Hip replacement surgery is becoming more prevalent with advancing technology and better-quality prosthesis. The quality of life after this surgery is also improving.
According to OECD, an average of 174 people per 100,000 undergo hip replacement surgeries per year (data from the year 2019). That’s almost a 22% increase in 10 years.
Everyone who undergoes hip replacement surgery is treated by a multidisciplinary team. Physiotherapists are a part of that team and our role plays a big part in getting you to the point where you can move independently and enjoy recreational activities.
Keep reading as we’ll discuss:
- What hip replacement is?
- Types of hip replacement
- How much physio is needed after hip replacement?
- Overview of the physical therapy treatment after hip replacement
- The top 10 exercises you will find in a physiotherapy program after hip replacement
Quick Intro to Hip Replacement Surgeries
Hip replacement surgery is a procedure where your entire hip joint or some part of it is replaced with prosthetic segments.
It’s mostly done as an elective procedure in elderly patients. But young patients also undergo hip replacement to fix a fracture, traumatic injury to the joint, or a congenital issue (things that are present by birth).
The most common reasons for doing hip replacement surgery are:
- Osteoarthritis of the hip
- Loss of bone (necrosis)
- Tumors
- Hip fractures
- Congenital hip dislocation
Types of Hip Replacement
To understand the types of hip replacement, you first need to understand the anatomy of the hip joint. It consists of two components: the femoral component and the pelvic component.
The femoral component is shaped like a ball (called the femoral head) and it’s the top of the long bone of your thigh.
The pelvic component, called the acetabulum, is shaped like a bowl and it’s where the femoral head inserts.
When you rotate your leg or move it up and down, the ball of the femoral head moves in the acetabulum. Both segments need to be in good condition to work efficiently.
Hip replacement surgeries are of two main types:
- Partial hip replacement: only one surface of the joint is replaced. It’s usually the femoral component
- Total hip replacement: both surfaces of the hip joint are replaced
The prosthetic surfaces that surgeons insert in the place of your hip joint are of different materials. For example:
- Metal-on-metal polyethylene
- Ceramic on polyethylene
- Metal on metal and so on
Your surgical team chooses the type of surgery you need based on the issues you’re facing. Age plays a significant role as well because the longevity of the prosthetic joint is a much bigger concern for younger patients than it is for older ones.
How Much Physiotherapy Do You Need After Hip Replacement?
You need extensive physical therapy after hip replacement surgery.
You have to join a formal rehab program, the duration of which depends on the type of surgery you had (partial vs. total hip replacement), cemented or uncemented joint, activity level before the fixation, and several other factors.
Cemented and uncemented fixation:
A cemented fixation involves a polymethylmethacrylate paste that’s inserted around the implant to fix it to the bone.
The uncemented (also called cementless or non-cemented) fixation does not use any such paste to hold the implant in place. The implant has a porous surface. It’s designed in that way so that the bone grows all around it and even through it. Hence the two are interlocked and the implant essentially becomes a part of the bone after a few months.
Generally, you need some type of physical therapy from the first day after surgery to several months. The good news is that you can do most of it while living at home or in the outpatient department so you don’t need to be hospitalized for it.
The average length of hospital stay after hip replacement is 3 days. You could end up staying longer if there are complications or home sooner than 3 days if you satisfy the discharge protocol.
Physical therapy after hip replacement is designed in phases.
The immediate post-operative phase lasts for 3 days after surgery when you’re hospitalized. Based on your specific surgical procedure, you’ll have to take care of certain precautions while exercising during this time. The goal is to get you moving in bed and decrease postoperative stiffness.
Phase 2 begins after discharge and lasts for nearly 3 weeks. You have to visit the physiotherapist in their clinic as per your appointments or they can visit you at your home.
The goal of this phase is to improve muscle strength, cardiovascular endurance, gait pattern, and postural awareness, and restore a complete range of motion (within dislocation precaution).
Phase 3 (approx weeks 7-12) is where the home exercise program has the most value. Most patients are discharged from outpatient physical therapy at this time and continue rehab independently at home.
You should have a full painless range of motion in your hip by the time this phase starts, walk without assistive devices and even drive.
The goal of this phase is to enable you to perform all your activities of daily living and most of your low-intensity recreational activities with no pain and minimal restrictions.
Phase 4 (approx weeks 12-16) emphasizes on complete return to activity with appropriate strength and endurance. This phase usually involves high-intensity exercises suitable for athletes and the younger population with demanding jobs so not every patient needs it.
Physiotherapy Treatment After Hip Replacement
Dislocation precautions make up a big part of the physiotherapy treatment after hip replacement for the first 3 months. These include weight-bearing precautions and range of motion precautions.
Dislocation precautions: these are activities that you shouldn’t do because they put your joint at risk of dislocating from its place. Joints are vulnerable after replacement surgery so it’s extremely important to observe dislocation precautions.
Applying too much weight too soon risks moving the joint from its position before it’s fully set in place. Similarly, you can’t move your hip and legs in certain ways (for a specific duration after surgery, usually around 90 days) because it can damage or loosen the prosthetic joint.
