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 exercise performed mostly lying
- Learn to sit down and get up
- Get on 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 or 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 outward.
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 on 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 moment 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 with 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 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, 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 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).
Rehabilitation after hip arthroplasty: recovery phases, exercise description, video
After any surgical intervention in the human body, it takes time to restore it.
Surgery for hip arthroplasty is no exception.Contents
The main causes of hip arthroplasty
Arthrosis is when the cartilage of the hip is affected. Often occurs deforming osteoarthritis - a disease of older people, who simply wear out the cartilage. As a result, the patient has pain, joint mobility decreases, etc. Other reasons for the manifestation of arthrosis of the hip joint may be an abnormal development of it and poorly fused bones after fractures in the joint region.
Fracture of the femur neck
For people of advanced age, such a trauma can become a sentence, becauseSuch a fracture in them, more often than not, does not grow together. The only way to put a person on their feet and not only is to undergo an operation to replace the hip joint endoprosthetics.
Arthritis joints are also susceptible to all kinds of inflammatory diseases( eg, rheumatoid arthritis).
Regarding rehabilitation after hip replacement, there is no single technique here.
Post-operative recovery largely depends on the underlying causes that necessitated the operation itself. Take, for example, a fracture of the neck of the thigh. Operative intervention soon after an injury is a pledge of a faster recovery of the patient, becausethe muscles surrounding the hip joint did not lose their functions and tone. It's another matter, if a person for a long time did not fully step on the aching leg, suffered and suffered from pain, and only after a few years he undergoes an endoprosthesis operation. In this case, rehabilitation will take much longer, becausethe patient for a long period could not fully rest on the aching leg, as a result of which muscle atrophy occurred.
The same rules apply to the situation with arthrosis: an uninhibited disease and time-spent endoprosthetics will help to recover much faster than delaying the operation for a long time - because of this, not only the bone tissues, but also the muscles suffer.In any case, whatever the reasons for the need to carry out the operation, the rehabilitation exercises are almost the same for all situations, and the entire recovery process begins immediately after the operation.
Beginning - 0th phase of rehabilitation
Zero phase of postoperative recovery - this is the very first step of the entire rehabilitation process.
The main objectives that need to be addressed in this phase are:
- Improving the blood supply of the legs in order to avoid the formation of blood clots.
- Strengthening the muscles and "working out" movements of the hip joint.
These exercises are mandatory and will help not only to recover more quickly, but also to reduce postoperative pain.
Classes should be started as soon as anesthesia goes away - if it was an injection in the back( regional anesthesia), then the patient can not move his legs for the first 2-6 hours. The pace should be slow and cautious. At first, not everything will turn out equally well. However, exercises should be done every day in the morning, afternoon and evening hours.
Foot pumpThis exercise can be done right after the operation and throughout the rehabilitation process. Lying( sitting) in bed or sitting in a chair, slow movements of the foot are made - up and down. Exercise should be done several times every 5-10 minutes.
Rotation in the AnkleDuring this exercise, rotational movements of the foot of the operated leg are performed: first 5 times clockwise, then as many times counterclockwise. In the rotational movements only the ankle joint( not knee!) Should be involved. This exercise can be done both lying and sitting.
Exercise for the quadriceps femorisThe quadriceps femoris muscle is located on the front surface of the thigh. The essence of the exercise is the tension of the quadriceps muscles s .To do this, you need to try to straighten the knee, pressing the back of the foot to the bed. In tension, the muscle should be held for 5-10 seconds. Exercise is done 10 times with both feet.
Knee flexion with heel supportHeel - without detaching from the surface of the bed and bending the knee - pulls up to the buttocks. In this case, the knee should not bend towards the other leg, and the angle of the hip joint bend should not exceed 90 °.Exercise is done 10 times.
On the first day after surgery, it may be difficult to do this exercise - in this case it is better to wait and not to do it. If the difficulty with the exercise will occur later, you can help yourself to tighten the heel with a tape or a folded sheet.
