Reminder after hip replacement. Motor mode after endoprosthetics. Special therapeutic exercises

Life after replacement hip joint First of all, it implies long-term rehabilitation and restoration of the sore leg and its performance. During this period, it is necessary to limit heavy physical activity and prescribe special physical therapy. A set of exercises is prepared by the attending physician. At first, all of them are performed under his supervision, and over time they can be done at home. With due diligence and careful adherence to all the rules, it will be possible to live a normal life in the shortest possible time.

Early period

The early recovery period begins after anesthesia and lasts approximately 4 weeks. At this time, it is necessary to reduce the swelling caused by the operation. It is very important to heal the suture quickly, and also to ensure that no complications arise in the body.

Physical therapy begins on the first day after surgery. It is necessary to restore all functions of the joint and surrounding muscles. Exercises are performed 3 times a day with both legs in turn. It will depend on them future life and joint function. The following exercise options may be offered:

The foot moves up and down.
Rotation of the ankle left and right. You cannot use your knees for work.
Tension the upper thigh with the leg straight for a few seconds, then relax. Repeat 10 times. At first, the leg will not straighten completely, so do not be alarmed.
Clenching and unclenching the buttocks for a few seconds. Repeat 10 times.
Lunge the straight leg to the side at a permissible distance and return to the starting position. You won't be able to do the exercise right away either.

Once the patient can sit, it is necessary to learn how to move correctly with the replaced joint. To use crutches or other support of your choice for the first time, sit on the edge of the bed and place your feet on the floor. With the crutches at your sides, slowly stand up, holding the crutches tightly and leaning on them. Make sure the floor is non-slip and there is nothing to prevent you from climbing.

Movement has its own system. Keeping your body straight and your foot position correct, lean on the crutches and move your operated leg to the side. In the first days, do not lower the sore limb to the floor. Gradually you are allowed to lower your leg, transferring your body weight to it. Monitor your physical condition, walk as much as your body allows.

The course of further therapeutic exercises is selected individually for each patient. She will completely restore the sore leg and move it to further stages of recovery. You need to do several approaches a day, keeping a slow and smooth pace. It will also be effective breathing exercises, which is performed together with the rest of the set of exercises. When the muscles tense, you should inhale, when they relax, exhale.

Late period

Recovery time during this period begins one month after surgery and lasts 90 days. At this time, it is necessary to carefully strengthen the muscles through special training and restore full range of motion. After a person has recovered a little and can already get out of bed and sit down on his own, training on an exercise bike is added, and learning to walk up the stairs begins.

How to move up the stairs correctly? The ascent begins with placing the crutch on the upper surface, followed by the healthy leg, and only after that the operated leg. At this stage, the main thing is to restore balance and further attempts to move without support. Until you are sure that you can do without a cane, it is better not to give it up (this is also called Nordic walking).

When training endurance, you first need to walk 3 times a day for 5 minutes, gradually increasing the load. To maintain the results achieved, take long walks and do a number of exercises, for example with a band. To do this, secure the latter to furniture or a door, and wrap the other part around the ankle of the operated leg. Turn your back to the fabric and move your limb slightly to the side. Lift your leg forward with your knee straight and slowly return it back. The healthy side turn towards the band, move the limb to the side, and then return to the starting position.

Exercise on an exercise bike will help restore joint mobility. The seat is adjusted so that your feet lightly touch the pedals when your leg is extended. Start pedaling at reverse side. When you feel no special effort, start twisting in standard mode. Exercises begin with 15 minutes twice a day, after which classes are carried out 3 times for 30 minutes. Exercise bikes with short pedals will simulate regular cycling. The time is set individually.

Walking backwards on a treadmill will also help. Stand on the machine with your back to the dashboard and grab the railing with your hands. Approximate speed - 2 km/h. Start the movement by rolling from your toes to your heels, and when your entire leg is on the treadmill, straighten your knee completely.