These positions vary depending on the surgical approach for your hip replacement. For example, you can’t cross your operated leg or move it past your centerline after a hip replacement with a lateral approach (name of the surgical technique).
Since these precautions are dependent on your type of surgery, it’s best to ask your physiotherapist for the exact precautions you need to take. Or you can share details of your surgery with us by clicking here and we can discuss precautions with you.
In-Bed Exercises
We begin low-intensity exercises on the first post-op day after hip replacement surgery. It is part of the phase 1 exercises. Your physical therapist will usually teach these to you before the surgery and discuss the reasoning behind them to motivate you to do the exercises even if you’re in some pain.
Bedbound? Here are some safe exercises you can do to stay active
Transfer Out to Bed
Becoming independent is often a major goal for hip replacement patients. And so that’s our focus as well. We teach you positioning and safe bed transfer procedures within the first two or three days after surgery. These include standing after sitting in bed or transferring from the bed to a wheelchair.
It helps patients to feel confident in walking out of the hospital on their own feet after discharge and sitting in their car independently or with minimal assistance.
Walking and Stair Climbing
You’ll go through different stages of walking reeducation after hip replacement. This training begins with an assistive device such as a cane or a walker. We teach you to:
- Distribute body weight evenly on both legs
- Stand up straight and pay attention to your walking posture
- Look straight ahead and avoid objects on the floor while maintaining your balance and walking speed (called cadence)
Stair climbing is an advanced stage of gait reeducation. You practice going up and down the stairs with proper foot placement in a safe environment with the support of your physical therapist.
Return to Activity
Your physical activity goals are the goals of your physical therapy rehab as well. These vary between patients. For a middle-aged person, returning to competitive golf can be a goal but walking independently and not being in pain can be the goals for an 80-year-old.
You’ll most likely be discharged from the hospital during the return to activity stage of physical therapy rehab after hip replacement and visit your physiotherapist in the outpatient department.
The exercises you will perform here will be based on your goals and type of surgery. These exercises will progressively increase in intensity as you get better.
Top 10 Exercises for Physiotherapy After Hip Replacement
The exercises mentioned below are some of the most common ones in a physical therapy program after hip replacement surgery.
But not all of them are suitable for every patient. Your physical therapist might use some of these exercises, or they might not, depending on your dislocation precautions, surgical complications, pain level, and other individual factors.
Active Range of Motion Exercises of the Lower Limb
Here are some exercises that we start in phase 1 of physical therapy after hip replacement:
1. Ankle Pumps
Bring your ankle closer to your body and then farther away similar to the motion of pushing the pedals while driving.
2. Hip Rotations
Lie down with your legs straight. Rotate one leg inwards so that the toes of that leg point towards the other foot. Rotate the leg outwards so that your toes point out. It’s similar to the waving motion you do with your hands.
3. Hip Flexion and Extension
Lie down. Bend one knee and bring it towards your chest. Return back to the starting position. You can do the same while sitting down.
4. Knee Flexion and Extension
Sit in a chair or on your bed with your legs hanging down. Straighten your leg and bend it again.
5. Heel Slides for Combined Active Range of Motion Exercises of the Ankle, Knee, and Hip
Lie down in a bed and slide your heel to bring your knee towards your chest.
Strengthening Exercises of Lower Limb Muscles
Here are some muscle-strengthening exercises that we include in the physical therapy rehab program for hip replacement:
1. Static Quads
Phase 1 muscle strengthening exercises are isometric (such exercises don’t have a big or visible movement upon muscle activity). Lie down in a bed with your legs straight. Place a cushion under your knee and press down on it. Hold this position for 10 seconds. It builds strength in your thigh muscles.
2. Gluteal Clench
You can build strength in your buttock muscles by clenching them and holding this position for a couple of seconds.
While lying down, simply clench your gluteal muscles for 15 seconds and then release. This is an isometric exercise suitable for phase 1 of physical therapy after hip replacement.
3. Squats and Lunges
As you progress to the advanced phases of rehab, we incorporate closed-chain exercises for muscle strengthening. These are for patients who have good pain tolerance.
You can do squats, lunges, or push and pull objects using your lower limb muscle strength. Initially, you have to do them with body weight only and progress to free weights or with weighted bars as suitable.
4. Core Stabilization
Walking with an upright posture helps distribute body weight evenly across both hips. Core stability is important for that.
You’ll perform low-intensity core exercises in laying, standing, and sitting.
5. Balance Training
This includes weight shifting while standing still, stepping up and stepping down on a stool, sidestepping, walking on uneven surfaces, walking backward, navigating hurdles, and walking without assistance.
Balance training improves independence and reduces the chances of falls.
In Summary
Physiotherapy after a hip replacement has a big role in the success and longevity of the implant. Most older patients who undergo this type of surgery have a history of decreased mobility due to pain, bad postures, and disturbed walking patterns because of compensation for a bad hip.
Hence fixing these issues through appropriate exercises and precautions enhances the life of your prosthetic hip by taking the excess load off of it and distributing it across other joints.
If you’ve recently had hip replacement surgery or are planning on getting one soon, contact us for a personalized home exercise program and ask us any questions about the rehab process, duration, complications, expected recovery, and more.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.