Recovery after total hip replacement. Recovery after hip replacement

03.05.2024

An operation, even performed at the highest level, will not be effective without high-quality postoperative treatment. Comprehensive rehabilitation after hip replacement - exercise therapy, physiotherapy, prevention of complications - allows you to get the full potential from this type of treatment. Without rehabilitation, you risk maintaining pain, lameness, and limited range of motion.

Introductory briefing

After hip replacement, rehabilitation lasts an average of 3 months. It consists of stages, for each of them its own system of treatment and rehabilitation measures has been developed, based on physical exercises and auxiliary procedures. A step-by-step therapeutic effect on the prosthetic segment allows you to prevent complications, quickly eliminate swelling and painful signs, thoroughly develop the limb, restoring the functionality of the leg.

A good and calm stitch approximately on the 3rd day after the operation.

We hope that you have thought about such a device in advance.

Physical activity is planned and optimized in accordance with the timing and individual criteria by a rehabilitation physician. At home, you will need to take contraindicated types of activity seriously, train strictly according to the instructions, without forcing loads, always come to the clinic for scheduled examinations, and in case of any pathological manifestations (pain, swelling, hematoma, etc.) immediately contact your doctor.

General principles of rehabilitation

The goals of rehabilitation are the following:

complete elimination of the inflammatory process and pain that results from surgical procedures;
normalization of the state of the muscular-ligamentous complex, which brings the articular bones (pelvic and femoral) into coordinated movement;
strong fusion of the prosthesis components with the bones, which occurs gradually during the natural reparative processes of bone tissue renewal;
preventing the development of negative consequences.

Drug treatment

After surgery, you must strictly take all prescribed medications; this is vital. And if someone thinks that it is harmful to the body, then problems are not far off.

Includes taking or injecting specific medicinal compounds, namely:

antibacterial medications from the spectrum of antibiotics (against the development of infection);
anticoagulant protective drugs (against venous thrombus formation);
non-steroidal anti-inflammatory drugs (against pain and inflammation);
gastroprotectors and drugs that improve the functioning of the urinary tract;
protein and calcium supplements to accelerate the regeneration of bone and muscle structures.

Comprehensive physiotherapy

Physiotherapy is an excellent addition to motor recovery.

These are procedures of electromyostimulation, electrophoresis, UHF, laser treatment, massage, balneotherapy and mud therapy, aimed at:

reduction of pain and swelling;
elimination of spasmodic phenomena in muscles;
stimulation of blood circulation and lymph circulation in the structures of the problematic leg;
increased muscle tone and strengthened ligaments;
activation of metabolic and regenerative processes in the lower limb.

Rehabilitation after hip replacement at home and in the hospital is a rather long and labor-intensive process that requires strength and patience. But if it is organized correctly, working capacity returns by the end of the 10th week. If the postoperative stages are complicated, recovery after hip replacement will most likely take 2 times longer.

There is a direct relationship: patients who are not overweight and lead an active lifestyle as much as possible before surgery recover faster than others.

Description of rehabilitation stages

Basic recovery after hip replacement takes 10 weeks. Of these, 3 weeks are the early phase, from the third to 10 weeks are the late stage. And all this time it is necessary to fruitfully carry out tasks and exercises for rehabilitation after hip replacement, dictated by the surgeon and rehabilitologist. Together, specialists create an effective physical therapy regimen.

The essence of training exercises is repeated, regularly repeated and consistently increasing physical activity, which gradually improves motor activity, dynamically improves and restores performance. After the entire specified period of time after surgery on the hip joint, rehabilitation does not completely end. All the achievements that the patient has been pursuing for so long and finally achieved the cherished painless freedom of movement must be consolidated.

Wonderful sanatoriums that provide proper rehabilitation after partial replacement and total hip replacement are located in the Leningrad region, Krasnodar region, and Karelia. If we talk about foreign European resorts, the clear leaders here are Teplice and Jáchymov, located in the Czech Republic.

Early stage

The person undergoing surgery is immediately transferred from the operating room to intensive care for 24 hours. This is done to control the main functionally significant indicators of the body’s condition: heart rate, breathing, blood pressure, etc., which is mandatory after any surgical procedure. They immediately begin antibiotic therapy and the administration of anticoagulants, take tests, and, if necessary, perform a blood transfusion. Breathing exercises are prescribed to prevent congestion in the lungs.

Compression cuffs are used to prevent thrombosis.

From the second day until the end of the 3rd week of the rehabilitation period after hip replacement, clinical care and recovery are carried out in the inpatient unit. The patient will be bothered by pain, which is a normal reaction of the body, therefore, in addition to taking NSAIDs, he will be shown physical therapy and cold dry compresses locally. They will relieve swelling located on the outer soft tissues above the replaced joint. Soreness and swelling, as soon as the suture heals, will stop causing suffering.

The arthrot is used from the second day after surgery for passive development of the joint.

Debilitating pain does not need to be endured; it will have a detrimental effect on both your psychological state and the activity of the main internal organs and systems, for example, the heart, stomach, intestines, circulatory and respiratory systems. Their dysfunction will prevent the normal launch of self-regulation and regeneration mechanisms. Therefore, do not torment yourself and your body, which is already weakened: if it hurts unbearably, tell the nurse or doctor about it, and they will provide you with the necessary help. If the painful manifestations are not severe, then, of course, it is better not to overuse pain relief.

Well, now let’s move on to consider the question: how is human activation carried out:

Walking on crutches is possible from 2-3 days in a light mode, leaning on crutches or a walker. The technique of using means of support and the method of movement when moving in space is usually taught to the patient in the preoperative preparatory period. Walking in the first days is allowed only under the guidance of a methodologist-instructor.
At this time, drainage tubes will be placed in the wound, so even if there is no pain, walking will not be enjoyable.
Sitting is allowed for the 3rd day, but it is important not to allow an excessive bending angle at the hip; the permissible maximum is an angle of 90 degrees and no more. You cannot stay in one “sitting” position for a long time (maximum 15-20 minutes); moreover, you must sit on a surface of normal height, not with low seats.
At first, the following rule applies: the patient either walks or lies horizontally, and cannot sit for a long time.
When a person is lying down, a special anatomical cushion must be placed between the limbs, which will protect against unwanted adduction of the limb and its crossing with the healthy leg. For now, you can only turn on your healthy side. You need to sleep and lie exclusively on your back.
Crossing your legs increases the risk of dislocation.
It is recommended to perform flexion-extension of the ankle and rotation of the feet during rehabilitation after surgery on the hip joints, as soon as the anesthesia wears off.
The exercise is safe and can be performed without special restrictions.
It is proposed to work with knee flexion/extension: sliding the heel along the bed sheet, bend the leg at the knee joint to a right angle and return it in the same way to a straight horizontal position.
If it is difficult to slide your foot along the surface, remove the sock.
You will also need to perform the following exercise while in bed: smoothly move the problematic limb to the side, while the toe of the foot strictly “looks” at the ceiling. Return to the starting position, relax, rest for 1 minute. Do 5 sets in a row. All exercises after hip replacement should not be done intensively with jerks!
In this exercise, the big toe should point straight up.
In the immediate postoperative period of rehabilitation after hip replacement, isometric exercises are prescribed to contract the quadriceps, gluteal, and calf muscles. Thanks to simple exercises on the tension of the corresponding segments, their tone increases, elasticity and firmness improve. Perform the workout in bed (lying on your back) according to the principle:

After leaving the hospital after hip replacement, rehabilitation in this scenario is easy to practice at home. However, the proposed range of activities must be supplemented, because then comes the late recovery phase, for which there are specific standards.

Late period

Successfully completed early stage rehabilitation measures culminate in the patient being discharged from the hospital. Now we either have to undergo rehabilitation after hip surgery at home or in a specialized treatment and rehabilitation center. There you will be organized high-quality, professional rehabilitation after surgery; it is unlikely that it will be possible to develop a hip joint at home so comprehensively and competently. Unless, of course, you yourself are an orthopedic traumatologist or exercise therapy instructor.

Balance exercises allow you to use stabilizer muscles that are not involved in normal life activities.

What are the specifics of late rehabilitation after hip replacement, and what new exercises are added?

Walking, starting from the 22nd day, is carried out up to 3-4 times a day for about half an hour, and closer to the third month, the total duration of walking daily should be approximately 4 hours. It is important to practice the correct posture of the body and gait when moving, to get rid of the usual adaptive postures and movements that a person is accustomed to long before the operation.
Walking with full load on the prosthetic limb is possible after 1-1.5 months if a cemented prosthesis model was used. If a cementless method was used, it is not advisable to create a full support until at least 2 months have passed.
The abolition of crutches and walkers, as a rule, occurs at the turn of 1.5-2 months, then the patient switches to a cane. It is not recommended to stop using a cane until the lameness disappears and you have absolute confidence in walking.
Late rehabilitation exercises after hip replacement include more varied and active types of training, but your doctor should recommend them to you. We suggest that you familiarize yourself with what common methods of exercise therapy are usually used in specialized centers.

Work with a rubber band, with exercises for abduction and flexion of the limb with resistance (do not cross your legs!).
Starting position lying on your back. Alternately bend your legs at the knee joints, lifting your limbs, the direction of movement of the knee is toward you.
Your hands can be placed on your stomach or extended along your body.
Lie on your stomach. Bend your legs simultaneously or alternately, bringing your feet closer to your buttocks. In the same position, lifting the straightened legs up (alternately) is useful. You can also imitate swimming, with only your arms actively working, your chest raised, your limbs straight (if it is not difficult for the patient, he can slightly lift his legs off the floor).
Try to touch your heel to your buttock. It is unlikely that you will succeed, but this should be the goal.
Alternate abduction of straightened limbs in the lateral direction from a lying position on the back and on the stomach. To do this, you need to slightly raise your working leg and move it to the side, then carefully return to the starting point. By analogy, we do gymnastics after hip replacement and in a vertical position.
The toe is directed strictly upward as the exercise progresses.
Lifting straight limbs one by one, while pulling the toe towards you. The task can be performed in both a lying and standing position. If the patient is exercising while standing, then you need to hold on to any support suitable for insurance, for example, the back of a chair.
Hold for a few seconds at the end point.
Raising a bent leg, extending it in weight, followed by bending, and at the end, place a flat limb on the floor. This technique, as you might understand, is done in a horizontal position of the body.
You can give additional load by placing your healthy leg on top of the sore leg.
If you had surgery on the hip joint 1-1.5 months ago, rehabilitation is proceeding well, then you can include the “bicycle” exercise in your daily routine.
A bicycle is the best equipment for physical activity.
In addition to the listed methods of training, partial squats, quiet exercises on an exercise bike, on balancing equipment to develop support strength and balance, as well as various techniques of movement with a ball and weights are included. Additionally, a visit to the pool is prescribed, where therapeutic exercises in water and recreational swimming will be carried out.

Distant phase

It is reasonable if rehabilitation after hip replacement takes place in a sanatorium at a later date. In addition to rehabilitation and physical education methods, which are implemented using various rehabilitation equipment and exercise equipment in the gym or in the aquatic environment, health clinics specialize in the use of natural healing sources, unique in their chemical and biological composition.

Start visiting the pool, it is very useful.

In sanatoriums, recovery after hip replacement is based on the use of peloid therapy courses (therapeutic mud applications) and balneotherapy in the form of brine (mineral), radon, carbon dioxide, pearl baths, etc. Swimming in the pool. Organic and inorganic substances contained in healing mud and waters penetrate into the body at the time of the treatment session and fruitfully contribute to:

strengthening bones, increasing muscle endurance;
resorption of skin, tendon, muscle scar formations, mobility increases not only at the site of the artificial joint, but also in other osteochondral organs;
improving blood supply and nutrition in problem segments;
eliminating swelling of soft tissue structures;
getting rid of the pain factor, which often continues to disturb to one degree or another, even after a long time has passed from the moment of prosthetics;
coherence of the central nervous system, mental harmony, positive attitude, normalization of sleep and daytime vigor.

Rehabilitation after surgery Hip arthroplasty is to create special conditions for the patient that would contribute to the speedy restoration of full motor functions and a full life of a person.

It is very important that, while at home, a person can effectively and restore your motor activity in the shortest possible time to the maximum extent possible. To do this, there are a number of rules, following which you can achieve success.