Another exercise:

Lying on your healthy side, bend your knees and hips.
Keep your heels together and slowly lift your knee up.
There should always be a pillow under your head and a bolster between your legs. They can be removed only with the permission of a doctor.

Remote period

This period is final, it can last from six months or longer depending on age, physical condition and the patient's willpower. Here, complete restoration and adaptation of the joint occurs: bones grow together faster, ligaments and muscles function better. More complex ones are added to the basic exercises from previous periods:

Lying on your back, do a “bicycle.”
In the same position, pull one leg at a time towards your stomach, bending them at the knees and lightly pressing on them with your hands.
Lying on your healthy side with a bolster in your perineum, lift your leg and hold it as far as possible.
While lying on your stomach, bend and straighten your knees.
In the same position, lift both legs in turn and move them back.
Standing with your back straight, squat slightly while holding onto the object.

Exercises with a low step platform (10 cm) will be effective. Stand on the step and, keeping your body weight on your affected leg, take a step forward from the platform with your healthy leg. It is necessary to have a mirror in order to control your own actions, perform the exercises correctly and not roll your foot to the side. Second exercise: standing on the floor, step up onto the step with your healthy leg, keeping your injured leg on the floor. Both steps increase over time to 15 and 20 cm.

During any recovery period, all physical therapy occurs under the strict supervision of the attending physician. Never ignore his prohibitions. Gymnastics is not performed through pain and does not stop prematurely. Additionally, during this and other periods, various types of appointments are prescribed. medicines. All of them are adjusted individually for each patient. The complex of drugs will necessarily include the following:

painkillers (over time, their use will decrease significantly and then stop);
antibiotics to reduce infectious threats;
vitamins;
medicines aimed at treating concomitant diseases body.

Allowed during this period

You can and even need to do therapeutic exercises after discharge. Do necessary work around the house, unless she expects heavy loads on foot. Go for walks in the company of relatives and friends so that someone is nearby if your condition suddenly worsens. Alternate gymnastics, rest and work.

When can you drive a car? Only 2 months after surgery. When boarding, the seat should be moved back as far as possible. It is allowed to carry heavy objects, but only for short distances or with long breaks. If possible, it is better to use a backpack that will distribute the weight of the item being carried evenly.

Is it possible to resume previous training? Continue your favorite sports activities, especially if it's walking or skiing, as they will keep your body in good shape. Swimming pool allowed. Better give up aggressive species sports: running, wrestling, etc., since they significantly exceed the capabilities of the joint.

Sex after hip replacement is allowed 2 months after surgery. This time is most optimal for ligament restoration.

You can wash in the bathroom, but if possible, the first 6 weeks should be given preference to the shower. It is better to leave the bathroom doors open at this time so that loved ones can come to the rescue.

Do not turn your bathroom into a sauna - this will have a bad effect on still fragile muscles.

You can not relax and strictly follow the advice of your doctor during all recovery periods, not forgetting about physical therapy at all stages. The late period is often called “deceptive”, because by that time the leg no longer hurts, the ability to move around and perform more independently returns. complex actions. At these stages, patients often relax and forget about all the doctor’s instructions. As a result, frequent dislocations and the return of previous pain.

Absolutely forbidden

There will be restrictions during the recovery period, so it is necessary to follow a number of rules. At the early stage of rehabilitation, try to sleep only on your back for several days, it is better to turn over on your side with the help of a nurse, and after about a week you are allowed to lie on your side. Do not overload your leg during this period: do not make sharp turns, do not bend it more than 90 ° and do not cross your legs. For convenience, you can place a pillow between them.

For the entire rehabilitation period (especially in the first days), be as careful as possible, avoid falls, do not twist your feet and do not turn your torso if you are standing still. Do not sit in one position for more than 20 minutes, avoid soft and low chairs, chairs without armrests. Ideally, when sitting, your legs will be at right angles. Lift carefully, holding the armrests firmly.

Do not walk or stand for too long; running is prohibited. Various types of leg exercises are useful, but overloading them is not recommended. The load should increase gradually. The integrity and strength of the prosthesis directly depends on this. Try not to bend over to pick up a fallen object, but to lift it using special devices or with the help of loved ones.