Shortening the buttocksIn this exercise, the gluteal muscles are involved: they need to be squeezed and held tight for up to 5 seconds. The exercise is repeated 10 times.
LeadIn the exercise, the operated leg is involved, which should be taken as far as possible further away and then returned to its original position. And so up to 10 times. As a rule, on the first postoperative day, this exercise is not enough for anyone - in that case, it is not worth hurrying to do it.
Lifting the straight legDuring this exercise, the hamstrings should be stretched so that the knee of the foot lying on the surface of the bed is maximally straightened. Then you need to try to raise your straightened foot at least a few centimeters above the surface of the bed. And so on 10 times with the "sick" and healthy leg. Completion of the final phase-zero exercise is also not all effective in the first postoperative days, so it is not necessary to hurry with it.
All the above-described zero-phase exercises of the rehabilitation process should be performed not only in the very first days after the performed endoprosthetics operation.of the hip joint. Improvement of blood supply, strengthening of muscles and restoration of working functions of the hip joint will be relevant throughout the rehabilitation period.
"Severe care" or 1st phase ofAt this stage of postoperative rehabilitation( 1-4 days), the patient, under the supervision of a doctor, learns some independent things, namely: getting out of bed, going to bed, walking on crutches or walkers,chair and get up from it, use the toilet and do exercises.
The first postoperative day for the patient is necessary to lie in bed - even the procedures that you may need, the patient will carry on a gurney.
On the second day, the doctor responsible for treatment or rehabilitation of the patient will put his ward on his feet and force him to walk on crutches or with a walker, and it will be possible to step on the operated leg.
And do not just step on, but( in most cases) "lean" on it with the whole body weight. Under certain circumstances, the doctor may assign less radical partial loads to the newly acquired hip joint - increasing the load on the operated leg will take place gradually.
Rule of right angle, or prevention of dislocation
How much, how and what to do exercises is not all that the owner of the hip endoprosthesis needs to know. It must always be remembered that careless behavior in the post-operative period can lead to dislocation of the joint. To avoid this, several rules must be followed in the first months after endoprosthetics:
Rule No. 1: The right angle rule means that you can not bend your leg in the hip more than 90 °( ie, the knee of the leg should beBelt, not at the same level or higher).Also, you can not cross your legs and squat.
In order not to violate the rules of the right angle at night and not subject a new joint to the threat of dislocation, 1-2 pillows can be placed between the legs.sit on a chair or in an armchair is possible only if the rule of the right angle is observed, i.e.the angle of the bend of the hip joint is less than 90 °.
Rule No. 2: When lying in bed or sitting on a chair, the operated leg should be slightly moved away from the healthy leg( if sitting, then, as it were, in the rassiryachku).
This will relax those muscles that have undergone surgical dissection during the installation of the endoprosthesis. After the surgeon has sewn them again, the muscles require 3-4 weeks of rest to fully heal. Do not strain your leg again and keep it in a slightly retracted position. To verify the correctness of the position of the operated leg, you can do a small test - a test of the thumb. To do this, the finger is placed on the outer surface of the thigh and if the leg is in the right position, then its knee will be to the right of the finger, if the foot is right, or to the left if the left leg.
Rule # 3: When in bed, you can not reach for a blanket or other thing that is in the legs.
To do this, use accessories or assistance from others. This applies to shoes - you can not wear shoes without a spoon, and in hospital conditions it is best to wear shoes without a back.
Rule # 4: You can not sleep on your operated side, but only on a healthy one!
In this case, between the knees should be a roller or cushion, which will help relax the gluteal muscles and protect them from separation.
Rule No. 5: Lie down on your back, do not always keep a pillow or roller under your knee.
This, to some extent, helps to reduce the pain syndrome, but at the same time, the constant bent knee position will further complicate the extension of the hip joint.
After a 1-1,5 month period, the muscles surrounding the new joint, the tendons and ligament are so strong that you can drop some of the precautions described above - for example, from a pillow between the legs at night.Approximately from the second day after the operation, you should already try to get up - if not yourself, then with someone's help.
