How to recover after a hip replacement
Restoration of the health of a patient who has undergone joint surgery is necessary within the first hours after awakening from anesthesia. Rehabilitation after hip arthroplasty( TDS) is a complex of exercises, different for each period. It may also depend on the type of fixation of the prosthesis, the condition and age of the patient, the presence of concomitant diseases. Rehabilitation should be carried out not only in the hospital, but also after discharge, in a specialized medical center or at home.
Rehabilitation of TBE - first of all it is physical exercises
Rehabilitation after hip replacement
Rehabilitation after TBS replacement is divided into early and late postoperative periods, in which there are different tasks and degrees of stress on the diseased limb. The recovery of each patient passes individually and is determined by many factors.
Recovery in the early postoperative period
- Prevent postoperative complications
- Master exercises performed mostly lying
- Learn to sit down and get up
- Learn walking on crutches
Combating possible complications
The main concerns for the early period after joint replacement:
- Taking care of the correct position of the aching leg
- Reducing pain and swelling
- Wound dressing
- Maintaining a sparing diet
- Thrombotic prophylaxisEducation
Requirements for the position of the legs and movements
- The first days are allowed to sleep only on the back of the
- . In order for the legs of the patient not to approach the unacceptable distance or to cross, a wedge-shaped pillow or roller
is placed between the legs. After the operation, it is necessary to set the correct position of the legs using the wedge-shaped pillow
- Turning to a healthy side can be done already eight hours after the operation, asking to help a nurse or nurse. The legs should be bent at the knees, pressing them with the ankle joints
- . The amplitude of flexion of the aching leg in the knee should not exceed 90 °.
- Sharp turns of the legs, rotation of the TBS are unacceptable.
. Reducing pain and swelling
No one can escape pain after the operation. Anesthesia goes by - and inevitable pain attacks begin, accompanied by swellings as well. To tolerate this already exhausted patient is difficult, and the help comes:
- Anesthetic therapy
- Drainage of accumulating fluid in the joint:
- in the joint cavity is inserted a drainage tube emerging on the surface
- tube is removed as soon as the cavity ceases to accumulate exudate
- Lining the affected areaice
- If pain is accompanied by an infectious process, antibiotics
should be used. Bandages of wound
- The first dressing is usually performed on the second day after operation
- The frequency of the subsequent dressings is determined by the surgeon, with a frequency of at least one in two to three days.
- Stitches are removed after 10-14 days:
- , thread removal can occur and earlier, if the
- wound is in satisfactory condition, absorbable threads should not be removed.
Food and water intake
After the patient comes to, he may have a thirst and an appetite. This is a reaction to anesthesia .But a little drink and eat a little bit of crackers can only 6 hours after the operation . Usual food intake is allowed on the next day .
The first days are necessary to keep a diet, which includes:
- Meat broth, slightly salted, with mashed meat
- Oatmeal porridge, mashed potatoes
- Lactic acid products
- Fruit jelly, unsweetened tea
Then the usual diet or usual diet corresponding to chronic diseases of the patient is prescribed.
Prevention of thrombosis
After surgery, blood coagulability is always increased - this is a natural reaction of the body, aimed at accelerating the healing of the wound. Therefore, during this period there is always a threat of thrombosis, and if the patient still has a history of venous insufficiency, the risk is doubled.
For the prevention of thrombosis, the following measures are used:
- Dressing of the lower extremities with an elastic bandage
- Taking heparin, warfarin and other anticoagulants
- Special exercises for the limbs
Modes of loading on the operated side
- If using a cement fixation method for replacement of the joint :
- initial loads on the operated legshould be already in the early rehabilitation period, in the first postoperative days
- full loads - in a later period
- In case of cementlessmethod of fixing :
- 10-15% of the full load after 7-10 days
- Half of the load after 21 days
- Full load at the end of a two-month period
- Special clinical cases :
- Stroke, internal diseases, oncological diseases,deep old age, etc.-in all these cases, exercise should be started as soon as possible after surgery, and in full-load mode.
- In acute pain:
- , the limited load regimen is applied at any stage of the
rehabilitation. The artificial joint has an ideal mobility, but in itself it will not move: you need to "tie" it to the muscles. And this is possible only through active rehabilitation, strengthening the muscles.
