Features of rehabilitation after hip replacementRehabilitation after hip arthroplasty is a long process of recovery with physical exercises and other supportive procedures. Diseases of joints, including hip joints, are one of the most common and at the same time dangerous. The fact is that any damage to the joints has its consequences, the most terrible of which is loss of efficiency. In fractures or any other damage, the joints also often become unusable. In severe cases, an urgent operation is required to restore a habitual way of life to a person.
Endoprosthetics are very popular today in cases of severe joint deformities. The removal of the joint, and then its replacement with a prosthesis - the only way out with rheumatoid arthritis, joint tumors and severe hip fractures. Rehabilitation after endoprosthetics takes about 14 weeks, during which the patient must fully develop the joint and prepare it for daily workloads. For this, it is necessary to perform a whole set of exercises, which is appointed by the attending physician.
The length of the rehabilitation period after the operation depends on several factors. Among them - the age and physiological characteristics of the patient. As a rule, the older a person, the slower he heals various wounds, etc. When replacing the hip joint, one should constantly be under the supervision of a doctor so that there are no problems with restoring the motor function. In order to get used to the prosthesis, you need to start moving soon after the operation, but the recovery should go on a certain schedule. The fact is that immediately the load on the endoprosthesis is contraindicated. A special treatment is made, according to which the patient lives for about 3 months.
Rehabilitation after hip arthroplasty is divided into 5 phases( including the zero phase).Follow all the doctor's recommendations, then you quickly get to your feet. Not everyone knows why a hip replacement is needed. As practice shows, doctors do not see any other way out at the last stages of degenerative joint diseases.
Otherwise, you risk remaining an invalid. It is important to remember that the operation is done only when the conservative method of treatment has proved useless.
Development of the disease in the hip joint
Why use the hip joint? Its main function is the connection of the trunk and lower limb( legs).The joint is the link between the pelvic bone and the femur, that is, thanks to it, a person is able to move.
The hip joint is one of the main elements of the whole organism, so any damage to it has serious consequences. If we talk about fractures of the neck of the hip, then immediate surgical intervention is required, since the joint itself will not be restored. Medicines will also be useless.
Hip joint pathologies appear for various reasons. The genetic predisposition also plays a role. The risk group includes people who have repeatedly received joint injuries. Any deformation revealed at the initial stage of pathology development leads to further destruction of the cartilaginous tissue and bone.
Arthritis breaks the joint head, which leads to disability
The most common indication for endoprosthetics is the severe form of arthrosis( a disease that destroys the joint head).Osteoarthritis of the hip joint is characterized by the following symptoms:
- Painful sensations during movement and with loads on the joint.
- Reduces the amplitude of motion in the affected joint.
- A crunch in the joint, with the heavier the stage of the disease, the more pronounced the crunch.
Due to the fact that the symptoms are pronounced, the disease can be recognized in the early stages of development. In the clinic, you will need to undergo an X-ray examination to confirm the diagnosis and identify the severity of the disease. Then the doctor prescribes appropriate treatment, which consists of the use of painkillers, non-hormonal anti-inflammatory drugs, chondroprotectors, physiotherapy and sanatorium treatment.
An effective method of treatment of arthrosis is homeoosinia - the introduction of acupuncture points of homeopathic remedies according to a certain scheme.
In more advanced cases, a hip replacement can not be avoided.
Endoprosthesis of the hip joint
Today, operations of hip arthroplasty are conducted quite often. Total replacement is called replacing both parts of the damaged joint( cup and head) with artificial joints. It is not so difficult to create a copy, because the joint design is not difficult. It is known that the classical total endoprosthesis consists of a leg, a cup and a head. In this case, the globular head is located on the stem, and then inserted into the other part - the cup.
After total hip replacement, the rehabilitation process is strictly controlled by the doctor. Remember that the operation of endoprosthetics does not always proceed successfully. In rare cases, it is possible to get an infection or develop an allergic reaction. In the first case, it is necessary to take antibiotics, in the second case, the outcome depends on the reaction of the body to the artificial prosthesis. Today, medicine has taken care of reducing allergies - prostheses are made of safe materials. Prosthetic hip joint is an outlet for many people suffering from its dysfunction.