In the standing position, holding on to a stable and reliable support( the back of a chair or a bed), you should perform a series of exercises - at least 10 times each.
Raising the knee in the standing position
The knee of the operated leg does not rise too high - below the waist - and is held for two seconds, then lowered.
Straightening in the hip in the standing position
The operated leg is slowly retracted, with the back being held straight. In this position, the leg is held for 2-3 seconds, and then returns to its original position.
Leg bend in standing position
The feet, knee and thigh of the operated leg must be in the forward direction, the body of the straight leg - in this position, the leg is withdrawn to the side. Then slowly the leg returns to its original position( the foot should stand on the floor).
Objectives of the first phase
The complex of rehabilitation measures at this stage of the postoperative period combines the strengthening and development of muscles and a new joint in a recumbent, standing and walking position.
- 1st stage : training of the hip muscles( lifting of the straight leg and squeezing the cushion sandwiched between the legs), buttocks( squeezing the buttocks) and the shin( move the foot).
- 2nd stage : getting up from the bed, you should pull the operated leg.
- Stage 3 of : associated with walking on crutches or walkers. Excellent, if on the 4th or 5th day after endoprosthetics the owner of a new joint is able to walk 100-150 m in 4-5 days walks. When walking, avoid hobbling - the steps may be small. The load on both legs should be symmetrical( if there are no medical contraindications).By the 4th-5th day, one should normalize one's gait, i.e. The operated leg at walking should not be tightened, and put forward a healthy leg.
"Deceptive Opportunities" or Phase 2
Five days after the surgery for hip replacement, a new phase of recovery and rehabilitation begins, during which the needs to learn how to move up and down the .This kind of load on the operated leg requires strength in the muscles and mobility of the joint itself, and it would be best to avoid walking up the stairs until complete recovery. However, the realities of life are such that we have stairs everywhere.
Walking on the stairs is an ascent of the
. Once the stairs can not be avoided, we should move along them in a certain sequence:
- When climbing( and descending) the stairs, you should take one step at a time, and hold the hand pertaining to the healthy leg.e.if the right leg is operated, then you need to hold the handrail with the left hand.
- Going up the stairs should start with a healthy leg.
- After that on the step above the operated leg is put.
- A crutch or a supporting stick is moved to the same step.
Walking on the stairs - descent
To descend the stairs you need to start in the reverse order: the movement "opens" the crutch( or stick), which is put on the step below;For the crutch, the operated leg is sent to the same step;Following the operated leg, a healthy limb is placed.
Why are "deceptive opportunities"?
As a rule, after 5 days after the operation, a person undergoes postoperative weakness, he can already do some exercises, the feeling of the leg is getting stronger, and that's exactly what can be a disservice. Successful postoperative recovery makes you want to force events, neglect basic safety rules - do not use pillows, reach for objects, "run" more than 100-150 m, etc. As a result, such bravado can only lead to increased pain( muscles in fact have not really healed yet) or, God forbid, dislocation of the joint.
"Getting Started" or Phase 3
After a month and a half after the operation, the muscles have already grown quite well, and now it is time to increase the load on them. The main goals of this rehabilitation phase( from 4 to 8 weeks after the operation) are:
- Strengthening and full recovery of the muscles of the hip, with a view to the subsequent transition from two crutches to two sticks, then use only one cane, and in the end - to complete abandonmentauxiliary support items when walking.
- Learn to walk back, i.e.back.
- Restore a sense of balance - for example, balancing on one leg, holding your hand for any support.
- Restore the functioning of the hip joint so that you can not only straighten the leg, but also start it back at an angle of 10-20⁰.
- By the end of this rehabilitation period, a person with a hip joint endoprosthesis must cope with the "Tilt forward" and "Stand up and walk for a while" tests.
And now more about how and with what exercises all this can be achieved.
Exercises with resistance using elastic tape
Exercises using elastic tape are done in the morning, afternoon and evening hours 10 times. The elastic band at one end is attached to the ankle of the operated leg, and the other to the Swedish wall, a heavy piece of furniture or, at worst, to the closed door. To maintain balance, you should hold on to the back of a chair or bed. The essence of the exercise is pulling forward a straight "sick" leg.
