LIHN. Physical Therapy After Hip Replacement. Long Island Health Network. Higher Standards, Better Care.

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Maurice Sims
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1 LIHN Long Island Health Network Higher Standards, Better Care Physical Therapy After Hip Replacement

2 Physical Therapy After Hip Replacement 2 Table of Contents Why Do I Need Physical Therapy?...3 What Are Hip Precautions?...4 What Type Of Exercises Will I Have To Do While I Am In The Hospital?...5 Getting In And Out Of Your Bed...7 Sitting Down/Standing...8 Using A Walker/Crutches...9 Stair Climbing/Getting Into A Car...10 Additional Exercises To Be Done After Discharge...11 Walking...13 Additional Resources...14

3 3 Why Do I Need Physical Therapy? Why do I need physical therapy? Physical therapy is an important part of the recovery process. Your surgeon and physical therapist will develop an exercise program for you. It generally includes exercises to stretch and strengthen the muscles surrounding the hip joint, as well as training in activities of daily life. The goal of physical therapy is to regain strength and movement that may have been lost because of pain and limited use due to the disease process over time. When does physical therapy begin? Physical therapy usually begins the day after surgery. Most people will be able to stand and walk, with help, within 1 day after surgery. At first you will walk with a walker. What can I expect from physical therapy? As you progress with the exercise program and move your new joint: Muscles will grow strong again. Pain will lessen. Flexibility will increase. Movement will improve.

What Are Hip Precautions? Hip precautions are limits to protect your new hip joint and allow for healing. There are different precautions based on the type of surgery you had done.

4 What Are Hip Precautions? Hip precautions are limits to protect your new hip joint and allow for healing. There are different precautions based on the type of surgery you had done. Your surgeon or therapist will tell which ones you need to follow and the length of time you will need to follow them. Some of the following hip precautions may apply to you: No crossing of the legs. Do not bend at the waist. No twisting motion with the hips. Do not turn your leg inward. 4 Do use a pillow between knees when sitting or lying down.

5 What Type Of Exercises Will I Have To Do While I Am In The Hospital? 5 Immediate After Surgery Exercises You may begin the following exercises immediately after your surgery. They are important to: Help prevent complications with your breathing. Help prevent blood clots in your legs. Increase your circulation. Deep Breathing and Coughing Exercises Until you are up and moving well, take at least deep breaths, followed by a cough, every hours while you are awake. You will be given an incentive spirometer to help you breathe. It will encourage you to take slow, deep breaths and expand your lungs. Breathe In Ankle Pumps Slowly move your foot up and down. Do this exercise several times as often as every minutes. This exercise can begin immediately after surgery and continue until you are fully recovered.

6 What Type Of Exercises Will I Have To Do While I Am In The Hospital? Quad Sets Tighten your thigh muscle. Try to straighten your knee. Hold for seconds. Repeat times times a day. 6 Gluteal Sets Tighten buttocks muscles. Hold for seconds. Repeat times times a day. Abduction Exercise (leg slides) Slide your leg out to the side as far as you can. Then bring it back to the middle. Repeat times times a day. Heel Slides Slide your heel toward your buttocks bending your knee. Keep your heel on the bed. Do not let your knee roll inward. Repeat times times a day. Do not get the hip past 90 degrees

Getting In And Out Of Your Bed While you are in the hospital you must ask for assistance to get in and out of bed! 7 Getting Out of Your Bed Move your body to the edge of the bed.

Sit on the side of the bed and slowly push yourself up. (Do not stand if you are dizzy!) Getting in Your Bed Sit down on the edge of the bed with both feet on the ground.

7 Getting In And Out Of Your Bed While you are in the hospital you must ask for assistance to get in and out of bed! 7 Getting Out of Your Bed Move your body to the edge of the bed. Use your arms to assist you to sit up in bed. Keep your legs apart when getting out of bed. Slide on your buttocks to lower your legs to floor. Sit on the side of the bed and slowly push yourself up. (Do not stand if you are dizzy!) Getting in Your Bed Sit down on the edge of the bed with both feet on the ground. Using your arms, slide your buttocks backward until your knees are on the bed. Pivot on your buttocks as you lift your legs onto the bed. Remember to keep your legs apart. Use a pillow to keep your legs apart when lying in bed.

Sitting Down/Standing Sitting Down Do not sit on armless chairs, rocking chairs, sofas, stools or chairs with wheels.

Slowly back up to the chair, bed or toilet until you feel it against the back of your legs. Place both arms on the armrests.

8 Standing Slide your hips to the edge of the chair, bed or toilet seat so that your feet are flat on the floor.

8 Sitting Down/Standing Sitting Down Do not sit on armless chairs, rocking chairs, sofas, stools or chairs with wheels. Sit in a chair that keeps your hips higher than your knees (You may need a cushion or pillow to raise the height of the chair). Slowly back up to the chair, bed or toilet until you feel it against the back of your legs. Place both arms on the armrests. Slowly lower yourself down keeping the operated leg straight out taking the weight on your non-operated leg. Do not bend forward. 8 Standing Slide your hips to the edge of the chair, bed or toilet seat so that your feet are flat on the floor. Bend your non-operated leg under you to hold your body weight. Keep your operated leg straight out in front of you. Do not bend forward. Use your arms to push down on the edge of the bed, chair arms or toilet seat, and lift yourself up.