Endoprostheses can be made of metal and plastic, ceramics and plastic, pure ceramics or metal. All materials do not cause any harm to the tissues and do not cause discomfort.
Rehabilitation after hip arthroplastyThe attending physician after hip replacement advises to keep an active lifestyle at home. But this does not mean that it is necessary to heavily burden the operated leg in the first month. Rehabilitation after the replacement of the hip joint, as a rule, takes about 3 months, 2 of which should not be devoted to gymnastics exercises.
In the first two months you will walk on crutches, try to develop a leg: sit down gently, lie down, do elementary movements. Do not try to stand on the operated leg unless 3 months have passed. This time, take a little load, which you will increase every month. It will be useful to sit on a chair, hanging legs. If you are standing on crutches, then try to take your foot off the endoprosthesis to the side. Thus, you force the muscles to work, speeding up the healing process.
How to get out of bed? The sequence is this: first, lower the healthy leg, and then put it under the patient and gently guide down, to the floor. It is not recommended to lie down on the unoperated side without a special roller. In addition, do not turn sharply the whole body, the movements should be cautious, smooth. During the rehabilitation period after joint replacement, it is forbidden to put one foot on the other, and also sit on a low surface, as there is a risk of dislocation of the endoprosthesis head.
If you do not have any infection, do not use antibiotics. In case of pain( especially in the first month after the hip joint prosthesis), one should take painkillers.
Rehabilitation after surgery involves the following exercises:
- When you firmly stand on crutches, gradually take the operated leg back and stand in this position for 3 seconds. Back try to keep it straight. Exercise should be repeated 10 times, but try not to load your foot at first.
- Gently lift the knee of the operated leg. Do this slowly, for a few seconds. Then return the leg to its original position.
- When you stand upright, and the foot and knee will move forward, take your foot to the side. After a few seconds, return it to its previous position.
The process of rehabilitation after hip replacement takes a long time and requires a lot of patience. However, if you successfully pass this period, you will walk without problems for the next 15 years( the expiration date of the prosthesis).
What is osteoarthrosis
Osteoarthritis can affect any joints. Most often, DOA develops the knee joints, then the spine. Osteoarthritis of the hip joints is the third most common. The process can be either one-sided or two-sided.
In this case, the cartilage, lining the surfaces of contiguous bones, is destroyed in the joint, the articular fluid acquires a tendency to inflammatory processes, and marginal bony proliferation appears. In later stages, the joint space( the gap between the bones) disappears, and movement in the joint becomes impossible. The causes of the disease are:
- genetic predisposition;
- metabolic disorders( eg, deposits in the joints of uric acid, hydroxyapatite).
A characteristic symptom is the pain in the area of the projection of the joint, which increases during exercise( walking).The pain syndrome can reach such intensity, that the patient loses ability independently to move. Osteoarthritis can not be cured by conservative methods. With proper traditional treatment, only maintaining the state of remission is possible. So, the replacement of the hip joint is the only way to restore health and keep working capacity. The duration of the operation is 1-3 hours. It depends on what prosthesis is performed - full or partial. The patient is under general or spinal anesthesia. For rapid recovery and optimal treatment results, several hours after the end of the operation, special exercises should be started.
Initial phase( 1st day after surgery)
The first step is the set of exercises necessary to improve blood circulation in the legs and prevent the formation of blood clots. Such a gymnastics is performed sitting or lying 3 times a day with both feet, regardless of whether the joint was replaced on one or both sides.
- Static tension of the quadriceps muscle of the thigh.
- Flexion of the leg in the knee.
- Move the foot up and down.
- Raising a straight leg 10 cm from the surface of the bed.
- Drawing a straight leg to the side.
The first phase( 2-4 days after the operation)
The patient continues to perform the already existing set of exercises. To them are added new ones.
- Raising a leg bent at the knee. The starting position is at the support.
- Straight leg to the side in standing position.
- Take the straight leg back in standing position.
