Rehabilitation after hip replacement starts in a day and lasts from 3 to 4 months. Medicines are prescribed only in the early days, and then recovery occurs due to physical education, gymnastics, massage and physiotherapy procedures. The rehabilitation period is affected by the age of the patient, the degree of damage to the structures of the hip joint, and the patient’s compliance with all the recommendations of a rehabilitation doctor.
- Introductory Instructions
- General Principles
- Medication Therapy
- Complex physiotherapy
- The rehabilitation period in a hospital
- Preparation at home before the arrival of an operated relative
- Rehabilitation Stages
- Early period
- Postoperative Rules
- Diet after surgery
- Late stage
- Remote phase
- Home Exercise
- Gymnastics on the simulators
- Possible complications
- General recommendations after completing the course
Rehabilitation of patients after replacing the hip joint (TBS) with an endoprosthesis consists of several stages. In the early period, special attention is paid to the restoration of tissues damaged during surgery, the elimination of postoperative pain, and the prevention of complications. After 2 weeks, the late stage of rehabilitation begins. Its main tasks are:
- strengthening muscles, ligament-tendon apparatus, stabilizing the artificial hip joint;
- gradual strong bonding of endoprosthesis elements with bones due to natural tissue regeneration;
- the acquisition of the correct motor stereotypes, the correction of posture and gait, changed during the illness.
The planning and optimization of physical activity is carried out by a rehabilitologist. During rehabilitation at home, the patient is required to follow all instructions, proper dosing of loads, regular visits to scheduled examinations, and a mandatory visit to the attending physician if his health worsens.
Rehabilitation after endoprosthetics of TBS is aimed at the full and comprehensive restoration of all functions of the replaced joint. The patient should recover in the optimal time frame in society, independently serve himself in everyday life, engage in professional activities. Rehabilitation should begin as early as possible, be continuous, consistent, integrated and continuous. An individual approach to the recovery of each patient is practiced – therapeutic measures are carried out in a planned manner, but if necessary, the rehabilitation doctor corrects the previously adopted scheme.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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To avoid infection of tissues whose integrity is impaired during arthroplasty, not only treatment of sutures with antiseptic solutions allows. Patients are prescribed a course of taking antimicrobials and antibiotics – macrolides, cephalosporins, semi-synthetic protected penicillins. The following remedies are also included in treatment regimens:
- anticoagulants, venoprotectors, preventing venous thrombosis;
- non-steroidal anti-inflammatory drugs for the relief of pain and inflammatory processes;
- gastroprotectors that protect liver cells from damage with increased pharmacological load;
- means that improve the functioning of the urinary organs.
For accelerated restoration of bone tissue, balanced complexes with vitamins and minerals containing high doses of calcium, as well as chondroprotectors that accelerate the metabolism in bone structures are used.
To normalize the functions of motor nerves and muscles, sessions of electromyostimulation, or therapeutic effects of pulsed electric currents, are performed. At the early and late stages of rehabilitation, ultraviolet irradiation of sutures, magnetotherapy, UHF therapy, laser therapy, electrophoresis with anesthetics, analgesics, chondroprotectors, calcium salt solutions, and B vitamins are used.
The main goals of physiotherapy are to strengthen the muscles and ligament-tendon apparatus, eliminate residual pain and inflammatory swelling. Under the influence of physical factors, blood circulation in the region of TBS improves, and nutrients necessary for their regeneration begin to flow to damaged tissues.
The rehabilitation period in a hospital
For 2 weeks after arthroplasty, the patient is in a hospital. His condition is monitored by the attending physician, the surgeon who performed the operation, and junior medical personnel. The main tasks of patient care are the prevention of postoperative complications and the elimination of pain. Despite the fact that painful sensations are quite natural, analgesics are necessarily used for their relief. Even moderate pain seriously worsens the psychoemotional state of a person, makes you doubt the speedy recovery.
After about 2 days, a rehabilitologist begins to deal with the patient. He shows how to breathe and clear his throat, so as to prevent congestion in the lungs, not to disrupt the cardiovascular system. Physiotherapy exercises begin with passive exercises, including with the help of mechanotherapy.
Preparation at home before the arrival of an operated relative
After the patient is discharged from the clinic, a long late stage of rehabilitation begins. The patient is still moving with difficulty, some pain remains in the area of the established endoprosthesis. So that he quickly adapts to new conditions, learns to walk without relying on his operated leg, has mastered the skills of everyday activity, it is necessary to equip an apartment or a house.
|Bed||It is advisable to purchase a functional bed with a height-adjustable headrest equipped with hanging handrails to facilitate lifting from the bed|
|Floors||Walking on thick carpet, laminate, parquet can be dangerous. The best option is a thin, well-stretched coating that cannot be caught on crutches or a cane.|
|Restroom||In the first 2 months after surgery during sitting, the TBS bending angle should not exceed 90 degrees. Therefore, you need to purchase an extra semi-rigid pad on the toilet seat|
|Walls||Walls in the room should be equipped with handrails so that a person can maintain balance when bending or trying to sit down. They should be placed near the toilet, in the hallway, in the kitchen near the dining table|
|Chairs||During the rehabilitation period, soft chairs and sofas are strictly prohibited. Seats will require medium-height chairs with a hard or semi-rigid seat.|
Due to the phased therapeutic effect on the operated leg, complications are prevented, swelling and pain are quickly eliminated, TBS is developed, and limb performance is restored.