Such surgical intervention is usually performed for certain forms of femoral neck fractures, rheumatoid arthritis, and coxarthrosis. A few decades ago, such diseases provided for mandatory disability. Nowadays, thanks to advances in orthopedics, the patient has the opportunity to restore the full functions of his hip joint by replacing it with an endoprosthesis. However, after the operation it is necessary to carefully adhere to doctor's recommendations and give yourself strictly dosed but regular physical activity.

A properly planned rehabilitation period after endoprosthetics surgery consists of three main stages.

Early postoperative period

In the first hours and days after the operation to install the prosthesis, the patient is under the supervision of the attending physician. It is mandatory for a person to carry out control of blood pressure, temperature, body, pulse. At least 12 days must pass from the moment of surgery to discharge from the hospital.

On the first day after surgery, significant swelling persists, which can be reduced with an ice compress.
If necessary, the attending physician prescribes drug treatment - antibacterial therapy, anti-inflammatory and antiplatelet agents.
Pain syndrome occurs in the early postoperative period. This phenomenon is absolutely normal and natural for the operation performed. As a rule, the attending physician prescribes tablets or injections of analgesic drugs in this case. The duration of use is controlled by the attending physician based on the patient's condition.
The patient should spend the first day lying on his back. It is not recommended to bend the leg at an angle of less than 90 degrees to prevent dislocation in the joint.
A special cushion is placed between the patient’s limbs to avoid injury. In the first days, the patient is recommended to slightly move the operated leg to the side.

If the patient's blanket is too low at his feet, it is strictly forbidden to get up and take the blanket on his own.

Late period

After the early period of rehabilitation after hip replacement has been completed, the next stage begins. Several months may pass from the day of surgery to the end of this period. The patient is gradually allowed to increase the duration of walking with support. A prerequisite for this is to keep your back straight and look straight ahead.

The maximum amount of time you can walk after a total joint replacement is 30 minutes a day. You can gradually increase the speed of movement and distance, but the time must remain the same. In the first 2 months, a person should not walk up stairs higher than 1 flight..

A prerequisite for rehabilitation after endoprosthetics surgery is to provide the patient with complete mandatory rest in the correct position. It is best to rest while lying on your back. If for some reason the patient prefers to lie on his side, a pillow or a small soft cushion must be placed between the knees.

It is best to sleep on a hard orthopedic mattress. During the rehabilitation period after hip replacement, it is necessary to get dressed with the help of loved ones while sitting on a chair. Since bending towards the feet promotes maximum flexion in the hip joint, it is strictly forbidden to put on socks or shoes on your own during this period. It is recommended to move around with the help of a cane during this time..

Functional recovery period

The rehabilitation period after surgery to replace the hip joint begins three months later, but the recovery measures are far from over.

If after the end of the rehabilitation period for total joint replacement there is still pain and discomfort in the joint or leg, you need to use a cane. The person is allowed to return to his job and drive a car no earlier than after a few months. However, at least 12 months must pass before professional sports are allowed to take place.

In some cases, the rehabilitation period after hip replacement at home can be significantly extended by the doctor. The following factors may influence this:

Age of the operated patient.
Anamnestic data.
The presence of concomitant systemic pathologies.
Intolerance to certain medications.

To speed up the rehabilitation process after endoprosthetics and make it more intense, the doctor may prescribe therapeutic exercises, massage, and kinesiotherapy. Every year it is highly advisable to undergo a course of treatment in specialized sanatoriums for the rehabilitation of patients with diseases of the musculoskeletal system.

Preparing the living space for the patient

To ensure that the patient after hip transplant surgery is as comfortable as possible to promote maximum recovery:

It is necessary to remove all carpets and rugs from the floor so that the patient does not catch his foot or crutch and fall.
It is advisable to install special handrails on walls in places with increased danger. We are talking about the patient’s bathroom, toilet, bedroom.
If possible, you can buy or rent a special medical bed that can be adjusted in height. In such a bed, not only is it much more comfortable to rest, but it is also very easy to get out of it.
You must wash in the shower or bath while sitting. You can place a low chair or stool in the bath or shower stall. You can place a special board on the edge of the bathtub. It is recommended to attach special handrails to the wall to make it easier for the patient to get out of the bath.
You must place a special stand or inflatable ring on the toilet. This is due to the fact that the patient should not bend his legs at the joints more than 90 degrees, and standard toilets do not facilitate this.

What can you do after surgery?

Rehabilitation after hip surgery at home includes the following rules of conduct:

1. It is allowed to rest on your back for at least 40 minutes a day with a frequency of at least 4 times.

2. Clothes should only be worn while sitting.

3. Only relatives can put stockings, socks and shoes on the patient.

4. When sitting on a chair, you must spread your feet at least 20 cm apart.

5. You can little by little do household chores according to your abilities - wash dishes, dust, cook.

6. Walking without support on your own during the recovery period after hip replacement is allowed no earlier than after 4 months.

7. If you have to stay in one place for a long time, it is better to sit on a chair.

8. It is necessary to sleep in such a position that the toes of the affected limb are facing upward.

9. When resting, place a special cushion or pillow under your feet.

In order for the joint to remain securely in place during the recovery period after hip replacement, it must be held securely and firmly by the muscles. To do this, they need to be trained using special sets of gymnastic exercises. These simple recommendations after hip replacement will help the patient improve their quality of life and restore full functioning.

Any surgical operation is a colossal stress for the human body. During the recovery period, it is not recommended to perform the following actions that could harm the patient and disrupt the proper functioning of the joint:

2. It is prohibited to stand in one place for a long time. As a last resort, this should be done with your feet shoulder-width apart and keeping your body straight. This pose promotes maximum relaxation of the muscles in the hip joint.

3. It is not allowed to sleep or lie turning on the sore side or crossing your legs.

Until the prosthesis has completely taken root, it is recommended to walk very smoothly and at low speed. It is better to use a cane when walking. It must be held on the side of the operated limb.

What kind of training can you do?

You can improve your quality of life after hip replacement with measured physical activity. At the later stage of rehabilitation, special exercises using a rubber band can be very effective. It is attached to a stationary surface and placed on the operated limb. It is necessary to gradually stretch the tape with the affected leg back and forth. It is recommended to consult with your treating orthopedist and exercise therapy specialist and find out how much training you can do during the day.

Exercising on exercise bikes is allowed in strictly limited doses. It should be remembered that you cannot bend your leg more than 90 degrees. First you need to learn how to pedal backwards, and then forward.