The main goal of this rehabilitation period is to go to full self-service( get up, sit down, walk, visit the toilet yourself).At this time there is a risk of dislocation of the prosthesis. In order to level it, it is necessary to sleep with a pillow between the knees, not to lie down on the operated side and keep the knees constantly bent, even if it reduces pain.
Second phase( up to 21 days after endoprosthetics)
Patient needs to continue to increase the load. At the end of the first week, you should learn how to walk neatly up the stairs. When climbing, you first need to step on the operated leg, then healthy, while descending - on the contrary.
The risk of dislocation of the prosthesis is preserved, therefore it is necessary to follow all the recommendations of the previous stage.
Third phase( up to 2 months after surgery)
The phase of active training of the gluteal and femoral muscles. The elastic band acts as a kind of simulator, which allows all exercises to be carried out with resistance( flexion in the hip joint at the support, retraction of the leg in standing position).
The patient should walk often and gradually, gradually increasing the time of walking up to 2 hours a day in several stages.
In the department of physiotherapy exercises( in a hospital and polyclinic) the patient is assigned exercises on a stationary bike, which perfectly develop muscles, and also pacing on the platform.
Fourth phase( up to 4 months after prosthetics)
This time conceals a hidden danger to patients. Having successfully passed the previous stages of rehabilitation, having learned to walk without a cane, without feeling pain and limitations of mobility, people stop doing exercises. This is a big mistake! Insufficiently strong muscles, especially in the elderly, quickly detune, which increases the risk of injury( falling due to loss of balance, for example).
Exercises to strengthen the leg muscles should be performed regularly for a long time, preferably for the rest of your life. It is impossible to be trained through pain. However, it is not necessary to confuse the pain in the joint with the pain in the muscles( due to the accumulation of lactic acid) and under this pretext to give up exercise. It is necessary to perform half-squats( strictly with a straight back), pacing, drawing a straight leg with resistance or a little burden, walking along a path or practicing on an exercise bike.
You should also follow a balanced diet. The diet should contain a large number of proteins( except for the sick gout), carbohydrates( preferably long ones, ie cereals, whole-grain baking), fats( with sufficient amounts of omega-3 unsaturated fatty acids from seafood).Proper nutrition will not help gain weight to avoid stress on the joint.
The list of medications will be issued by your doctor. It usually includes vitamin complexes and supplements containing glucosamine and chondroitin in therapeutic doses.
Endoprosthetics of the hip with proper rehabilitation allows the patient to return to daily life in the shortest possible time.
Rehabilitation after hip arthroplasty: motor mode
After completion of the operation to establish an endoprosthesis in the hip joint, a course of restoring the normal functioning of the joint and also the muscles adjacent to it is required. In this case, the duration and effectiveness of the rehabilitation course depends on many factors. Rehabilitation after hip arthroplasty is carried out according to different schemes. Therefore, it is necessary to apply an individual approach to each individual patient.
Much depends on the age of the patient, on his general condition and physical development of the muscles. Accordingly, the older the patient, and also, the more he is physically weakened, the longer the rehabilitation process will take place.
Also of great importance is how much time passed between the injury and the operation. In the event that a rather long period has passed, most likely, the muscles managed to significantly atrophy, since the damaged joint could not function fully.
A similar situation may occur with arthrosis. If the operation was carried out in a timely manner, when, despite the pain, the person could still move independently, and the muscles had to work, but to the critical point the matter has not yet reached, then the recovery process will be a little faster and more successful.
But it also happens that a person suffers pain for years, hoping that everything will pass by himself. To the doctor, he turns, when the pain becomes quite unbearable, and a person can not simply walk.
In such cases, the muscles have time to atrophy. Accordingly, the process of postoperative rehabilitation will take longer and more difficult. Considering all such factors, it is possible to draw up a general rehabilitation program that is applicable to all patients. This program is based on certain principles and goals, and an individual approach to each individual patient is also applied.Want to have a good sleep? Orthopedic pillow with the effect of memory will ensure the correct position of the spine during sleep and normalizes the muscle tone of the cervical region.
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The rehabilitation process can be broken down into several periods or phases.
