REHABILITATION OF YOUR TOTAL HIP AFTER SURGERY
Contents:
How is the rehabilitation done
Muscles that do the work - abductor muscles
How is the rehabilitation done
Length of stay in the hospital after total hip replacement has decreased from two weeks to only about five days.
For patients operated on with the modern surgical technique, called Minimally Invasive Surgery, the stay is even shorter, these patients leave hospital the operation day or the next day after surgery.
Obviously, giving detailed advices on rehabilitation through Internet site would be meaningless. These advices must be given i, before and after surgery to every patient individually. You should also advices how much weight you can put on your new total hip.
You should have learned individually your rehabilitation program already before the operation. After surgery, there is then time to give the finishing touches to this program. During the few days you will stay in the hospital after surgery, your muscles would not have time to regain the previous power, so that much training remains after leaving the hospital.
Depending on your condition, you may require a stay at a rehabilitation facility or you may go home. That is a decision that you can come to with your surgeon and PT depending on what you feel you can cope with and what you are able to do.
If you go home, a PT will take over your rehabilitation, seeing you two-three times a week during the first months. During a typical session, the PT may apply ice to reduce pain and swelling, and prescribe specific exercises for you to do at home to restore range of motion and muscle strength in your new total hip.
It is important that your PT has close contact with your surgeon concerning the surgical approach and restrictions to certain movements in your new hip joint. With this knowledge your PT then prescribes individual exercises to you with respect to the muscles that were moved, released, and sutured back during the surgery.
Home exercise program is an extremely important aspect of your recovery. Be prepared to continue with a home exercise program for at least three months after surgery, but it could require as much as one year to achieve optimum muscle strength and range of motion in your new total hip.
The muscles that do the work
Remember that even the most advanced, best models of the total hip device will be propelled by your own muscles. You will do the work once the operation is finished.
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Abductor muscles: Your PT will give you instructions how to activate the muscles and when. Nineteen individual muscles (or their important parts) cross the hip joint; however the most important muscles (if one can say that) are the muscles that put the leg to the side = abduct the leg. These muscles called abductor muscles are often weak before the surgery, they are important stabilizers of the hip joint, their power is often diminished through surgical approach, and their full power can be rehabilitated back.
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| Picture: Abductor muscles: |
The limp - lack of muscle power
The lack of power in the abductor muscles causes that the rump drops down when the patient puts weight on the operated on leg. The patient with weak muscles around the total hip is limping. Scientist call it positive Trendelenburg’s sign and causes unsightly gait pattern
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Limp = Trendelenburgs sign A: weak abductor muscles after total hip surgery left side. Upper picture: When the patent raises the right leg the pelvis drops down to the right side. The rump on the right side sinks. This causes limp. Lower picture: The pelvis balances on the operated on total hip. When the patient lifts the right leg the whole body weight presses the pelvis down to the right side. The weak abductor muscles on the left side cannot balance the body weight and so the pelvis drops to the right side.
Normal walk = B: strong abductor muscles: Upper picture: When the patient raises the right leg the pelvis tilts upward on the right side. Lower picture: The pelvis balances on the healthy left hip joint. The abductors muscles have normal strength. The pull of the strong abductor muscles over-balances the body weight and tilts the pelvis upwards on the right side.
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| Picture: Limp = weak abductor muscles |
Statistics demonstrated that about 80% of all total hip patients had weak abductor muscles before the surgery.
3 months after surgery the muscle strength improved so that only 12% of them had Trendelenburg’s sign= still is limping. The muscle power increases continuously even after the three months passed so that one year after surgery only 5% of all total hip patients re still limping (Downing 2001).
The range of motion in the operated on hip
It increases successively. The maximal range of motion after total hip replacement depends on the preoperative range of motion. Patients with good range of motion will achieve even better range of motion. Patients with very limited range of motion before the surgery will achieve considerable improvement of their range of motion but seldom an excellent range of motion.
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References:
Downing ND et al: Hip abductor strength following total hip arthroplasty. A prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand 2001;72:215-220