Exercise with resistance - flexing of the hip joint
To do this exercise, you should stand with your back to the door, a heavy object or a wall where one end of the elastic band is fixed. In this case, the operated leg with the other end of the elastic band on it should be slightly left aside. The prosthetic leg with the straightened knee rises forward, and then without haste is put on former place.
Exercise with resistance - pulling the leg in standing position
It is necessary to stand with a healthy side to the object on which the elastic band is fixed, and take the "sick" leg aside, and then slowly return it to its original place.
How and how much to walk?
First of all, it is necessary to know that in no case can not refuse a crutch or walking stick until you are confident in your own balance .At the first stage of , you need to walk daily 3-4 times .The duration of each such walk should not exceed 5-10 minutes .At the second stage, when the muscles become even stronger, stamina will increase, the number of daily walking can be reduced to 2-3, but at the same time make them longer - from 20 minutes to half an hour. Doing walking( 3-4 times a week for half an hour) is recommended after complete recovery, supporting the result in muscles.
Exercises on the simulators: training of the extension of the hip joint
For this exercise, the uses the special simulator .The peculiarity of this exercise is that it is necessary to exclude the movement of the spine( in particular, its lumbar region), sincethe inclusion of the waist helps the patient compensate for what his hip joint can not yet do.
We twirl pedals of an exercise bike
A bicycle is an excellent assistant in strengthening muscles and "working out" of the hip joint. To start the , the exercise bike should correctly adjust the to fit itself: the seat must be at such a height that the leg with the straightened knee barely touched the pedal.At the first stage of work with an exercise bike, the pedals need to be turned in the opposite direction. Go to the second stage - torsion of the pedals forward - should be only when back pedals turn easily and without much effort.
As the muscles get stronger, the needs to increase the load level of the .If in the beginning the pedals should be twisted no more than twice a day for 10-15 minutes, then in time you can go to the 20-30-minute torsion pedals 3-4 times a week. At the same time, one should not forget the rules of the right angle, which prohibits lifting a knee above the hip joint.
Exercise using a stationary pedal with short pedals
The seat of an exercise bike with short pedals( 10 cm) is adjusted so that the "sick" leg touching the pedal in its lowest position is perfectly straight.
The return of the ability to balance is no less important than strong muscles. Training balance can begin with attempts to stand on one leg, holding on to any reliable support. Similar searches for balance should be made with both legs, but you need to start with a healthy leg. Gradually exercises on balance become more complicated.
Dynamic balance training on the unoperated leg and with the elastic band
For this exercise, take a 2-meter elastic tape, the loose ends of which are attached to some heavy and fixed object - for example, to the Swedish wall - at a level of 20 cm from the floor. The patient, standing on the operated leg, puts a loop on the healthy leg at the ankle level. In this case, he should stand at a distance of 60-70 cm from the object( wall), on which the tape is fixed. The general rack should combine a straight case and slightly bent knees .And in this situation, the patient with a healthy leg with an elastic band flips to the side. Thus, the muscles of both the operated and healthy legs are trained, there is consistency in their work, and therefore balance.
Balance training - step-down exercises with visual control
At the beginning, a low 10-centimeter step is used. A patient standing on the step starts descending from a slow step forward with a healthy foot .At that moment, the entire weight of the body lies on the operated leg. Exercise should be done, standing in front of the mirror, so that you can control the condition of the legs - when descending, it is especially important to avoid possible stalling on the aching leg. Then you should return to the starting position and repeat the exercise. If everything goes well, then in time you can increase the step height to 15-20 cm.
Balance training - step-up exercises with visual control
This exercise is performed exactly the same as the previous one. The only difference is that now the patient faces a 10-centimeter steppe on the floor. With a healthy foot, he makes a slow step forward to the step, while leaning all over his body on the operated leg. In front of him is a mirror for visual control of the situation with the position of the feet. Just like in the first case, it is necessary to avoid during the ascent to the stepping over towards the prosthetic foot. Gradually, you can increase the height of the step to 15-20 cm.