This phase of rehabilitation begins a few hours after the operation. First, it is necessary to restore blood circulation. This is required for the normal functioning of the limb and preventing the formation of blood clots in the blood vessels.
As soon as the action of anesthesia passes, it is necessary to do the following exercises( it must be remembered that all exercises should be performed by both legs, not only the patient):
- Movement of the foot foot up and down, the so-called "foot pump".Exercise should be repeated several times every 10-15 minutes, as soon as the sensitivity of the foot returns. Do the exercise during the entire rehabilitation period.
- Rotate the ankle to the right, then to the left 5 times. It should be remembered that rotation should be performed only at the expense of this joint. The knee does not participate in this exercise.
- Work of the anterior muscle of the thigh( four-headed muscle).It is necessary to strain the front of the thigh, straightening. You can pull the socks forward. At first, there will be no full leg straightening, there may be pain. But it is necessary to try, and eventually the exercise begins to work out. Keep the muscles of the front of the thigh in tension takes 5-10 seconds. Repeat the exercise for 10 approaches for both( !) Legs.
- Bend the knee, moving the heel towards the buttocks. The heel should be pressed against the surface. The knee should not rotate to the other leg. The hip joint should not bend more than 90 degrees. Repeat exercise 10 times.
- Squeeze the buttocks and hold in tension for 5-7 seconds. Repeat the exercise should be at least 10 times.
- In the lying position, move the elongated leg sideways to the maximum possible distance, then return it to its original position. In postoperative days, this exercise is likely to fail, but over time it begins to work out. Repeat exercise 10 times.
- Raise the straightened leg up a few centimeters. As in the previous case, this exercise can not be performed first. Repeat the exercise 10 times.
The first phase of
The next phase of rehabilitation after endoprosthetics begins on the 2nd day after the operation. At this time, the patient will be able to get up and move gently on crutches, leaning against the injured leg, but not at full strength. Over time, this load will increase.
The purpose of the 1st phase of rehabilitation is to restore the person's ability to move independently, including on the stairs( at first, of course, using crutches).
When traveling, it is important to follow certain rules, namely:
- To prevent dislocation, it is necessary to bend the leg in the hip joint by no more than 90 degrees. It is forbidden to cross your legs, squat and toss your foot on your leg, when such an opportunity will appear due to the subsidence of pain.
- In order to avoid similar actions in a dream, it is necessary to lay cushions between the legs.
- You can sit down only on such chairs, where the knees will not rise above the level of the navel, that is, the hip joint will not bend over 90 degrees.
- In the position lying on the back of the legs should be slightly apart in the sides, as in the sitting position.
- Do not bend lower than the navel, when dressing shoes or other activities while sitting, lying or standing. Always remember about 90 degrees!
Exercises 1st phase:
- In standing position, lift the elbow parallel to the ground. Hold the foot in this position for 5 seconds, then lower it. Several approaches are required for this exercise.
- In the standing position, straighten the leg and slowly pull back( the back in the lower back can be held by hand).Hold the limb in this position for 5 seconds, then lower it. Repeat the exercise several times.
- Standing elongated leg to the side. Hold the limb for 5 seconds, then lower it. Repeat the exercise several times.
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The second phase of
This phase of rehabilitation after hip arthroplasty begins about a week after surgery, includes exercises whose task is tomoving the patient on the stairs. They are carried out only with the supervision and assistance of a doctor, so here we will not touch on these exercises, since it is necessary to guide the attending physician, which is based on the patient's condition, as well as some other factors.
Rehabilitation after joint replacement is the most important task for both the people who underwent this operation and their physicians. Most of the questions posed by such patients, one way or another, concerns the duration of the recovery period and the peculiarities of its course. The time of the recovery period depends on many conditions, however, the average values are from one month to six months.
Rehabilitation after hip replacement can be conditionally divided into two parts - short-term and long-term. At the first stage of recovery, the main goal of the patient and the doctor is to master the patient some movements and the possibility of falling asleep without taking pain medications. During 2-4 days of the early period, the patient is encouraged to try to move in bed, and perform static exercises to work the muscles. Rehabilitation after hip joint surgery will occur more quickly if the patient begins performing respiratory gymnastics.