You can train to balance your body position in space. To do this, you can first stand on the healthy leg and then on the operated leg, replacing the legs one by one. At the very beginning, you can stick to a wall or other suitable surface. Gradually, the load on the legs can be expanded by adding swing with your free leg first and then pulling back the rubber band. These comprehensive workouts will help improve blood circulation and increase the strength and elasticity of the thigh muscles.

A very good tool for training at home is a special platform for doing step aerobics. These exercises perfectly train the body to balance and maintain balance.

Can be included in physical complex for recovery after hip surgery exercises on a treadmill. You need to move along it with the movement, and not against it. The feet should roll smoothly from toe to heel.

At the initial stages of rehabilitation after total hip replacement the patient is allowed to walk for no more than 10 minutes. Gradually, the load time increases to 30 minutes, and they must be spaced 2-3 times during the day. Even after complete recovery and abandonment of the cane and other supports, it is recommended to take walks for 30–40 minutes 3–4 times a week. A full life after hip replacement requires a balanced diet, adherence to a work-rest regime, and periodic monitoring by a specialist.

Studies show that complications after hip replacement develop in 1% of young people and 2.5% of older patients. Despite the minuscule probability of developing negative consequences, they can affect anyone, and especially those who did not strictly follow the rehabilitation program.

Image of the position of the endoprosthesis in the human body.

Complications after hip replacement are caused by improper postoperative care and physical activity after discharge from the hospital. The second reason is the surgeon's mistakes. And third, this is an incomplete preoperative examination, as a result of which hidden infections (tonsils, cystitis, etc.) were not cured. The success of treatment is influenced by the qualifications of the medical staff, where the patient received high-tech medical care - surgical and rehabilitation treatment.

The pain can be different, there is “good” pain - after moderate physical activity. And there is a “bad” one, which speaks of problems that need to be urgently diagnosed.

Complication statistics as a percentage

Surgery to install a hip joint prosthesis is the only method that “puts” the patient back on his feet, relieves him of debilitating pain and limited ability to work, and allows him to return to healthy physical activity. Unpleasant pathological situations associated with implantation occur infrequently, about which the patient should be informed. According to ongoing randomized controlled trials, the following data were obtained:

dislocation of the head of the prosthesis develops in approximately 1.9% of cases;
septic pathogenesis – in 1.37%;
thromboembolism– 0.3%;
periprosthetic fracture occurs in 0.2% of cases.

They develop not through the fault of the surgeon, but of the patient himself, who did not continue rehabilitation or did not adhere to a special physical regimen after the end of recovery. The deterioration of the condition occurs at home, when there is no close monitoring from doctors that was in the clinic.

Not a single orthopedic specialist, even with rich and impeccable work experience, can 100% predict how a particular body will behave after such complex manipulations on the musculoskeletal system, and give the patient a complete guarantee that everything will go smoothly and without incidents.

Differentiation of pain: normal or not

Pain after hip replacement will be observed in the early period, because the body has undergone a serious orthopedic operation. The painful syndrome during the first 2-3 weeks is a natural response of the body to a recent surgical injury, which is not considered a deviation.

Until the surgical injury heals, the muscle structures return to normal, until the bones and the endoprosthesis become a single kinematic link, the person will experience discomfort for some time. Therefore, a good pain reliever is prescribed, which helps to cope with early painful symptoms more easily and to better concentrate on treatment and rehabilitation activities.

Well-healing suture after surgery. It is smooth, pale and has no discharge.

Painful sensations must be differentiated and examined: which of them is normal and which is a real threat. This can be done by the operating surgeon. The patient’s task is to notify the orthopedic doctor if there are any uncomfortable signs.

Main risk factors

Surgical intervention does not exclude complications, and serious ones at that. Especially if mistakes were made during the intra- and/or postoperative period. Even small errors during surgery or during rehabilitation increase the likelihood of unsatisfactory hip arthroplasty. There are also risk factors that increase the body’s susceptibility to postoperative consequences and often become their cause:

advanced age of a person;
severe concomitant disease, for example, diabetes mellitus, arthritis of rheumatoid etiology, psoriasis, lupus erythematosus;
any previous surgical intervention on the “native” joint, aimed at treating dysplasia, femoral fractures, coxarthrosis deformities (osteosynthesis, osteotomy, etc.);
re-endoprosthetics, that is, repeated replacement of the hip joint;
local inflammation and purulent foci in the patient's history.

It should be noted that after hip joint replacement, elderly people are more susceptible to complications, and especially those over 60. In addition to the underlying disease, elderly patients have concomitant pathologies that can complicate the course of rehabilitation, for example, reduce resistance to infection. There is a reduced potential for reparative and restorative functions, weakness of the musculo-ligamentous system, osteoporotic signs and lymphovenous insufficiency of the lower extremities.

It is more difficult for older people to recover, but this can be done successfully.

Concept and methods of treating consequences

Symptoms of complications after hip replacement will be presented below in the table for better understanding. A quick visit to a doctor at the first suspicious signs will help to avoid the progression of adverse events, and in some situations, to save the implant without revision surgery. The more advanced the clinical picture becomes, the more difficult it will be to respond to therapeutic correction.

Dislocations and subluxations of the endoprosthesis

Negative excess occurs in the first year after prosthetics. This is the most common pathological condition in which the femoral component is displaced in relation to the acetabular element, resulting in separation of the head and cup of the endoprosthesis. Provocative factors are excessive loads, errors in the selection of the model and installation of the implant (defects in the placement angle), the use of a posterior surgical approach, and trauma.

Dislocation of the femoral component on x-ray.

The risk group includes people with hip fractures, dysplasia, neuromuscular pathologies, obesity, joint hypermobility, Ehlers syndrome, and patients over 60 years of age. Individuals who have undergone surgery on a natural hip joint in the past are also particularly vulnerable to dislocation. The dislocation requires non-surgical reduction or open repair. If treated in a timely manner, the endoprosthetic head can be adjusted in a closed manner under anesthesia. If the problem continues, the doctor may prescribe a repeat operation to reinstall the endoprosthesis.