Passive exercises on mechanical simulators after the replacement of TBS are usually performed to prevent muscle contractures, but not to strengthen the muscles. They can not replace the exercise therapy that needs to be done with their own efforts and without which complete recovery is impossible
Early postoperative exercises
Goals of exercise therapy in the early postoperative period
After the hip replacement at the very beginning of rehabilitation, the following goals are set:
- Prevent blood stagnation, speed upwound healing and reduce edema
- Restore the supporting function of the diseased leg and the full range of movements of the
LFK for the first two to three weeks performslying in bed. But getting up on the feet is literally on the second day
The initial gymnastics complex is very simple, but there are certain requirements:
- Exercises are often performed throughout the day:
- intensity - up to five to six times per hour for several minutes( obtained on average inhour for therapeutic gymnastics takes 15-20 minutes)
- Nature and pace of exercise - smooth and slow
- All exercises are combined with breathing, approximately according to this scheme:
- with muscular tension breathe
- when exhaled exhale
The complex includes exercises for the gastrocnemius, femoral and gluteal muscles of both extremities.
On the first postoperative day:
- Alternate reciprocating motion with stops:
Left foot goes to itself, right side to itself, then vice versa
Simultaneous movement by foots as foot pump
- Pinching and unclenching of fingers on both legs
On the second day after surgery:
- Static exercises :
- Pressing the back of the knee for five to seven seconds to the bed, followed by relaxation - thus training the thigh muscles
- A similar pinching of the heels - the shin muscles and the hamstrings of the thigh are trained.
- Slipping the patient with the leg to the side and back, withoutdetachment from the surface of the bed
- Slip with the bending of the foot :
- Sliding the patient with the foot on the sheet, bending the leg in the joints no more than 90 °
- Returning the same way the leg in the(First, you can lighten your task with an elastic band or a regular towel)
- Straightening with
- lifting This exercise is performed using a roller of no more than 10-12 cm height, placed under the knee
- Slowly stretching the femoral muscle, straighten the leg and hold it inthis position is five six seconds. Then just as slowly lower it
Straightening straight leg with lifting using roller
These exercises must be alternated with each other:
In one hour we do one, in the second one another, etc.
How to sit down
It is necessary to sit down carefully for the second day. How it's done?
You need to sit down by sticking on the handrail in the direction of the healthy foot
- You need to lean on your elbows or hold the frame over the bed
- You need to sit in the direction of the healthy leg, lowering it to the floor first, then pulling to it( you can use it with an elastic bandage)operated limb
- The shaft between the legs must be
- The legs must be pre-banded with elastic bandages
- . When planting, observe the straight position of the trunk and do not turn the foot outwards.
From the second day, The mechanotherapy of the hip joint begins.
The period of circulation after the replacement of TBD
It can also be called "walking through the agony": too little time has passed since the operation, the wound still hurts, and the doctor, despite the pains, already orders to stand on the crutches literally the next day. And this is not a surgeon's whim:
The earlier you start walking, the less likely it is to develop contractures and more chances to restore the full volume of movements.
All the difficulties of walking on crutches are described in detail in our article. Rehabilitation after knee replacement, therefore,walking on crutches on the stairs
Load on the injured leg
- During the first postoperative week, you just need to touch the foot of the floor
- Then go to the 20% load on the aching leg: this is equalit is estimated to carry its own weight without weight of the whole body, that is, stand on its foot without support of it.
Increase the load with bringing it to half should be performed for each patient individually:
If the pain and swelling in the leg do not pass, then the load increase is premature.
Long-lasting pain and swelling
Long-lasting pain and non-decreasing puffiness may be signs of postoperative complications, dislocation of prosthesis, abnormal walking or incorrectly performed medical gymnastics
. In any case, the reasons must be understood by the surgeon.
Walking on crutches on the stairs
The method of walking on crutches on the stairs is determined by the direction of movement - up or down
The method of walking is determined by the direction of movement - up or down:
- When climbing up the stairs, the movement starts from the unoperated limb:
- We rely on the crutches and move the healthy leg to the step
- We push off the crutches and transfer the weight of the body to it
- We tighten the operated leg while moving the crutches to the top step, or we move the crutches after the painful leg
- When descending from the ladder, all movements occur in the reverse order:
- Initially transferred to the bottom step of the crutches
- Relying on crutches, put down without a stop bobleg
- We transfer the healthy leg to the same step and rely on it
Walking on crutches on the stairs can begin after the exercises for the leg in standing position are mastered
LFK on the tenth day after the operation
Exercises in standing position
- When performing theirit is necessary to hold on to the handrails, the back of the bed or chair
Retreatment of the operated leg forward, to the side, back to 20 - 30 cm
- Each exercise must be repeated up to 15 times up to 10 times a day
- Examples of exercises:
- perforated foot forward, sideways, backward to 20 - 30 cm
- Lifting the leg with a bent knee to a small height
Exercises in the horizontal position
- Repeating all isometric exercises with alternately pressing the legs, knee extensors and gluteus muscles to the floor:
- Static tension is achieveddue to the tension of the abdominal muscle and the extension of the foot sock to itself
- Isometric relaxation follows at the time of relaxation
- Flexion and retraction of the affected leg to the side by the slip method
- ByErection of the patient leg at an angle of not more than 90 ° with its holding on the weight and a slow descent
Lifting the operated leg at an angle
- Retracting the diseased leg to the side with the position on the side:
between the legs it is necessary to place the pillow
- Flexion-extension of the legs in the supine position
Flexion-extension of the legs in the supine position
All this complex of exercise therapy should be continued at home.