Analgesics should not be taken during physical therapy. Every kilogram is an additional load on the leg, which significantly reduces the life of the prosthesis. There is no special diet: you need to monitor your weight and physical condition.

At home, follow the standard recommendations after endoprosthetics, which your doctor will advise you about. Shoes should only be low-heeled; for the time being, it is necessary to remove all objects that can be caught by feet: wires, rugs, children's toys. Keep a close eye on your pets, especially if you know they tend to get in the way.

Under no circumstances should you visit a sauna or bathhouse in the first 3 months after surgery. Avoid taking hot baths. The heat itself will not be affected - the problem may arise in the leg itself due to blood clots formed there.

Take some time to take a steam bath, keeping this rule in mind. Use caution when immersing yourself in a bathtub or shower: hold the sides firmly with your hands, shift your weight to the bottom, then move your limbs there.

If you notice changes in the joint area, do not try to get rid of the pain yourself. If there is pain, redness, swelling, or fever, consult a doctor immediately. By following these rules, the patient will achieve significant improvements, and his life after hip replacement will be as comfortable as possible.

People who are recommended for joint replacement surgery often worry that fast running or exercise is contraindicated after joint replacement. sports dancing, roller skating. If your doctor says that you should not exercise after surgery active species sports, thank him for the information and forget about it.

Exercise after knee replacement is not only allowed, it is encouraged. It is much more harmful to lie on your bed after the hospital and become depressed. There will be no benefit from such a state, but active loads V in moderation They will even help restore natural mobility to the joint. Let's figure it out from the beginning: from the indications and methods of the operation to the final recovery and possibilities after it.

Is it possible to do without endoprosthetics in case of joint pathologies?

It should be remembered that the destruction of articular tissue occurs gradually (with rare exceptions). You cannot wake up one day and find out that cartilage has stopped performing its functions. Regular medical checkup An experienced specialist can identify the disease by early stages. In most cases, the situation can be stabilized and managed “ little blood"without radical measures.

Is it true, therapeutic treatment will not reverse the process, the destroyed area will not be restored. With proper treatment, the processes of thinning of the joint tissue will simply slow down, full recovery will not come. If you are not a fan of active life, just take the course drug treatment. You will be able to walk without pain, work and take care of yourself on your own.

For people who love sports (even if they are not professional athletes), it is better to consider the option of replacing a diseased joint with a custom implant. Is fast running contraindicated after endoprosthetics? Outdated opinion! Today, orthopedists guarantee complete restoration of active mobility, subject to several rules. And caution, of course.

Conclusion: you can do without surgery if the disease does not interfere with normal movement and pain symptoms do not cause discomfort. You can “heal” the disease with pharmaceuticals, but only endoprosthetics guarantees the return of the joint to full functionality.

Endoprosthetics - an operation for the lazy and old?

Today people are in a hurry to live, think about own health once. Poor nutrition excess weight, sedentary work, sedentary lifestyle life and bad habits are faithful allies of joint diseases. Every day they interfere with the functioning of our biological system, loosening it. For example, smoking not only affects the lungs, but also impairs blood circulation. A joint deprived of timely blood flow thins over time and becomes vulnerable to mechanical stress. Simply hitting yourself is enough to cause a fracture.

For professional athletes and people leading an active lifestyle, the step towards endoprosthetics is precisely physical activity. An abrupt stop while running, an unsuccessful jump or fall, a blow - as a result, an injury is incompatible with the natural functioning of the joint.

Third category potential patients orthopedic surgeon – people prone to inflammatory diseases. Arthritis, osteoporosis and arthrosis, congenital or acquired, can cause severe destruction of joint tissue and lead to the operating table. People with arthrosis pain do not think that fast running is contraindicated after endoprosthetics. They could just walk on their own and painlessly. Therefore, joint replacement during the progression of inflammatory processes is the only chance for recovery.

Why does endoprosthetics give a high cure rate?