During the first week after arthroplasty, the patient must observe a gentle motor regimen.
Prevention of postoperative complications is diaphragmatic breathing exercises, proper positioning of the operated leg, sparing exercises to improve lymph and blood circulation, strengthen the muscular skeleton of the limb.
If indicators of blood pressure, body temperature, heart rate are included in the norm, then the patient is allowed to get out of bed 2 days after the endoprosthesis replacement. He can walk around the ward, the hospital corridor, using crutches.
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The correct movement on crutches, including the ascent and descent of the patient’s stairs, is taught at the preoperative preparation stage. In the first weeks of walking, there should be only 3 fulcrum – crutches and a healthy leg. The operated limb is not involved in the movement.
On the 3rd day you can sit on hard chairs, taking a position of the body in which the hip joint is bent at an angle of less than 90 degrees. At first, you can’t sit for longer than 15-20 minutes.
The patient rests lying on his healthy side, placing a tight small roller between his legs, and sleeps on his back.
1-2 days after the installation of the prosthesis, the development of the leg begins. Gentle exercises are shown – sliding feet on the bed, their inclinations from side to side, low-amplitude flexion of the knee and ankle joints.
Diet after surgery
In the first days after surgery, the patient receives mainly liquid and viscous food – cereals, milk and fruit jelly, clear broths, mashed soups, well-minced meat. Gradually, he returns to the usual daily menu. The diet should consist of red meat, liver, dairy products, whole grain bread, fresh fruits and vegetables. 3-4 times a week you need to eat fatty fish (salmon, herring, horse mackerel) – the main source of polyunsaturated fatty acids and fat-soluble vitamins.
At a later stage, the duration of the walks gradually increases. By the end of the second month, the patient should move about 4 hours a day. During the illness, his gait and posture changed pathologically due to frequently occurring pains, compensatory muscle tension, and destruction of TBS cartilage. Now it is necessary to develop motor stereotypes for the correct distribution of loads on the operated and healthy leg, as well as on all parts of the spine.
The limb should be fully loaded after 4-6 weeks, but only with cement fixation of the endoprosthesis. If a cementless implant placement was used, then a full-volume leg load is possible after 2 months. Walking with a cane is shown until the limp completely disappears, until a person begins to feel confident when moving.
After about 3-4 months, the patient freely rests on the operated leg, moves without orthopedic appliances. The remote rehabilitation stage begins. During this period, spa treatment is very useful. Mountain and sea air has a healthy effect on the whole body, strengthens the immune system, tones. In specialized medical institutions, all functions of the leg are restored with the help of radon, pearl, carbon dioxide, hydrogen sulfide baths, mineral waters, and therapeutic mud.
Classes at home should be daily, with a gradual increase in dosage loads. Most often, rehabilitation doctors include the following exercises in treatment complexes:
- lie on your stomach, alternately, and then raise your legs together, trying to touch the heels of the buttocks;
- lie on your back, bend your legs, pulling your feet as close to the body as possible;
- to sit on a chair, holding on to the seat, raise legs alternately, bend them and lower them to the floor;
- stand up, lean against a wall or chair, do shallow lunges forward and backward.
The number of repetitions is 10-12. The movements should not be sharp, high-amplitude. Exercises need to be performed smoothly, a little slowly, constantly listening to the sensations that arise.
Gymnastics on the simulators
Rehabilitation centers are equipped with simulators, classes on which allow you to recover much faster. After endoprosthetics, exercise bikes with pedaling both forward and backward are especially in demand. For walking, rehabilitologists recommend using treadmills, after setting the speed at about 2 km / h, and then gradually increasing it.
Complications after endoprosthetics develop quite rarely, since preventive measures are taken in a timely manner. Sometimes there are local infectious processes, thrombosis, thromboembolism, periprosthetic bone fracture, neuropathy of the small tibial nerve. If the first symptoms of complications are detected, the patient should immediately report them to the attending physician.
General recommendations after completing the course
After restoration of the functional activity of the operated leg, a person can lead a familiar lifestyle, but with some limitations. Doctors are allowed to play sports, but in a sparing mode, without power loads on the endoprosthesis. They also recommend attending routine medical examinations, taking vitamins, chondroprotectors, and supplements with a high calcium content.