Late rehabilitation of the hip joint
And now, after the operation, it's been two months already, but TBS is still rather stiff, and you step on the operated leg uncertainly. It means - full recovery has not happened and you need to continue rehabilitation:
- At home to perform the previous exercises plus gymnastics with the support of the injured leg
- Do it on the simulators
Exercise bike for the hip joint
The exercise bike is an effective method of strengthening absolutely all the muscles connected to the joint.
The exercise bike needs to be lightened and corresponding to a small angle of joint bending.
height. However, you do not need to overdo it with it:
- Use the simulator in the low speed mode
- Adjust the seat height so that the hip joint bends no more than 90 °, and when the knee of the foot is straightenedbarely touched pedals of an exercise bike
Video: Rehabilitation of TBS after joint replacement
Features of rehabilitation after hip arthroplastyRehabilitation after hip arthroplasty is a long process of recovery through exercise 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 a 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 neglected cases, it is necessary to do without hip arthroplasty.
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 under the supervision of 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 - 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 a hip replacement advises you 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, go to bed, 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 directly, and the foot and knee will be propelled 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).
The time period of this phase is the first day after endoprosthetics. All movements are carried out very carefully. At this time, you can do the following exercises:
- "foot pump" - movements of the foot up and down several times( this exercise should be done throughout the rehabilitation period);
- short-term tension of the anterior hamstrings;
- shortening the buttocks and holding them in this position for five seconds;
- sidetracking and returning to the starting position of the operated leg;
- leg bending in the knee with heel support;
- rotation of the foot of the operated leg clockwise and counter-clockwise;
- of the raised limb for a few seconds.
All exercises should be done slowly and very carefully. Each should be repeated about 10 times. Not all of these exercises can be obtained immediately. If in the process of performing any movement there are difficulties, then it can be a little delayed, and a little later, try again.
LFK after endoprosthetics - one of the elements of rehabilitation
For the prevention of vascular disorders it is recommended to bandage both legs with elastic bandages. Do not forget about a healthy leg: it is recommended to raise and lower the leg, and also to take it aside. It is forbidden to cross your legs. Lying is best on your back. If you need to lie on your side, there must be a roller between your hips.
First phase( "strict care")
The duration of this phase is from one to four days after the operation. The patient can already sit neatly on the bed. In this case, you can not cross your legs and strongly bend them in the hip joint, and also lie on the operated side.
When sitting, do not allow the hip joint to be below the knee. Sitting is recommended on hard chairs, putting a pillow under your buttocks. It is not recommended to sit in soft armchairs, since when you stand up, the load on the hip joint will be too great. Lying on the bed it is recommended to take your foot to the side. Contraindicated to throw your foot on the leg.
The next day after endoprosthetics, you can start walking slowly, leaning on crutches. Almost all patients are recommended immediately to try to step on the operated leg, the so-called load on the principle of tolerance to pain. By the fourth day, you can already walk 100-150 meters several times a day.
New zero exercises are added to the exercises of the zero phase, which are performed in the standing position, but with support:
- flexion of the legs in the hip and knee joints;
- retraction of the straightened leg back.
Phase II( "deceptive capabilities")
This phase begins on the 5th and ends on the 21st day after endoprosthetics. During this period, an increase in motor loads is assumed. You can slowly descend and climb the stairs, for a longer time is paid to walking, observing the following rules:
- Walking is recommended not more than 30 minutes at a time.
- Going up the stairs, first put on the step of a healthy leg, and only then operated.
- Walking is allowed only with crutches or special walkers.
The name "deceptive opportunities" this phase got because the pain is almost over, and the patient seems that he can already more than the doctor allows. Many of the patients neglect the rules, the observance of which prevents the dislocation of the joint, stop putting the roller between the hips. Violation of the rules can lead to increased pain and dislocation in the operated joint.
The basic exercises of exercise therapy that are added in this phase:
- Lying on the abdomen:
- flexing the leg in the knee so that the heel is directed to the buttocks;
- lifting of the legs by the tension of the gluteal muscles.
- Lying on the back:
- alternating the legs to the sides;
- flexion of the legs in the knees, without detaching the feet from the floor.