Paraprosthetic infection

The second most common phenomenon, characterized by the activation of severe purulent-inflammatory processes in the area of the installed implant. Infectious antigens are introduced intraoperatively through insufficiently sterile surgical instruments (rarely) or after intervention they move through the bloodstream from any problematic organ that has a pathogenic microbial environment (often). Poor treatment of the wound area or poor healing (in diabetes) also contributes to the development and proliferation of bacteria.

Discharge from a surgical wound is a bad sign.

A purulent focus has a detrimental effect on the strength of fixation of the endoprosthesis, causing its loosening and instability. Pyogenic microflora is difficult to treat and, as a rule, requires removal of the implant and re-installation after a long time. The main principle of treatment is a test to determine the type of infection, long-term antibiotic therapy, and abundant lavage of the wound with antiseptic solutions.

The arrows indicate areas of infectious inflammation, this is exactly what they look like on an x-ray.

Thromboembolism (PE)

PE is a critical blockage of the branches or main trunk of the pulmonary artery by a detached thrombus, which formed after implantation in the deep veins of the lower limb due to low blood circulation resulting from limited mobility of the leg. The culprits of thrombosis are the lack of early rehabilitation and necessary drug treatment, prolonged stay in an immobilized state.

This complication is dealt with quite successfully at this stage of medical development.

Blocking the lumen of the lungs is dangerously fatal, so the patient is immediately hospitalized in the intensive care unit, where, taking into account the severity of the thrombotic syndrome: administration of thrombolytics and drugs that reduce blood clotting, NMS and mechanical ventilation, embolectomy, etc.

Periprosthetic fracture

This is a violation of the integrity of the femur in the stem area with an unstable and stable prosthesis, occurring intraoperatively or at any time after surgery (several days, months or years). Fractures more often occur due to reduced bone density, but may be the result of incompetent development of the bone canal before installing an artificial joint, or an incorrectly chosen method of fixation. Therapy, depending on the type and severity of the damage, consists of using one of the methods of osteosynthesis. The leg, if necessary, is replaced with a more suitable configuration.

Implant failure occurs very rarely.

Sciatic nerve neuropathy

Neuropathic syndrome is a lesion of the peroneal nerve, which is part of the structure of the greater sciatic nerve, which can be caused by lengthening of the leg after prosthetics, pressure of the resulting hematoma on the nerve formation, or, less commonly, intraoperative damage due to careless actions of the surgeon. Nerve restoration is performed through etiological treatment with the optimal surgical method or through physical rehabilitation.

When an inexperienced surgeon works, there is a risk of injury to the femoral nerves.

Symptoms in the table

Syndrome	Symptoms
Dislocation (impaired congruence) of the prosthesis	Paroxysmal pain, muscle spasms in the hip joint, aggravated by movements; in a static position, the severity of pain is not so intense; forced specific position of the entire lower limb; Over time, the leg shortens and lameness appears.
Local infectious process	Severe pain, swelling, redness and hyperthermia of the soft tissues over the joint, exudate from the wound; increase in general body temperature, inability to step on the foot due to pain, impaired motor functions; purulent discharge from the wound, up to the formation of a fistula, is observed in advanced forms.
Thrombosis and pulmonary embolism (thromboembolism)	Venous congestion in a diseased limb can be asymptomatic, which can lead to unpredictable separation of a blood clot; with thrombosis, swelling of the limb, a feeling of fullness and heaviness, and nagging pain in the leg (intensify with load or change of position) can be observed in varying severity; PE is accompanied by shortness of breath, general weakness, loss of consciousness, and in the critical phase – blue discoloration of the skin of the body, suffocation, and even death.
Periprosthetic bone fracture	Acute pain attack, rapidly growing local swelling, redness of the skin; crunching sound when walking or palpating a problem area; severe pain when moving with an axial load, tenderness of soft structures on palpation; deformation of the leg and smoothness of the anatomical landmarks of the hip joint; impossibility of active movements.
Lesser tibial nerve neuropathy	numbness of a limb in the hip or foot area; ankle weakness (foot drop syndrome); inhibition of motor activity of the foot and toes of the operated leg; the nature, intensity and location of pain can be variable.

Preventive measures

Complications after hip replacement are much easier to prevent than to then undergo labor-intensive and lengthy treatment to get rid of them. Unsatisfactory development of the situation can nullify all the efforts of the surgeon. Therapy does not always give a positive effect and the expected result, therefore leading clinics provide a comprehensive perioperative program for the prevention of all existing consequences.

Infections are treated with antibiotics, which in itself is quite harmful to the body.

At the preoperative stage, diagnostics are performed for infections in the body, diseases of internal organs, allergies, etc. If inflammatory and infectious processes are detected, chronic diseases in the stage of decompensation, surgical measures will not begin until the identified foci of infections are cured, venous-vascular problems will not be reduced to an acceptable level, and other ailments will not be brought into a state of stable remission.

Currently, almost all implants are made from hypoallergenic materials.

If there is a predisposition to allergic reactions, this fact is examined and taken into account, since the choice of medications, endoprosthesis materials and type of anesthesia depends on it. The entire surgical process and further rehabilitation are based on assessing the health status of internal organs and systems, age criteria and weight. To minimize the risks of complications after hip joint replacement, prophylaxis is carried out before and during the procedure, after surgery, including the long-term period. Comprehensive preventive approach:

drug elimination of the infectious source, full compensation of chronic ailments;
prescribing certain doses of low molecular weight heparins 12 hours in advance to prevent thrombotic events; antithrombotic therapy continues for some time after surgery;
the use of broad-spectrum antibiotics active against a wide group of pathogens a couple of hours before the upcoming hip replacement and for several days;
technically impeccable surgical intervention, with minimal trauma, avoiding significant blood loss and the appearance of hematomas;
selection of an ideal prosthetic structure that completely coincides with the anatomical parameters of the real bone connection, including its correct fixation at the correct orientation angle, which in the future guarantees the stability of the implant, its integrity and excellent functionality;
early activation of the patient in order to prevent stagnant processes in the leg, muscle atrophy and contractures, inclusion from the first day of exercise therapy and physiotherapy procedures (electromyostimulation, magnetic therapy, etc.), breathing exercises, as well as high-quality care for the surgical wound;
informing the patient about all possible complications, permitted and unacceptable types of physical activity, precautions and the need to regularly perform physical therapy exercises.

Communication between the patient and the medical staff plays a huge role in successful treatment. This is what is called service, because when the patient is fully instructed, he better perceives the processes occurring in his body.