Learn to walk back
This exercise is done on a treadmill, only the patient stands on it not as usual( facing the control panel), but with the back. The speed limit of the track is set no more than 1-2 km / h. Walking backwards is moving from the fingers to the heel of the .At the same time, when the foot is standing all the way on the path, the leg in the knee should be straightened.
Exercise, lying on its side - abduction in the hip joint
The patient lies on his side, with the injured leg being on top. Legs in the knees and in the hip joint are slightly bent. Under the head must be a pillow, so that there is no tension in the muscles and skewing of the pelvis. At the initial stage, you can still use a roller between the legs. Holding his heels together, the knee of the operated leg goes up, while the pelvis and back do not move.
Passage of tests - inclination test
It is necessary to stand sideways to the wall, on which tape-centimeter is fixed. The legs should be slightly apart. Pulling his hand forward, the patient bends as much as he can, while he can not "help" himself with his feet. This distance is measured. In total, there are three such measurements - before and after training. The received data allow to judge about efficiency of the done exercises.
The norm for men under 70 is 38 cm, and for those over 70 - 33 cm. For women under 50, the norm is 40 cm, up to 60 - 38 cm, up to 70-37 cmsee, over 70 - 34 cm.
Passage of tests - stand up and walk for a while
To pass this test, the patient sits on a standard chair. His knees should be bent at an angle of 90 degrees. At the command "start" the patient gets up and runs in a straight line three meters. Then it unfolds and returns to its original place. The time spent on walking back and forth is fixed by a stopwatch. Measurements are made before and after training to determine their effectiveness.
Normative indicators for 40-49-year-olds are 6.2 s., 50-59-year-olds - 6.4 s, 60-69-year-olds - 7.2 s, 70-79-year-olds - 8.5 s.
, in addition to strict compliance with the right angle rule, you should also avoid a long time( more than one hour) in one position. Do not do the exercises if they cause pain.
"Complete recovery" or the 4th phase of
This phase of rehabilitation covers the stage of 9-14 weeks after the operation, during which it is necessary to achieve complete recovery of strength, hip and hip function. In addition, at this stage, the patient learns to walk backwards on the stairs( up and down), and also work on the tests "tilt test" and "get up and walk for a while", if it failed to achieve the desired results at the 8th week of the rehabilitation process.
The declared goals of the last stage of rehabilitation are achieved in the same ways as before - through exercises. For example:
- Thigh muscles - train half-squats, squeezing the pillow sandwiched between the legs.
- Gluteal muscles - are trained by squeezing-unclenching the buttocks.
- Absorbing muscles - strengthened by stretching the tape with the knees to the sides.
- Balance training - stand with two legs on the rocking platform, throw the ball into the wall and catch it while standing on one leg. Exercises with elastic tape
- Walking - walking in both directions along the treadmill with different speed modes. Walking backwards.
- Exercise Bike - classes at this phase of rehabilitation are best performed on an exercise bike with long pedals.
- Exercises with step - step height in the 4th phase should be increased.
You can not self-deal with your own rehabilitation without consulting a doctor. You can not do exercises through pain. Do not drop the exercise, even if tangible results are achieved.
Hip Endoprosthetics: Recovery and Rehabilitation
The hip joint is the largest joint in the human body. Connecting the torso and legs, it gets a lot of work, so the diseases and lesions of this joint cause unbearable pain, which requires immediate medical intervention.
Among hip joint diseases: coxarthrosis, infectious arthritis, pathology of blood supply to the bones, and others. Endoprosthetics of the hip joint is the replacement of the destroyed joint element on the implant. The implant can be made of materials such as metal or ceramics and contain stainless steel, cobalt, chromium or titanium. The surgeon selects the appropriate material and size of this material, based on individual indicators. The prosthesis( older people) serves a lifetime, but younger patients may need to undergo a second operation on the hip joint.