9 Using A Walker 9 You will use a walker to help you keep your balance. Place the walker in front of you. Hold onto the walker firmly with both hands. Be certain all four legs of the walker are on the floor before moving forward. Move the walker forward. Step forward placing your operated leg toward the walker. Then take a step with your non-operated leg. (Do not take big steps or get too close to the front of the walker). Hold your head up and look straight ahead. Follow your own specific weight bearing instructions when using your walker. Using Crutches Stand up tall and look ahead while you walk. Move the crutches forward first, followed by your operated leg. Then move your non-operated leg forward. Follow your own specific weight bearing instructions when using crutches.

10 Stair Climbing The ability to go up and down stairs requires both flexibility and strength. You will need a handrail for support. At first you will only be able to go one step at a time. Always go up the stairs with your non-operated leg and down the stairs with your operated leg. Remember "up with the good" and "down with the bad." You should have someone help you until your therapist tells you, you can do it alone. Do not try to climb steps higher than those of the standard height of seven inches and always use the handrail for balance. Getting Into A Car Move the seat back as far as it goes, and recline it slightly. This will help you bring your operated leg into the car. Back up close to the seat and place one hand on the back of the seat and the other hand on a stable support surface. Sit down slowly keeping your operated leg straight. Slide back as far as you can go. Swing your legs in, bending your knee to a comfortable position. TIP: Adding a firm cushion to the seat will help you keep your operated hip straight and will help you get in and out of the car easier. You can also put a plastic bag on the seat to help you slide. 10

11 Additional Exercises To Be Done After Discharge Sitting Knee Extensions Sit in your chair. Straighten your knee out as far as you can. Hold for seconds. Slowly lower your leg. Repeat times times a day. 11 Standing Knee Raises / Hip Bending Stand with support for balance. Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for seconds and put your leg down. Repeat times times a day.

12 Additional Exercises To Be Done After Discharge Standing Hip Abduction Stand with support for balance. Lift your operated leg out to the side while standing tall. Keep your hips level. Keep your upper body straight and toes pointing forward. Hold for seconds. Slowly return leg to the starting position. Repeat times times a day. 12 Standing Hip Extension Stand with support for balance. Lift your operated leg backward slowly. Keep your back straight. Hold for seconds. Return your foot to the floor. Repeat times times a day.

13 Walking 13 Take a cane or walker with you until you have regained your balance skills and your surgeon/physical therapist tells you that you don t need it. In the beginning walk minutes times a day. As your strength improves, you can walk further for longer periods. Once you have fully recovered, regular walks will help maintain your strength. Additional Exercises Your surgeon and physical therapist will instruct you on additional exercises as you progress in your recovery. Limitations Your surgeon and your physical therapist will discuss with you any activity limitations while you are recovering.

14 Additional Resources 1. American Academy of Orthopaedic Surgeons (AAOS) 6300 N. River Road Rosemont, Il Telephone: Website: 2. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) 1 AMS Circle Bethesda, MD Telephone: TTY: Website: 14

15 LIHN Long Island Health Network Higher Standards, Better Care 15 Brookhaven Memorial Hospital Medical Center 101 Hospital Road Patchogue, NY (631) Home Care Department (631) J.T. Mather Memorial Hospital 75 North Country Road Port Jefferson, NY (631) St. Catherine of Siena Medical Center 50 Route 25A Smithtown, NY (631) St. Francis Hospital - The Heart Center 100 Port Washington Boulevard Roslyn, NY (516) South Nassau Communities Hospital One Healthy Way Oceanside, NY (516) Home Care Department (516) Good Samaritan Hospital Medical Center 1000 Montauk Highway West Islip, NY (631) Home Care Department (631) Mercy Medical Center 1000 North Village Avenue Rockville Centre, NY (516) St. Charles Hospital 200 Belle Terre Road Port Jefferson, NY (631) St. Joseph Hospital 4295 Hempstead Turnpike Bethpage, NY (516) Winthrop - University Hospital 259 First Street Mineola, NY (516) Home Care Department (516) Catholic Home Care 1150 Portion Road Holtsville, NY (631)

17 This booklet was updated June 2011 Acknowledgements: Total Hip /Knee Replacement: American Academy of Orthopaedic Surgeons (AAOS). What is Hip Replacement: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Blood Thinner Pills: Your guide to using them safely: U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. Patient Education for Total Hip or Knee Replacement: Orthopaedic Nursing What is Hip/Knee Replacement: UptoDate, Prepare your Home to Your Return after Total Joint Replacement: The Ohio State University Medical Center. Learning about Your Health, Total Hip Replacement: Caring for Yourself at Home: California Pacific Medical Center, A Sutter Health Affiliate. Total Hip Replacement: Thunder Bay Regional Health Sciences Center. Knee Joint Replacement, MedlinePlus, U.S. National Library of Medicine, NIH National Institute of Health,

18 ST. FRANCIS HOSPITAL THE HEART CENTER Healthcare Excellence Close to Home A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND Healthcare Excellence Close to Home Memorial Hospital Medical Center Members of: LIHN Long Island Health Network Higher Standards, Better Care MATHER JOHN T. MATHER MEMORI AL HOS PIT AL member - mather/ st. charles health alliance Catholic Home Care

LIHN. Managing After Your Hip Or Knee Joint Replacement. Long Island Health Network. Higher Standards, Better Care.

LIHN. Managing After Your Hip Or Knee Joint Replacement. Long Island Health Network. Higher Standards, Better Care. LIHN Long Island Health Network Higher Standards, Better Care Managing After Your Hip Or Knee Joint Replacement www.lihn.org Managing After Your Hip Or Knee Joint Replacement Table of Contents What Is