Rehabilitation after hip joint
The subsequent stage of rehabilitation after hip arthroplasty includes various physical exercises, such as walking with additional support( crutches).When teaching walking with the use of crutches or other additional support, you need to teach the patient to maintain balance while standing on a healthy limb. The training of patients who have undergone hip replacement after surgery is usually performed on day 3-6.The patient must learn the "rule of the triangle".A healthy leg under no circumstances is on the same line as crutches, it is either behind or in front of them. This position provides three points of support, and, consequently, a stable equilibrium. Some patients, especially the elderly, need rehabilitation after the operation of the hip joint in the form of walking with additional support for crutches by the so-called "step-in step".
When walking, the operated limb moves to the line of crutches, but the weight of the body is not transferred to it, the weight of the body through the hands is transferred to the crutches, after which the step is made with a healthy foot. The load on the operated limb should be strictly dosed. In this period, it is also important to heal tissues after surgery. The main indicator of a successful recovery period is the patient's well-being, his feelings, which concern not only the physical, but also the state of mind. This stage of recovery lasts about 6 months.
After endoprosthetics of the hip joint, rehabilitation of patients for the most part goes outside the hospital, becausethe discharge occurs 10-12 days after the operation. Patients must necessarily continue to perform recovery measures, strictly observing the advice of doctors. Even patients whose recovery is successful, within six months of the hip replacement surgery, need regular medical supervision after surgery. This is necessary so that the doctor can evaluate the progress of the recovery, and, if necessary, recommend the placement of the patient in the rehabilitation center in a timely manner. In this case, further rehabilitation after endoprosthetics of the hip joint will occur under the supervision of specialists - rehabilitation specialists by special methods. After the endoprosthesis of the hip joint, rehabilitation is more complete if the patient is given a massage. Especially massage is important in the presence of dystrophic changes in the hip joints, since in this case, an increase in the load on the operated limb during the rehabilitation period after the replacement of the hip joint can lead to a disruption of the limb's limb. Further prospects for recovery for the patient are the ability to move freely without experiencing pain.
In patients who underwent knee replacement, rehabilitation takes about three months, but in some cases the recovery period is longer. During the recovery period, the patient must learn to use a new joint. Ideally, after knee replacement, rehabilitation should be done so that the patient can freely and return to his normal rhythm of life as soon as possible.
The main tasks of the doctor and patient during rehabilitation after knee replacement should be to increase the strength of the leg muscles, increase the volume of joint movements, protect the installed prosthesis, and gradually return to the level of physical activity that was characteristic of the patient before. It is recommended to start recovery measures immediately after the operation, these can be the gymnastic exercises recommended by the doctor, which the patient performs daily. For rehabilitation after knee arthroplasty, the following procedure for performing restorative physical exercises has been developed.
On the first day it is possible to use a special medical device, neatly bending and unbending the knee joint. In addition, on the first day the patient is useful to sit on a bed, chair, try to get up and take a couple of steps in the hospital ward, necessarily using an additional support in the form of crutches. On the second day after surgery, activity should be gradually increased. At this time, patients can already walk in the ward using crutches, visit the toilet alone, if they feel comfortable, climbing and descending the stairs - three steps - will be useful. With each subsequent day, patients who underwent endoprosthetics of the knee joint rehabilitation are better if they continue to increase the number of performed physical exercises. By the time this patient needs to be discharged from the hospital, usually 3-4 days after the operation, he should be able to straighten and bend the joint 90 degrees, move freely using an additional support, go to the toilet himself, take a shower, put on clothes, go down and climb 3-5 steps of staircase.
