Physiotherapy Services Physiotherapy Guide to Hip Replacement AGH 01535 293656 Bingley Hospital 01274 563438 Ilkley Coronation Hospital 01943 609666 ext 241 Skipton General Hospital 01756 701726 Settle Health Centre 01729 822205
Patient Name How to Care for your New Hip Physiotherapist Name Introduction The aim of this booklet is to remind you of the exercises you need to perform following your total hip replacement. It will also advise you on the precautions you need to take in the future. What is a Total Hip Replacement? This is a surgical operation aiming to replace the surfaces of a damaged or diseased hip joint. One of the most common causes of damage in the hip joint is osteoarthritis. Another cause is rheumatoid arthritis. Osteoarthritis leads to wear and tear of the joint surfaces. The articular cartilage (gristle) that covers the moving parts of the bone is worn away. Eventually the bones rub on each other. This can lead to pain, stiffness and reduced mobility. The total hip replacement will replace these roughened surfaces. Do not bend your hip over 90 degrees. This means you must not bend forwards to touch your feet or pick anything up from the floor. You must not bend your knee up to your chest either. Your occupational therapist will provide you with equipment to perform your daily activities safely. Do not move your operated leg across the mid line of your body. This means you must not cross your legs when you are sitting or standing or lying. You must not sleep on your non operated side for 6 weeks as this will cause your leg to pass the mid line of your body. Do not twist your leg in or out. This means you must not twist your operated leg when turning around or when doing your exercises. Do not sit on low chairs or low toilet seats. This will cause your hip to bend past 90 degrees. You will be issued with a toilet raise by the occupational therapists to increase the height of your toilet. You will need to organise a chair at home that will be high enough for you to sit in. You are at risk of dislocating your new hip if you do not follow the above advice. If you have any questions or concerns please ask your physiotherapist, consultant or one of the ward staff. Check your wound site regularly for any redness, leaking fluid or increasing pain. If you notice any of these problems inform your nurse or doctor as soon as possible Looking to the Future Once you have gone home it is important you continue your exercise regime. Your goal is to achieve a strong leg that allows you to walk better than before your operation. You will usually return to see your consultant about 6 weeks after your operation. Physiotherapy is not normally organised after you leave hospital. You should be able to continue with the exercises you have been taught by yourself. If you are having difficulties with your new hip after 6 weeks you may be sent for physiotherapy in your local outpatient department. Best results are not achieved overnight. It may take months to gain your full potential. Don t be tempted to compare yourself with other people. Everybody will progress at their own individual rate. Created by: OORPSIG Approved by: (person) Date: 04/09/07 Version: 3 Review: 01/07/2016
Walking The day after your operation you may have a repeat x-ray of your new hip. The physiotherapist will go through your exercises and then will help you to get out of bed. You will use a walking frame to help you take your first steps. You will be encouraged to use your new hip as normally as possible. As your mobility increases and your confidence grows, you will progress to walking with elbow crutches to improve your walking pattern. Your forearms should sit within the cuff. The handgrips should point forwards. You may progress to sticks when you return for your check up after 6 weeks. You will be sent to the physiotherapy department where you will be given a stick. You will need to continue to be careful with your hip. Walking Pattern 1. Place walking aid one step ahead 2. Step forward with the operated leg (new hip) 3. Step through with the other leg 4. When steady, repeat stages 1 to 3. Stairs You will be taught how to perform steps and stairs by your physiotherapist before you go home. Walking Up Stairs 1. Step up one step with your non operated leg 2. Step up with your operated leg onto the same step 3. Move your crutches onto the same step Walking Down Stairs 1. Move your crutches down one step 2. Step down with your operated leg onto the same step 3. Step down with your non operated leg onto the same step Normal Hip Joint Smooth Cartilage covering head of femur (Ball) Femur (Thigh bone) Hip Joint with Arthritis Cartilage worn away Total Hip Replacement Pelvis Acetabulum (socket) Bony prominences (osteophytes) on acetabulum Stairs with a Handrail Always try to use a handrail when using stairs. Hold onto the handrail with one hand. Hold both crutches in the other hand as shown by your physiotherapist and in the picture. When using a handrail the order is the same as above. Replacement Ball Metal Insert into thigh bone Replacement (socket)