The patient must realize that the outcome of the operation and the success of the recovery depend not only on the degree of professionalism of the doctors, but also on himself. After hip joint replacement, it is possible to avoid unwanted complications, but only if you strictly follow the recommendations of specialists.

After any surgical intervention in the human body, time is required for its recovery.

Hip replacement surgery is no exception.

The main reasons for hip replacement

Arthrosis

This is when the cartilage of the hip joint is affected. The most common is deforming osteoarthritis - a disease of older people whose cartilage simply wears out. As a result, the patient experiences pain, joint mobility decreases, etc. Other reasons for the manifestation of arthrosis of the hip joint may be its incorrect development and poorly fused bones after fractures in the joint area.

Femoral neck fracture

For older people, such an injury can be a death sentence, because... Most often, such a fracture does not heal. The only way to get a person back on his feet and not only is to undergo hip replacement surgery.

Arthritis

Arthritis - joints are also susceptible to all sorts of inflammatory diseases (for example, rheumatoid arthritis).

As for rehabilitation after hip replacement, there is no single method.

Postoperative recovery largely depends on the underlying causes that necessitated the operation itself. Take, for example, a hip fracture. Surgery soon after injury is the key to a faster recovery for the patient, because the muscles surrounding the hip joint did not have time to lose their functions and tone. It’s another matter if a person did not fully step on his sore leg for a long period of time, suffered and suffered from pain, and only a few years later he undergoes endoprosthetic surgery. In this case, rehabilitation will take much longer, because The patient was unable to fully lean on his sore leg for a long period of time, as a result of which muscle atrophy occurred.

The same rules apply to the situation with arthrosis: not advanced disease and timely endoprosthetics will help you recover much faster than postponing the operation for a long time - because of this, not only bone tissue, but also muscles suffer.

In any case, whatever the reasons for the need for surgery, the set of rehabilitation exercises is almost the same for all situations, and the entire recovery process begins immediately after the operation.

Beginning - 0th phase of rehabilitation

The zero phase of postoperative recovery is the very first step of the entire rehabilitation process.

The main goals that need to be achieved in this phase are:

Improving blood supply to the legs to avoid blood clots.
Strengthening the muscles and “developing” the movements of the hip joint.

These exercises are mandatory and will not only help you recover faster, but will also reduce post-operative pain.

Classes should begin as soon as the anesthesia wears off - if it was an injection in the back (regional anesthesia), then the patient will not be able to move his legs for the first 2-6 hours. The pace should be slow and careful. At first, not everything will work out equally well. However, exercises should be done every day in the morning, afternoon and evening.

Foot pump

This exercise can be done immediately after surgery and throughout the entire rehabilitation process. Lying (sitting) in bed or sitting in a chair, slow movements of the foot are made - up and down. The exercise should be done several times every 5-10 minutes.

Rotation at the ankle joint

During this exercise, rotational movements are made with the foot of the operated leg: first 5 times clockwise, then the same number of times counterclockwise. Rotational movements should involve only the ankle joint (not the knee!). This exercise can be done either lying down or in a sitting position.

Exercise for the quadriceps femoris muscle

The quadriceps femoris is a muscle located on the front of the thigh. The essence of the exercise is to tense the quadriceps muscles s. To do this, try to straighten your knee, pressing the back of your leg to the bed. The muscle should be held in tension for 5-10 seconds. The exercise is done 10 times with both legs.

Knee flexion with heel support

The heel - without lifting off the surface of the bed and bending the knee - is pulled up to the buttocks. In this case, the knee should not lean towards the other leg, and the bend angle of the hip joint should not exceed 90°. The exercise is done 10 times.

On the first day after surgery, it may be difficult to do this exercise - in this case, it is better to wait and not do it. If difficulties with the exercise continue to arise later, you can help yourself tighten your heel using a tape or a folded sheet.

Contraction of the buttocks

This exercise involves the gluteal muscles: they need to be squeezed and held in a tense state for up to 5 seconds. The exercise is repeated 10 times.

Lead

The exercise involves the operated leg, which must be moved as far as possible to the side and then returned to its original position. And so on up to 10 times. As a rule, few people succeed in this exercise on the first postoperative day - in this case, there is no need to rush to do it.

Straight leg raise

During this exercise, the thigh muscles should be tense so that the knee of the leg lying on the surface of the bed is as straight as possible. Then you need to try to raise your straightened leg at least a few centimeters above the surface of the bed. And so 10 times with the “sick” and healthy leg. Not everyone can do the final exercise of the zero phase in the first postoperative days, so there is no need to rush into it.

Epilogue

All of the above exercises of the zero phase of the rehabilitation process should be performed not only in the very first days after the endoprosthetics operation. hip joint. Improving blood supply, strengthening muscles and restoring the working functions of the hip joint will be relevant throughout the rehabilitation.

"Strict Care" or Phase 1

At this stage of postoperative rehabilitation (1-4 days), the patient, under the supervision of a doctor, learns some independent things, namely: get out of bed, lie down in it, walk on crutches or a walker, sit on and get up from a chair, use the toilet and do exercises .

The patient must spend the first postoperative day lying in bed - even for procedures that may be necessary, the patient will be transported on a gurney.

On the second day, the doctor responsible for the treatment or rehabilitation of the patient will put his ward on his feet and force him to walk on crutches or with a walker, and it will be possible to step on the operated leg.

And not just step on, but (in most cases) “lean” on it with the entire weight of your body. Under some circumstances, the doctor may prescribe less radical partial loads on the newly acquired hip joint - the increase in loads on the operated leg will occur gradually.

The right angle rule, or preventing dislocation

How much, how and what exercises to do is not all that the owner of a hip endoprosthesis should know. You should always remember that careless behavior in the postoperative period can lead to joint dislocation. To prevent this from happening, in the first months after endoprosthetics you need to adhere to several rules:

Rule #1: The right angle rule - does this mean that you cannot bend your leg at the hip joint more than 90? (i.e. the knee of the leg should be below the waist, and not at the same level or higher). You should also not cross your legs or squat.

In order not to violate the conditions of the right angle rule even at night and not to expose the new joint to the threat of dislocation, you can put 1-2 pillows between your legs. You can sit on a chair or in an armchair only if the right angle rule is observed, i.e. The angle of flexion of the hip joint is less than 90°.