When writing out a patient, the doctor necessarily gives recommendations on the use of analgesics and measures that accelerate the further restoration of the functions of the operated leg. These recommendations should be carried out in strict accordance with the words of the doctor, otherwise the recovery process will be difficult. For example, a patient's refusal to take painkillers before going through physiotherapy can lead to the impossibility of performing the procedure because of the pain experienced by the patient. In case of insufficient elimination of the pain syndrome after taking the medication prescribed by the doctor, it is necessary to inform the doctor about your complaints, maybe the doctor will recommend another drug. A little to reduce edema, and unpleasant sensations will help such a folk remedy, like applying ice to an operated knee. Before applying, the ice must necessarily be wrapped in tissue to avoid frostbite. You can apply ice before and after exercise, as well as before going to bed, as the knee can swell in the evening.
For the first time, a half to two months of rehabilitation after knee replacement, the patient needs to continue the exercises shown to him in the hospital at home, increasing their duration and intensity. The moderate activity of the patient in the home is reflected most favorably during the recovery period. Doing uncomplicated homework helps the patient return to the old way of life, distracting from fears and unpleasant sensations. However, immediately upon returning home after discharge from the hospital and until the time of full recovery, the patient will necessarily need help and support. In the three to four months after the operation, you can add the following types of physical activity: walking on the spot, lifting to the toes and heels from the standing, standing, hips in standing position, bending the knees, keeping balance, standing on one leg, short cycling trips. At this stage of the recovery period, the doctor can already determine approximately the time when the patient does not need crutches anymore, he can move independently. In the future, if the recovery proceeds without problems, the patient can perform exercises with greater physical exertion than before. For example, to walk on the stairs, go swimming, yoga or dancing. Also, after consulting with the doctor, the patient can return to the work performed before the operation, if it does not involve heavy loads and resume driving. However, even with a problem-free recovery, patients should avoid certain types of activity, As they can negatively affect the joint and contribute to its destruction. Such kinds include jumping, running on skis, lifting weights, running, tennis.
Rehabilitation after joint replacement in full depends on the joint efforts of the patient and the doctor. The more detailed and more thoroughly the patient's physician consults, the more thoroughly the patient approaches the implementation of the doctor's recommendations, the greater the likelihood of complete recovery and return to the old life.
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Video: "Endoprosthetics of the hip joint: exercises"
Third phase of
The third phase of rehabilitation begins 4-8 weeks after the operation, depending on the physical condition and age of the patient.
In this phase it is necessary to master the movement without crutches, but for the present with the help of a cane.
For successful implementation of the third phase, the following exercises will help:
- Elastic band fastens in front around the ankle, and the other end - to a secure support. In the standing position, move the leg forward, then return it to its initial position. Repeat several times for each leg. This exercise should be done 10 times a day, in the morning, in the afternoon and in the evening.
- The exercise described above is performed exactly the same way, only the elastic band is attached to the back of the ankle. In the standing position, take the leg back, then return it to its initial position. Repeat several times for each leg. This exercise should be done 10 times a day, in the morning, in the afternoon and in the evening.
- Elastic band fastened to the side of the ankle. Take the straightened leg to the side, return the limb to its initial position. Repeat the exercise several times. Perform 10 sets per day.
- The exercises on the exercise bike perfectly strengthen the muscles of the legs and develop the mobility of the joints. It is important to adjust the seat so that the legs are as straight as possible and hardly reach the pedals at the lowest point. First you should practice 10-15 minutes 2 times a day. Over time, the load should be increased and dealt with for 30 minutes 3-4 times a week, or more often.
- It is important to conduct exercises for balance training. To do this, you must stand on one leg, leaning your hand against the wall, and rise up on your toe. Perform 10 repetitions per foot.
- Walking on the treadmill in the opposite direction. The foot rolls from the fingers to the heel. When the entire foot is placed on the treadmill, the knee is fully straightened. The speed of the track should be 1-2 km / h.
Video: "Rehabilitation after hip arthroplasty: support and movement"
So, after completing the entire rehabilitation course after hip arthroplasty, as a result of the exercises, a person should completely return the opportunity to walk normally without the help of a cane. In this case, the hip joint restores its functions. This usually occurs 7-8 weeks after the operation. It should be remembered that in order to prevent injuries in the future, you must constantly maintain your body in good physical shape, and after completing the rehabilitation course, you must perform all the above exercises.
Rehabilitation after: joint replacement, hip replacement, knee replacement