, speed up recovery and reduce the risk of complications.
Cryotherapy is cold therapy. Special forms filled with hydrogel are cooled and applied to the location of the endoprosthesis for 15 minutes. This relieves pain and relieves swelling.
Magnetotherapy is a hardware technique for stimulating microcirculation in tissues and accelerating healing.
Electrical stimulation - tissues are exposed to alternating weak current, due to which the muscles maintain tone even with limited physical activity. Lymph and blood flow improves.
Laser therapy for anti-inflammatory effect, pain relief and swelling.
The use of orthoses if the joint needs to be further stabilized. The orthosis (bandage) is selected by an orthopedic traumatologist. This device fixes the joint, relieves it and corrects the function of the leg. The load is redistributed to healthy areas, treatment time is reduced.
Kinesitherapy is a set of exercises that is selected taking into account the patient’s medical history, condition and a number of other factors. The load gradually increases, using walkers, crutches, and exercise equipment. This technique allows you to restore motor function.
Exercise therapy, which is best done under the supervision of a trainer. But in the long term, the practiced exercises can be done at home.
Massage is indicated in the absence of acute pain. It is carried out in order to increase blood flow and saturate tissues with oxygen for better regeneration.

General principles of rehabilitation

The goals of rehabilitation are:

complete elimination of pain and inflammation that are a consequence of surgical procedures;
ensuring strong fusion of the endoprosthesis components with the bones, which occurs gradually during the process of regeneration and renewal of bone tissue;
normalization of the function of the muscular-ligamentous apparatus, which sets the articular bones in motion;
prevention of side effects and complications.

Rehabilitation after endoprosthetics includes the following treatment methods:

1. Drug therapy. The patient is prescribed medications:

antibiotics (to prevent infection of the operated area);
NSAIDs (for inflammation and pain);
anticoagulant drugs (to avoid the formation of blood clots);
gastroprotectors, diuretics;
calcium and protein supplements (to accelerate the recovery of muscle and bone tissue).

2. Physiotherapy. Includes procedures such as electrophoresis, electromyostimulation, UHF, balneotherapy, laser treatment, mud therapy, massage after knee replacement at home.

Physiotherapeutic procedures have the following effects:

quickly relieve swelling and pain;
eliminate muscle spasms;
strengthen ligaments, increase muscle tone;
increase the speed of lymph flow and blood flow in the injured leg, which accelerates the flow of nutrients and promotes rapid regeneration;

The rehabilitation period after hip, knee, or ankle replacement is a rather labor-intensive and lengthy process. To endure it normally, the patient and his loved ones need patience and strength.

If the rehabilitation process is organized correctly, the patient’s ability to work returns by the end of the tenth week. If during the recovery process after surgery to replace a hip, knee, or ankle joint with an artificial analogue, side effects and complications arise, then the rehabilitation process can be very prolonged.