Rule #2: When lying in bed or sitting on a chair, the operated leg should be moved slightly to the side of the healthy leg (if sitting, then, as it were, in a squat position).

This will allow you to relax those muscles that were surgically cut when installing the endoprosthesis. After the surgeon has stitched them back together, the muscles need 3-4 weeks of rest for complete healing, i.e. Do not strain your leg too much and keep it in a slightly abducted position. To ensure the correct position of the operated leg, you can do a small test - the thumb test. To do this, the finger is placed on the outer surface of the thigh and if the leg is in the correct position, then its knee will be to the right of the finger if the leg is right, or to the left if the leg is left.

Rule #3: While in bed, you should not reach for a blanket or other object located at your feet.

To do this, you should use assistive devices or the help of others. This also applies to shoes - you cannot put on shoes without a spoon, and in a hospital setting it is best to wear shoes without a back.

Rule #4: You cannot sleep on the operated side, but only on the healthy one!

In this case, there should be a cushion or pillow between the knees, which will help relax the gluteal muscles and protect them from being torn off.

Rule #5: When lying on your back, you should not keep a pillow or bolster under your knee all the time.

This to some extent helps to reduce pain, but at the same time, a constant half-bent position of the knee will complicate the extension of the hip joint in the future.

After 1-1.5 months, the muscles, tendons and ligaments surrounding the new joint will become so strong that it will be possible to abandon some of the precautions described above - for example, using a pillow between the legs at night.

From about the second day after the operation, you should try to get up - if not by yourself, then with someone’s help.

In a standing position, holding onto a stable and reliable support (the back of a chair or bed), you should perform a series of exercises - at least 10 times each.

Standing Knee Raise

The knee of the operated leg does not rise too high - below the waist - and is held raised for about two seconds, and then lowered.

Straightening the hip joint in a standing position

The operated leg is slowly pulled back, while the back should be kept straight. The leg is held in this position for 2-3 seconds, and then returns to its original place.

Leg abduction in a standing position

The foot, knee and thigh of the operated leg should be in a straight direction, the body straight - in this position the leg is moved to the side. Then slowly the leg returns to its original position (the foot should be on the floor).

Goals of the first phase

A set of rehabilitation measures at this stage of the postoperative period combines strengthening and development of muscles and a new joint in a lying, standing and walking position.

1st stage: training the muscles of the thigh (raising the straight leg and squeezing the pillow sandwiched between the legs), buttocks (squeezing the buttocks) and lower leg (move the foot).
2nd stage: When getting out of bed, you should stretch your operated leg.
3rd stage: Associated with walking with crutches or a walker. It’s great if on the 4th or 5th day after endoprosthetics the owner of the new joint is able to walk 100-150 m in 4-5 day walks. When walking, you should avoid limping - the steps may be small. The load on both legs should be symmetrical (unless there are medical contraindications). By the 4-5th day you should normalize your gait, i.e. When walking, the operated leg should not be pulled up, but placed in front of the healthy leg.

“Deceptive Opportunities” or Phase 2

5 days after hip replacement surgery, a new phase of recovery and rehabilitation begins, during which you need to learn how to move up and down stairs. This kind of stress on the operated leg requires strength in the muscles and mobility of the joint itself, and it would be best to avoid walking on stairs until complete recovery. However, the realities of life are such that we have stairs everywhere.

Walking on stairs - climbing

Since we cannot avoid the stairs, we should move along them in a certain sequence:

When going up (and down) the stairs, you should take one step at a time, and hold on to the railing with the hand that belongs to your healthy leg, i.e. If the right leg is operated on, then you need to grab the railing with your left hand.
The movement up the stairs should begin with the healthy leg.
After this, the operated leg is placed one step higher.
A crutch or support stick is moved to the same step.

Walking on stairs - going down

You need to start going down the stairs in the reverse order: the movement is “opened” by a crutch (or stick), which is placed on the step below; behind the crutch, the operated leg is placed on the same step; The healthy limb is placed down after the operated leg.

Why "deceptive opportunities"?

As a rule, 5 days after surgery, a person’s postoperative weakness goes away, he can already do some exercises, the feeling of his legs gets stronger, and this is precisely what can do a disservice. Successful post-operative recovery makes you want to force things, neglect basic safety rules - do not use pillows, reach for objects, “run” more than 100-150 m, etc. As a result, such bravado can only lead to increased pain (the muscles haven’t really healed yet) or, God forbid, a dislocated joint.

“Getting started” or 3rd phase

A month and a half after the operation, the muscles have already fused quite well, and now it’s time to increase the load on them. The main goals of this rehabilitation phase (4 to 8 weeks after surgery) are:

Strengthening and complete restoration of the functions of the thigh muscles, with the goal of subsequently moving from two crutches to two sticks, then using only one cane, and in the end - to completely abandoning auxiliary objects for support when walking.
Learn to walk backwards, i.e. backwards
Restore a sense of balance - for example, balance on one leg, holding onto some support with your hand.
Restore the functioning of the hip joint so that it is possible not only to straighten the leg, but also to move it back at an angle of 10-20?.
By the end of this rehabilitation period, a person with a hip replacement should be able to pass the Forward Bend and Timed Walk tests.

And now in more detail about how and with what exercises all this can be achieved.

Exercises using an elastic band are done 10 times in the morning, afternoon and evening. An elastic band is attached at one end to the ankle of the operated leg, and at the other to a wall bars, a heavy piece of furniture, or, at worst, to a closed door. To maintain balance, hold on to the back of a chair or bed. The essence of the exercise is to stretch the straight “sick” leg forward.

Resistance Exercise - Hip Flexion

To do this exercise, you need to stand with your back to a door, heavy object or wall where one end of the elastic band is fixed. In this case, the operated leg with the other end of the elastic band on it should be slightly set aside. The prosthetic leg with the knee straightened is raised forward and then put back in its original place without haste.

Resistance exercise - standing leg abduction

You need to stand with your healthy side towards the object on which the elastic band is attached, and move the “sick” leg to the side, and then slowly return it to its original place.

First of all, you need to know that under no circumstances should you give up a crutch or cane until you are confident in your own balance.

