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Physical Therapy PHYSICAL THERAPY AFTER YOUR TOTAL HIP REPLACEMENT Full recovery from your total hip replacement surgery will take several months. This pamphlet will help you understand your recovery. Guidelines are included which discuss precautions to protect your new joint, exercises that increase you hip strength, and activities of daily living that will help you become an active partner in your care and recovery. THE NORMAL JOINT Your new hip is a ball and socket joint where the thigh bone (femur) meets the pelvis. A healthy hip has layers of smooth cartilage that cover the end of the femur part of the pelvis. The cartilage acts as a cushion and allows the ball of the femur to glide easily within the socket of the pelvis. The muscles around the joint support your weight and help move the joint smoothly so you can walk without pain. YOUR REPLACEMENT HIP PROSTHESIS Your new hip prosthesis has a femur and pelvis part made from metal and plastics. The cup replaces the worn hip socket of your pelvis. The ball replaces the worn end of your femur. The ball is attached to a stem that fits into your femur. The cup and stem are sometimes cemented, or metals may have a porous surface that bone will grow into and create a tight fit. GUIDELINES TO PROTECT YOUR NEW HIP JOINT Full recovery from your total hip replacement surgery will take several months. The following guidelines discuss precautions to protect your new joint, exercises to increase your hip strength, and activities of daily living to help you become an active partner in your care and recovery. Your new hip has limited range of motion after surgery. Adhere to the precautions for the first 6–8 weeks to protect your new hip from sliding out of position while the muscles heal. Some of these precautions will need to become life-long habits. Check with your doctor if you have any questions. When you are in bed, keep your legs apart. Place an abduction wedge or two regular pillows between your legs to keep them apart. The two pillows will also keep your legs from turning inward or outward. Avoid lying on the side of your new hip. Sleep on your back or on the unaffected side with the abduction wedge or 2–3 pillows between your legs. This keeps the pressure off your new hip. Your doctor will tell you when you can safely lie on the side of your new hip. Do not sleep on your stomach. Do not cross your legs or ankles when sitting, standing, or lying. Remember to keep pillows between your legs at night to keep from crossing your legs while sleeping. Also keep your knees apart while sitting. Sit with your feet shoulder-width apart. Keep your toes pointing forward. This prevents your hip from turning inward or outward. Never let your knees knock together while sitting. Avoid twisting your upper body while sitting. Do not lift your knee higher than your new hip when sitting. A cushion or pillow may be needed to elevate chairs. A toilet seat extender can be used to elevate toilet seats. Do not bend over at the waist or squat down to pick things up from the floor. Do not bend your upper body forward more than 90 degrees. It is best to avoid shoes that require tying for the first six weeks. Try to use slip-on shoes, or else have a caregiver assist you with tying your shoes. After six weeks, you may sit in a chair and place your ankle on your opposite knee to tie your shoe rather than bending down to the floor. Refer to the Adaptive Equipment section of this handbook for items that will assist you in self-care activities. Weight bearing on your new hip. The physical therapist will teach you to use a walker or crutches until your new hip heals. Your physical therapist and provider will tell you how much weight you can safely put on your new hip. At your checkups, your provider will tell you if your hip has healed enough to progress to a cane or one crutch. YOUR BALANCE MIGHT BE SHAKY FOR A WHILE • Use handrails on steps. • Use low-heeled or flat shoes. • Avoid wet or waxed floors. • Keep your floors free of items you could trip on. Throw rugs or small objects should be kept off the floor for your safety. • Watch for pets or other animals that could get in your way. • Avoid ice or snow. If you are riding in a car, stop every hour or so. Get out and walk around for a few minutes. This will help the circulation in your legs and keep your muscles from becoming stiff. Talk to your doctor about when sexual activity may be resumed and what positions should be avoided. DISLOCATION OF YOUR HIP The following symptoms may come from dislocating your hip: • Severe hip pain • An unusual bulge at the side of your hip • A shortening of your leg • Difficulty and/or pain when walking • Abnormal, extreme rotation of your leg If you suspect you have dislocated your hip, do not walk on it. Call your orthopaedic surgeon and/or go to the emergency department immediately. You may need to be admitted to the hospital. ADAPTIVE EQUIPMENT After your total joint replacement, you will benefit from several pieces of equipment. The most important part includes crutches and/or a walker, the other items below will make your daily activities easier and safer. Seat/shower bench: This seat allows you to sit while bathing and provides safety while in the shower. Seat cushion: Cushions are used to elevate the seat height of a chair, couch, car, or other surface. Elevated toilet seat: This device is attached to your toilet seat to elevate its height. Reacher/grabber: A reacher is used to pick up items off the floor and help you get dressed. Dressing stick: This device has a hook on one end and a pusher on the other end. It is used to help put on pants, skirts, and pull up zippers. Sock aid: This aid helps you safely put on your sock. Long-handed bath sponge: This sponge helps you clean hard-to-reach areas while bathing. Long-handled shoe horn: This shoe horn is attached to a long stick and allows you to put on shoes while sitting or standing. MANAGING ACTIVITIES OF DAILY LIVING FOLLOWING YOUR HIP REPLACEMENT CHAIR TRANSFER Avoid low seats and soft couches until otherwise told by your doctor. Stiff-backed chairs with armrests are ideal for sitting. If the seat is low, you may place one or two pillows in the chair to elevate the seat and facilitate transfers. It will also help you avoid bending the hip greater than 90 degrees. 1. Back up until you feel both legs touching the chair. 2. Slide your operated leg out in front of you as you reach back with one hand for an armrest. 3. Lower yourself slowly, keeping your operated leg straight out in front of you. Once seated, bend your knee slightly. 4. When getting up, scoot your operated leg out in front of you. Remember to keep your hip positioned less than 90 degrees. 5. Push up using the armrests and stand on your good leg, keeping your operated leg out in front of you. CAR TRANSFERS Sitting in the front seat is preferable because it generally has more leg room, can be adjusted for comfort, and allows the rider to more easily wear a seat belt. 6. Make sure the seat is as far back as possible. Back up to the car with your walker or crutches. Put your operated leg out in front of you. 7. Lower yourself slowly to the seat. You may roll the window down and use the car doorframe, along with the headrest, to support yourself as you sit. 8. Recline the seat back. Then scoot back into the seat and swing your legs into the car. 9. To get into the back seat in a semi-reclining position, use your arms and non-operative leg to scoot yourself back farther onto the seat. PUTTING ON UNDERWEAR OR PANTS 1. Sit on the side of the bed or in an armchair. 2. Use the dressing stick or reach-and-grab tool, and catch the waist of the underwear or pants with the hook. 3. Slip the underwear or pant leg over your operated leg first by lowering the reach-and-grab tool toward the floor by your foot. 4. Repeat for your non-operated leg. 5. Pull the underwear or pants up over your knees. 6. Stand with the walker or crutches and pull the pants or underwear up. 7. When undressing, take the pants or underwear off of your non-operated leg first. PUTTING ON SOCKS AND STOCKINGS 1. Slide the sock or stocking onto the stocking aid. Be sure the heel is at the back end of the plastic and the toe is against the end. 2. Secure the sock in place with a garter or the notches on the plastic piece. Do not pull the top of the sock over the top of the plastic piece. 3. Holding onto the cords, drop the stocking aid out in front of the operated foot. 4. Slip your foot into the sock and pull it on. 5. Remove the garter or release the sock from the notches on the plastic piece using your reach-and- grab tool. 6. Put the other sock on your other foot in your usual manner.
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