So, you’re in your 50’s, 60’s, 70’s or older and you’ve had a hip replacement. You have probably opted for this surgery because you were in a lot of pain and your ability to move has been getting worse. Now that you’re on the other side of the surgery you’ve been given a LOT of information about dos and don’ts that may have left you confused, and you probably have questions that have never been answered. This article should help you answer some of those questions, clarify some of the information you’ve been told either by your surgeon, your friends, or “Dr. Google;” and, help you get the most out of your physiotherapy rehabilitation program.
The number one question I’m asked as a physiotherapist is: ‘What activities will I be able to do?’ This is a complex question that takes into account your age, your previous activity level, and your general health. The patients who have the most successful surgeries often had severe limitations prior to surgery, but maintained strength, lost weight if they were overweight, and quit smoking or drinking prior to surgery.
Smoking and drinking can delay healing by a magnitude of months and cause healed tissue to become less resistant to stress, resulting in the risk of future injury. Losing weight before or even after your surgery reduces the strength necessary to perform activities; this can include simply standing up from a chair, climbing or descending stairs, walking down the block, or shopping at the grocery store. Losing weight decreases the stress placed on your prosthetic hip and improves its longevity. This means you are less likely to wear out the artificial hip and less likely to need a second surgery to replace parts in the future. Finally, maintaining strength means that you are already part way through the rehabilitation process before you have even begun!
Generally, patients who undergo a total hip arthroplasty (hip replacement) are able to resume the activities they did prior to their surgery with considerably less pain and greater ease. Patients are cautioned not to run or jump as this impact can wear out an artificial hip and in some cases even fracture bone in your leg or pelvis. Your surgeon, other specialists, and physiotherapist will work together to determine what activities are safe for you to perform; it is up to you as the patient to exercise and strengthen in order to achieve your activity goals.
The second most common question is: ‘What are my precautions and why do they exist?’ Precautions following hip replacement vary depending on your surgeon. The most typical and safest precautions include not lifting your knee above the level of your hip, not crossing your legs in any fashion, and not twisting (rotating) your leg to the left or right. The reason for these precautions is to avoid a hip dislocation, which is where the ball portion of the prosthetic comes out of the socket that it is in. This is a risk because the surgery involved cutting through muscle, tendon, and ligaments that stabilize the hip and these structures have a reduced ability to withstand stress and strain until they are completely healed.
The minimum amount of time to follow these precautions varies depending on your surgeon, but the standard length of time is 12 weeks. Some examples of activities that break precautions are as follows: bending down to pick something up, put on socks, or put on shoes (all knee above hip); twisting to the left or right when sitting or standing or turning by stepping past a your stationary foot (all twisting left/right); sitting or lying with your ankles crossed, knee over knee, or ankle on opposite thigh (all crossing legs).
The last question is: ‘Why do I still have pain and how long until I am fully healed?’ Simply put, surgery is planned trauma. Depending on your age, prior experience with pain, and overall health you may have pain for a number of weeks or months. Some patients even have some residual pain for years. Pain Science is much too complicated for this blog post but at its simplest, pain is a complex interaction between physical tissue damage, your prior experience with pain, your expectation of pain, and how ‘excited’ your nervous system is. Exercising and maintaining good health go a long way to pain reduction. Ultimately the focus of surgery and rehabilitation should be to improve your ability to be active first, while seeking to reduce your pain second. Full healing is a complex interaction of (you guessed it!) general health, strength before surgery, and time. More on the stages of healing in my next blog!
Ice, Ice, Ice – Jayme Gordon wrote a blog about What to do for a Sprain or Strain which includes instructions on how to I.C.E, which is both the activity as well as an acronym for ‘Ice’ ‘Compress’ and ‘Elevate’. These things are necessary for the first few weeks post-surgery to decrease pain, improve function, and facilitate healing. Check out her blog post for the details!
Hospital Exercises – Most hospitals hand out an exercise sheet and the physiotherapist in the hospital will have taught you exercises to do for your first few days after surgery before you see one of us in the clinic at Royal City Physio. Typically, these exercises include heel pumps (pointing your toes and pulling your toes to the nose), heel slides (lying on your back, slide your heel on bed towards and away from your butt), quad setting (squeezing the back of your knee down into the bed), quads over roll (placing a towel roll under the knee and straightening your leg over the roll so your heel lifts), and a glute squeeze (squeezing your butt while sitting or lying in bed). You’ll also be given instructions on how to sit and stand from a chair and how to walk with a walker or crutches. These exercises are EXTREMELY important! The leg exercises help prevent blood clots and maintain muscle strength up and down your entire leg. The standing and walking exercises reduce pain, improve your ability to move and prepare you for physiotherapy in the clinic. Generally, your exercises are your day job while you are recovering from surgery. If you want to return to any kind of activity you should perform these as often as possible.
Lose weight if you are overweight – Losing weight decreases the strength necessary to do your daily activities like stand from a chair, climb stairs, and walk distances. Losing weight also improves the life of your artificial hip, reducing the need for a revision/replacement of its parts.
Go to Physiotherapy – The hospital exercises that you were given are designed to help you manage for your first few days to a couple weeks after your surgery but by no means will get you back to activity. Going to regular physiotherapy for hands on manual techniques and activity specific exercises is necessary to maximize your recovery.
Don’t break your precautions – Breaking precautions puts you at risk for a hip dislocation and usually results in damaging muscles and tendons around your hip. These precautions are there for safety and to optimize your healing.
Don’t smoke – Smoking reduces healing by an order of magnitude. Studies on bone healing after a fracture show that smokers are 37% less likely to be healed after 2 years as compared to non-smokers (Patel, R., Wilson, Patel, P., & Palmer, 2013). While a hip replacement isn’t a fractured bone, the bone has to grow into the screws and the prosthetic in order to be secure, and this process would be considerably longer in someone who smokes. Smoking also has effects on muscle, tendon, ligament and even skin healing!
Patel RA, Wilson RF, Patel PA, Palmer RM. The effect of smoking on bone healing: A systematic review. Bone Joint Res. 2013;2(6):102-11. Published 2013 Jun 1. doi:10.1302/2046-3758.26.2000142
Stephen Baker graduated from Western University with a Masters of Physical Therapy. He has a passion for helping those with neck, hand or knee injuries return to their daily adventures. Book with Stephen today.