Operation for hip joint
These operations are carried out for thirty years and every year it is carried out with the help of more and more advanced technologies that significantly improve the results. As a result, patients suffer unbearable pain that accompanies any hip joint damage. In order to avoid complications during and after surgery, tell your doctor full information about your health condition. If you smoke, the doctor must know about it, since nicotine affects both the speed of rehabilitation and the patient's well-being during the operation. That there were no unforeseen circumstances, also it is not necessary to place the stomatologist before operation - the blood from a mouth can get in a blood flow, having infected a joint. Endoprosthetics of the hip requires a thorough examination.
During the operation, sometimes the blood of the patient suddenly suddenly becomes necessary - better give yours in advance, because it is not known how the body will react to someone else's blood, which usually is prepared by doctors for any firefighters.
Total hip arthroplasty( replacing both the pelvic and femoral joint elements) is, first of all, the longer-term operation of the implant, which eliminates the need for revision of the hip joint revision. In addition, in this case, the implant performs its function better, although there are disadvantages: this operation is more dangerous and blood loss in this case is greater.
Complications of hip arthroplasty are and depend on the characteristics of the body and the lifestyle of the patient, and also on the quality of the operation and the knowledge of the surgeon conducting it. Statistics show that the most common complications arose with the use of low quality implants - these are the first implants of the last century. With the progress in modern medicine, the number of complications has significantly decreased. After carrying out endoprosthetics of the hip joint, the patient can apply for a pension. The disability group after hip arthroplasty and the size of the pension, respectively, is determined by the indicators of the patient's ability to move, go to the store and so on.
Recovery after hip joint surgery
The duration of recovery after surgery depends on the patient - each rehabilitation period is individual. Recovery after hip arthroplasty does not include any specific technique, but some rules should still be followed.
- Sitting on a chair, put a pillow on the seat so that your knees are below your hips.
- Avoid excessively sharp movements, turns with legs, crosses and so on - all these manipulations will negatively affect the patient's well-being and the speed of his rehabilitation.
- Lying on your side( only not on the leg that was operated on), lay a small pillow between your legs to avoid displacement.
If symptoms such as fever appear, pain increases, swelling or other similar phenomena occur, then immediately consult a doctor.
It is worth remembering that it is important when exactly the operation was performed - immediately after the joint failure or after a long time. Of course, in the first case, the work of muscles can recover completely, which can not be said about the second case.
Rehabilitation after hip arthroplasty begins already in the hospital and continues for about a month at home. To increase the chances of completely rehabilitating, the patient must strictly follow the recommendations of doctors.
It is more difficult to rehabilitate old patients, so medical rehabilitation begins before surgery. Of course, endoprosthetics of the hip joint, whose rehabilitation takes time, is a complicated procedure, but do not despair - you will succeed.
Exercises for rehabilitation after hip arthroplasty
Exercises are an important part of restoring the muscles that are atrophied, if not done. Exercises after hip arthroplasty are quite painful, since pain immediately after the operation does not subside. However, do not spare yourself too much, because then it will be much more difficult to recover.
It is important that the patient knows what he is facing. Endoprosthetics of the hip joint, the video of which can be viewed on the Internet, will give you an idea of this.
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In the first two days after the operation for the replacement of the hip joint with a prosthesis, procedures for UHF or magnetotherapy with exposure to radiation and temperature to the seam area are shown. They relieve swelling, have an anti-inflammatory and analgesic effect( the procedure is carried out right in the ward without removing the bandage).If there are contraindications to these procedures, it is possible to carry out UV-irradiation of the wound at the moment of dressing.
To prevent stagnant phenomena in the lungs and the development of pneumonia in the initial period of rehabilitation, breathing exercises are performed, vibromassage of the thorax is prescribed. In the initial period of rehabilitation shows a course of exercise therapy, massage and active exercises for the joints of the limbs. The patient is taught isometric exercises( muscle tension of the diseased limb), which are performed for 1-5 seconds for the shin, thigh and buttock.
