One of the critical success factors for a positive outcome is following the physical rehabilitation process. In order to help achieve the goals for a successful hip resurfacing procedure, you must actively participate in the rehab process and work diligently on your own, as well as with the physical therapists, to achieve optimal results.
Your recovery program begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement needed during the first few days after surgery.
On the first postoperative day, you will be seen by the physical therapist and an occupational therapist. The physical therapist will assist you with walking. You will usually start out with a walker, but you may transition to crutches when you wish. Unless otherwise notified by Dr. James Rector, you may gradually progress your weight bearing as tolerated. Most patients will be walking with a cane or walking stick by 2 – 4 weeks. Let pain be your guide with weight bearing.
You may be given a device called an incentive spirometer that you inhale and exhale into. It measures your lung capacity and assists you in taking deep breaths. These exercises reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs following surgery.
The physical therapist will begin as early as 1 – 2 days after surgery. They will teach you some simple exercises to be done in bed that will strengthen the muscles in the hip and lower extremity. These exercises may include:
- Gluteal sets: Tighten and relax the buttock muscles
- Quadricep sets: Tighten and relax the thigh muscles
- Ankle pumps: Flex and extend the ankles
Your physical therapist will also teach you proper techniques to perform such simple tasks as:
- Moving up and down in bed
- Going from lying to sitting
- Going from sitting to standing
- Going from standing to sitting
- Going from sitting to lying
Although these are simple activities, you must learn to do them safely so that the hip does not dislocate or suffer another injury.
Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and your therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance of accident or injury.
The occupational therapist will also visit with you to teach you how to perform activities of daily living safely. They will provide you with a list of hip precautions which are designed to protect your new hip during the first 8 – 12 weeks following surgery.
- It is safe to flex your hip more than 90 degrees. As you become more comfortable, you may flex your hip as much as possible. To avoid dislocation, remember to always flex the left hip straight up toward the left shoulder and the right hip up toward the right shoulder. Occasionally, patients will develop stiffness and difficulty regaining flexion. Early motion helps minimize this problem.
- Do not cross your legs.
- Do not allow your legs to internally rotate (feet turned in) during the first 2 to 3 weeks.
- Do not twist while lying or standing during the first 2 to 3 weeks.
- Sleep on your back with a pillow between your knees to prevent crossing during the first 4 weeks.
- Strictly observe your weight bearing precautions during standing or walking.
Also, the occupational therapist will instruct you in the proper use of various long-handled devices for activities of daily living. These devices may include the following:
- A reacher to dress and pick things up from the floor.
- A sock aid that will assist in putting on socks.
- A long-handled sponge to wash your legs and feet.
- A leg-lifting device to move the operated leg in and out of the car or bed.
- An elevated toilet seat so that you don't violate your hip precautions when using the bathroom.
- An elevated bathtub chair to fit in the shower or tub.
Following surgery, a physical therapist may help you with your rehabilitation protocol. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regular basis to further strengthen your hip muscles. An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to manage.
Here is a list of potential exercises that you may be asked to perform (If an exercise is causing pain that is lasting, reduce the number of repetitions. If the pain continues, contact your physical therapist or physician):
- Ankle pumps
- Quadriceps sets
- Gluteal sets
- Heel slides
- Leg lifts
- Knee extensions
- Hip abduction
While at home, you will continue to walk with the assistive device unless directed by your surgeon to discontinue use. You must also remember to strictly follow the hip precautions and weight bearing instructions during the first few months following surgery. It is recommended that you not drive unless you have been approved by your doctor.
Life After Hip Resurfacing Surgery
After you have completed your hip rehabilitation, you should experience improved range of motion and have strength in your hip to return to most everyday activities. Below are a few warnings to keep in mind after your hip resurfacing surgery. Remember to listen to what your body tells you. If you begin to have pain or swelling, contact your physician for advice.
- Take care to protect your new hip from too much stress and follow your surgeon’s instructions regarding activity level.
- Do not perform high-impact activities, such as running and jumping, during the first year following your surgery to allow your hip bones to heal properly. While that same study of 2,385 BIRMINGHAM HIP resurfacing patients found that less than one half of one percent of patients experienced a femoral neck fracture in the first five years after surgery, the average time this fracture took place was just two and a half months after their surgery. Other studies have shown a fracture rate of up to 1.4%.
- Early device failure, such as breakage or loosening, may occur if you do not follow your surgeon’s limitations on activity level. Early failure may occur if you do not protect your hip from overloading due to activity level or fail to control your body weight. Accidents such as falls may also cause early device failure.