At the first stage you need to walk 3-4 times daily. The duration of each such walk should not exceed 5-10 minutes. At the second stage, when the muscles become even stronger, endurance increases, the number of daily walks can be reduced to 2-3, but at the same time make them longer - from 20 minutes to half an hour. Walking (3-4 times a week for half an hour) is recommended even after complete recovery, maintaining the results obtained in the muscles.

Exercises on simulators: hip extension training

For this exercise a special simulator is used. The peculiarity of performing this exercise is that it is necessary to exclude movements of the spine (in particular, its lumbar region), because engaging the lower back helps the patient compensate for what his hip joint cannot yet do.

An exercise bike is an excellent helper in strengthening muscles and “developing” the hip joint. To start the exercise bike must be adjusted correctly under you: the seat should be at such a height that your leg with a straightened knee barely touches the pedal.

At the first stage of working with an exercise bike, the pedals need to be turned in the opposite direction. You should move to the second stage - pedaling forward - only when the pedals spin backward easily and without much effort.

As the muscles get stronger, load level needs to be increased. If at first you should pedal forward no more than twice a day for 10-15 minutes, then over time you can switch to pedaling forward for 20-30 minutes 3-4 times a week. At the same time, we must not forget the right angle rule, which prohibits lifting the knee above the hip joint.

Exercises using an exercise bike with short pedals

The seat of an exercise bike with short pedals (10 cm) is adjusted so that the “sick” leg touching the pedal in its lowest position is completely straight.

Training balance

Getting your balance back is just as important as having strong muscles. Balance training you can start by trying to stand on one leg, holding your hand on some reliable support. This search for balance should be done with both legs, but you need to start with the healthy leg. Balance exercises gradually become more difficult.

Dynamic balance training on the non-operated leg and with an elastic band

For this exercise, take a 2-meter elastic band, the free ends of which are tied to some heavy and stationary object - for example, to a wall bars - at a level of 20 cm from the floor. The patient, standing on the operated leg, puts the loop obtained from the tape on the healthy leg at the level of the ankles. In this case, it should stand at a distance of 60-70 cm from the object (wall) on which the tape is attached. The overall stance should combine a straight body and slightly bent knees. And in this position, the patient swings to the side with his healthy leg with an elastic band. Thus, the muscles of both the operated and healthy leg are trained, consistency in their work appears, and therefore balance.

Balance training - step-down exercises with visual guidance

At first, a low 10-centimeter step is used. The patient standing on the steppe begins the descent with a slow step forward with the healthy leg. At this moment, the entire weight of the body lies on the operated leg. The exercise should be done while standing in front of a mirror so that you can control the condition of your legs - when descending, it is especially important to avoid the possibility of falling on your sore leg. This is then followed by returning to the starting position and repeating the exercise. If everything goes well, then over time you can increase the height of the step to 15-20 cm.

Balance training - step-up exercises with visual guidance

This exercise is performed in exactly the same way as the previous one. The only difference is that now the patient stands in front of a 10 cm step on the floor. With his healthy leg, he takes a slow step forward onto the step, while leaning his whole body on the operated leg. There is a mirror in front of him to visually control the situation with the position of the legs. Just as in the first case, it is necessary to avoid falling towards the prosthetic leg while climbing the step. Gradually you can increase the height of the step to 15-20 cm.

Learning to walk backwards

This exercise is done on a treadmill, only the patient stands on it not as usual (facing the control panel), but with his back. The speed limit of the track is set to no more than 1-2 km/h. Walking backwards is a movement from the toes to the heel. In this case, when the entire foot is on the track, the leg at the knee should be straightened.

Exercise lying on your side - abduction in the hip joint

The patient lies on his side, with the affected leg on top. The legs are slightly bent at the knees and hip joint. There must be a pillow under your head to avoid tension in the muscles and distortion of the pelvis. At the initial stage, you can also use a roller between your legs. Keeping the heels together, the knee of the operated leg rises, while the pelvis and back do not move.

Taking tests - tilt test

You need to stand sideways to the wall on which the measuring tape is attached. The legs should be slightly apart. Stretching his arm forward, the patient bends over as much as he can, while he cannot “help” himself with his legs. This distance is measured. A total of three such measurements are taken - before and after training. The data obtained allows us to judge the effectiveness of the exercises performed.

The normative indicator for men under 70 years of age is considered to be a distance of 38 cm, and for those over 70 - 33 cm. For women under 50 years of age, the norm is considered to be a distance of 40 cm, up to 60 - 38 cm, up to 70 - 37 cm ., over 70 - 34 cm.

Taking tests - get up and walk for a while

To take this test, the patient sits in a standard chair. His knees should be bent at a 90 degree angle. At the “start” command, the patient stands up and walks in a straight line for three meters. Then he turns around and returns to his original place. The time spent walking there and back is recorded with a stopwatch. Measurements are taken before and after training to determine its effectiveness.

Standard indicators for 40-49 year olds are considered to be 6.2 s., 50-59 year olds - 6.4 s., 60-69 year olds - 7.2 s., 70-79 year olds - 8.5 s.

Epilogue

In addition to strictly observing the right angle rule, you should also avoid staying in one position for a long time (more than one hour). You should not do exercises if they cause pain.

“Full recovery” or 4th phase

This phase of rehabilitation covers the period of 9-14 weeks after surgery, during which it is necessary to achieve full restoration of strength, motor functions of the hip joint and balance. In addition, at this stage the patient learns to walk backwards on the stairs (up and down), and also continues to work on the “tilt test” and “stand up and walk for a while” tests if it was not possible to achieve the desired results in the 8th week of the rehabilitation process .

The stated goals of the last stage of rehabilitation are achieved in the same ways as before - through exercises. For example:

Thigh muscles- train by doing half squats, squeezing a pillow between your legs.
Gluteal muscles- train by squeezing and unclenching the buttocks.
Abductor muscles- strengthened by stretching the tape with your knees to the sides.
Balance training- stand with both feet on a swinging platform, throw a ball at the wall and catch it, while standing on one leg. Exercises with an elastic band
Walking- walk in both directions on a treadmill with different speed settings. Walking backwards.
Exercise bike- exercises at this phase of rehabilitation are best done on an exercise bike with long pedals.
Step exercises- the height of the step in the 4th phase should be increased.

Epilogue

You cannot independently engage in your own rehabilitation without consulting a doctor. You can't do exercises through pain. You should not give up exercises, even if tangible results have been achieved.