The third phase( "getting started")
Exercises from the third phase of exercise therapy begin to do when the muscles and ligaments are strong enough, and the joint will get accustomed. As a rule, this happens 1-2 months after hip replacement. All exercises can be done at home. The load is increased by weighting. For this, elastic bandage is suitable. At this time, no longer need to put a cushion or pillow between the hips.
The duration of walks on foot is gradually increased to 3-4 hours per day. Despite the fact that during this period, quite significant load on the joint is possible, it is recommended to stop exercising when pain occurs.
rehabilitator will help you with special exercises. Basic exercises:
- flexion of the leg in the hip joint with resistance;
- leads the operated leg to the side with resistance.
In this phase, you can begin training on an exercise bike. The seat must be adjusted so that when the knee is straightened, the feet can barely reach the pedals. It is recommended to start lessons with the pedals turned back. The first classes should be short-term.
Late postoperative period
If, after hip replacement, more than three months have passed and when walking in the operated leg causes pain or discomfort, you can unload it using a cane. Patients who underwent surgery for hip arthroplasty, after three months can return to work in production and drive a car. However, if the work requires active movements, it is recommended to take a break every one or two hours for rest. Those who do not imagine their lives without sports are recommended to ski, swimming and cycling. It is important to remember that self-medication after hip arthroplasty can not only do no good, but also cause harm. Therefore, before you begin to perform certain exercises, you need to consult with your doctor.
Operation for hip replacement
The operation to replace the hip joint is an extreme measure. At the initial stages of these diseases, it is still possible to resort to conservative treatment. Mechanical damage or congenital anomalies are nevertheless subject to prompt intervention.
For arthrosis, everything is very individual. Most patients are offered first conservative treatment, and already by results judge the need to replace the joint. The exception is only the last stages of the disease, which can lead to disability.
According to reviews of patients who have undergone the operation to replace the joint, it is carried out in two forms: replace some specific part of the joint or perform a full prosthesis.
Partial replacement of
Prior to the installation of certain joint elements, preliminary removal of damaged or damaged elements is carried out. Often, the removal of the head of the bone, as well as its neck. In their place an artificial analog is established, which is selected according to the size of the "native" joint. The surface of the hip joint is made of metal or ceramic, which provides not only smoothness of movements, but also strength.
Hip joint in the hands of the doctor
The prosthesis is connected to the bone tissue with a pin, which provides the entire structure with additional strength. The cost of such an operation will be an order of magnitude lower than the total replacement and is determined individually based on the materials used and the nature of the clinic.More: What to do with aching leg joints?
Full joint replacement
When it is not possible to keep the hip joint at least partially, resort to its full prosthetics. For this purpose, the cartilage tissue from the bone is completely cleaned completely, and a metal or ceramic analogue is installed in its place.
As with the partial replacement of the joint, the entire structure sits on the pins, so that the new joint even exceeds the strength of the natural cartilage. They are made of titanium or stainless steel, which greatly affects their price. The hip joint thus receives additional support, since the pin holds together the bone and the head of the artificial prosthesis.
What kinds of prostheses exist
In order to ensure that the postoperative period has passed smoothly, not only the skill of the surgeon, but also the quality of the prosthesis itself. Replacement of the joint involves a one-time intervention, so the materials from which it is made must be high-strength and hypoallergenic. Moreover - each product is customized individually for each person.
The prosthesis itself consists of several parts that ensure its mobility. They can be made of different materials - metal, ceramic or plastic. Proceeding from the received data about who is being prescribed the prosthesis, what way of life the person leads, the doctor selects the optimal prosthesis, which can combine all three materials in different combinations.
For a person who leads a sedentary lifestyle, the replacement joint may consist for the most part of plastic with minor inclusions of metal. But for a person active wear resistance and durability of the prosthesis is important, therefore, it can be based on metal.
Hip joint for young people, who lead to the measure of an active lifestyle, prostheses with ceramic heads are created. They combine the strength of metal, but at the same time have the ease of plastic, which allows them to perform their functions in an optimal way.More: Endoprosthetics of the knee and its rehabilitation
How is the
replaced? The operative procedure for joint replacement lasts no more than three hours. It all depends on the complexity of the disease and the nature of the replacement( complete it or partial ).Anesthesia is used either generically or injected into the spinal canal, which provides a loss of sensitivity in the lower part of the body. There are a number of videos that show the basic nuances of the operation.
After successful operation, the patient can resume motor activity for physical education. Three days is usually enough to perform the simplest exercises that will improve blood circulation and stimulate tissue healing. Over time, exercises become more complicated, but this is all very individual, since all the ability to regenerate is different.
Rehabilitation after this kind of surgery is not long, which causes a person minimal psychological discomfort. Replacement of the joint in modern medical practice is not considered a complex operation, especially with the use of the latest technology and tools. Within a day or two the patient will be able to move independently using crutches.