Post-operative gymnastics is performed daily for 15 minutes for 3-5 visits, this allows to mobilize the CNS and strengthen the complex of metabolic-trophic processes in the muscles. This gymnastics is especially indicated for bilateral hip joint lesions.
Four days after the operation to replace the hip joint with a prosthesis, one must begin to learn how to walk on stairs in houses, always leaning on the handrails and do not more than one step at a time.
To restore mobility of the operated limb after joint replacement, the LFK course and massage are shown.
Climbing the stairs in the house:
- stepping up a healthy foot;
- to rearrange the operated leg on a step above;
- put on the step a crutch / cane.
Descending the stairs in the house:
- put the cane / crutch on the lower level;
- to make a step down the operated foot;
- attach a healthy leg.
Climbing the stairs in the house always begins with a healthy leg, and descent - with the operated.4-5 day is not in vain called the phase of "deceptive opportunities", because severe pain and weakness in the leg to the 5th day passes, and the patient wants to fully feel the limb after the replacement of the joint on the prosthesis. Do not neglect the rules and start overloading your leg, otherwise you can get a dislocation of the hip joint.
In the period from 2 to 3 weeks after endoprosthetics( after the removal of stitches), the restoration program includes massage of the TBS zone, using non-rough massage techniques and without pain. The following exercise complex is shown:
- exercises for small joints of the limbs;
- exercises for diaphragmatic and thoracic breathing;
- sitting in bed with the hands.
Special attention should be paid to the placement and fixation of special surgical limbs after endoprosthetics. The rollers are placed under the knee joint and from the outside to exclude the external rotation of the thigh.
In the period from 4 to 8 weeks it's time to increase the load on the muscles, train them, restore strength and balance of movements. This is necessary to "change" from the crutches to the cane. It is necessary to perform the following set of exercises, post-natal for the development of the muscles of the lower extremities and the hip joint:
- Classes with elastic band( resistance).Performed three times a day for 10 times. One end of the elastic band is attached around the ankle, the other - to any heavy furniture.
- Flexion in the hip joint( with resistance).Stand with your back to the wall, where an elastic band is attached, slightly set aside your leg. To lift it forward, the knee is straightened. Return to and.
- Legs in standing position. Stand up to the attached ribbon in a healthy side, the operated leg is taken to the side, return to and.etc.
During recovery after joint replacement, it is necessary to train with the help of special simulators
Walk with a cane until you are confident of balance. Walking - daily for 5-10 minutes three times a day. Later, the time and the frequency of walking should be increased.
After endoprosthetics, simplified exercises on simulators are recommended( check with the trainer or watch special videos).It is best to practice on a conventional exercise bike, which is used to restore muscle strength and hip joint mobility after endoprosthetics. At the beginning of the pedal to turn only back, then - forward( do not raise the high knee), after about a month you can gradually increase the load. The exercise bike is important to be specially adjusted in accordance with the growth.
At the heart of the late rehabilitation period after the operation to replace the prosthesis lies the passage of a health course within a specialized center or a sanatorium equipped with special equipment. Restorative treatment is selected individually for each patient, taking into account the characteristics of the body, the form and stage of the disease. The following complex of procedures for recovery can be used in the sanatorium:
- Massage massage - the actions of a manual specialist are aimed at restoring muscles and ligaments, relieving tension, improving blood flow, and removing pain.
- Acupuncture - reduces pain after surgery, eliminates spasm of blood vessels, improves nutrition of tissues.
- Physiotherapy - effect on the recovering area with the help of laser, ultrasound, temperature, electric current and other physical factors.
- Gryazerapiya - curative mud contains active minerals that activate metabolic processes, improve the nutrition of tissues.
- Hydrotherapy - aqua aerobics, hydrochloric and coniferous baths of a certain temperature, shower-sharko, etc. can be used.
. Replacement of a weaker load with a heavier load is allowed no earlier than 2-3 months, if the rules are not observed, complications can arise. Up to six months, it is recommended to carry out restorative measures at home: exercise gymnastics for 10-15 minutes a day, observe a special diet, drink medications prescribed by a doctor.