Before the Operation The physiotherapist may visit you before the operation for: Assessment of your movement, strength and walking To explain postoperative procedures To teach an effective exercise regime to: Increase circulation Increase muscle strength Increase hip movement and function To explain how to care for your new hip after the operation To help answer any further questions you may have After the operation Try to begin your exercise programme as soon as possible. Your physiotherapist will visit you the day after your operation to help remind you of your exercises. Deep Breathing Exercises When you lie flat in bed for any length of time, your breathing becomes shallower. Breathing exercises are designed to inflate the lungs with fresh air. This helps to reduce the effects of the anaesthetic and reduce the risk of a chest infection. Leg Exercises help to: Reduce the risk of blood clot formation Increase the muscle strength to support and control the hip Increase the movement of the hip and therefore increase its function Standing Exercises Standing on your good leg 8 Lifting your operated leg backwards keeping it straight e.g. a chair or sink Move your leg backwards using your buttock muscles Keep your knee straight Keep your body upright. 9 Hip Abduction Move your operated leg out sideways keeping your body upright. 10 Hip Flexion Bend your operated hip to lift your knee up in front of you 11 Knee Dips Bend both knees to lower yourself down You should lower yourself by about 10cm Hold for 5 seconds Rise up to start position get stronger Remember Your exercises are most effective when performed little and often. You should aim to perform your exercises every hour. You will have to work hard initially to increase your strength and movement to make the most of your new hip joint. However, it will be worth all the effort. You may find that doing your exercises can be uncomfortable or painful. Your discomfort should not prevent you from performing your exercises. If you need to, ask for some more pain relief so that you can perform your exercises with less pain.
EXERCISE PROGRAMME Movement and Strengthening Exercises These exercises can begin after your physiotherapist has told you that you can perform the exercises. Try to perform some of the exercises below every hour. 5 Hip and Knee Bending Place your sliding board underneath your heel and lower legs Keeping your heel on the board, bend your knee sliding your heel towards your bottom but not to bend the hip past 90 degrees. Hold for 5 seconds then lower gently This exercise can be done when you are lying in bed. Try to keep your foot, knee and hip in a straight line. 1 Deep Breathing exercises Take a deep breath in. Your stomach should move out as you do so. Hold the breath for 3 seconds, then sniff to get more air in, then breathe out.. Take 5 deep breaths every waking hour. Start this exercise as soon as possible after you wake up from your operation. Circulatory, Straightening and Strengthening Exercises You should start exercises 2 to 4 as soon as you wake up after your operation. 2 Ankle Exercises a Briskly move your feet up and down from the ankle. Point your toes, then bring your feet up towards you 6 Hip abduction (moving the leg out to the side) Place your sliding board underneath your heel and lower leg Slide your operated leg out to the side Then bring back to the middle This exercise can be done when you are lying in bed. Keep your toes pointing upwards. Do not let your foot turn outwards. b c Move your feet round in circles. Circle them one way then the other Once you are out of bed, sat in the chair Rest your feet flat on the floor. Briskly raise your heels then your toes alternately. 7 Knee Straightening in Sitting Sit in a chair or on the edge of your bed with your thigh supported Pull your toes up towards your knee Straighten your leg by raising your foot off the floor Hold your leg straight for 5 seconds then lower gently Ankle exercises should be performed for at least 1 minute every hour with both feet. The choice of ankle exercise depends on whether you are sitting on a chair or lying in bed. 3 Thigh Tightening With your legs straight out in front Pull your feet up to the ceiling and push knees down onto the bed Feel the thigh muscles tense Hold for 5 seconds, then relax Perform this exercise 10 times every hour when you are lying in bed. 4 Buttock Tightening Squeeze your buttocks tightly together Hold for 5 seconds, then relax Perform this exercise 10 times every hour when you are in bed or in the chair.