Today, surgery to replace the hip, knee and ankle joints is a routine operation in which risks are practically eliminated. If the situation does not cause concern, specialists will perform partial implantation and replace only the “sick” part of the joint. If studies reveal a high percentage of destruction, the segment is completely changed.

Modern surgeons prefer less traumatic interventions on the patient's body. With progress in computer technologies Minimally invasive gentle manipulations became possible with the help of special instruments and visualization of the process on the monitor. With rare exceptions, there is no need for abdominal operations, which can cause complications and leave a scar. Today, an incision or puncture is enough for intervention, which minimizes risks.

Computer navigation helps to penetrate precisely into the affected area without touching healthy tissue, remove the destroyed segment and install a prosthesis with millimeter precision. Also, directly during the operation, the mobility of the artificial joint is checked in the flex/extend, raise/lower mode. The technique allows you to speed up recovery and significantly reduce the rehabilitation period after knee or hip replacement.

Rehabilitation period after endoprosthetics

After hip, knee or knee replacement surgery ankle joint Not only fast running, but also any active movement in general is contraindicated. For the first two weeks, a rest regime is recommended. Next, from 14 to 60 days, you need to do exercises to strengthen the muscles and develop a new joint. After two months of physical activity, you can gradually begin active life: walking at a pace (not too fast), climbing stairs, driving a car.

Final recovery usually occurs after a year. During this period, you can begin active training and sports. Today, endoprostheses are made individually, according to the characteristics of each patient. Precise installation and absence allergic reaction allow you to feel the implant as an extension of your own body and does not cause discomfort.

Where is the best place to have endoprosthetics?

Looking on the Internet, you will find out that clinics that specialize in joint replacement and postoperative rehabilitation great multitude. It is believed that best treatment provided in Germany or Israel. Indeed, the level of medicine in these countries is beyond praise. True, there is one drawback. You will have to pay a considerable amount for treatment. Interestingly, with the same effectiveness of treatment of joint pathologies in Korea or the Czech Republic, you will need less money. Features of management. Additional rehabilitation in “advanced” clinics is also not free. Israeli and German clinics charge from $150 per day for each day of hospital stay beyond the period agreed upon in the contract.

Russians can undergo endoprosthetics in their homeland. The state's investment in healthcare has made it possible to open several specialized federal clinics that deal with joint replacement, both insurance policy, and on a paid basis.

Drawing conclusions

Is fast running contraindicated after endoprosthetics? With proper training and following medical prescriptions, you can run within 3-4 months after surgery. Think about it, would football players get prosthetics if they were then threatened with disqualification? No! This means you can run, jump and dance. Nothing is impossible for a person with a strong spirit.

Be sure to consult your doctor before treating any illness. This will help take into account individual tolerance, confirm the diagnosis, ensure the correctness of treatment and eliminate negative drug interactions. If you use prescriptions without consulting your doctor, it is entirely at your own risk. All information on the site is presented for informational purposes and is not a medical aid. All responsibility for use lies with you.

Memo for the patient

Before and after total hip replacement (endoprosthetics)

Instead of a prologue or what is endoprosthetics

Constant pain in your hip joint, resulting from an injury or disease of the joint, in Lately has become unbearable... It is difficult to remember at least one day when you did not feel it. All tested remedies that relieved pain before now provide only a short-term effect. Movements in the joint have become limited and painful. You began to notice that your leg cannot be fully straightened, it has become shorter. The attending physician at the clinic is less optimistic in his forecasts; he responds to persistent demands to reliably relieve you of pain either with silence or with poorly concealed irritation... What to do?

Our goal is not to scare you or throw you into panic. On the contrary, we will try to help you choose the right path for recovery.

So, all attempts to reliably get rid of pain with the help conservative methods treatments were unsuccessful. But even the thought of the possibility surgical treatment seems terrible to you. Moreover, you hear a wide variety of, sometimes contradictory and frightening, opinions about the results of operations...

To better understand possible operations, let's try to imagine the anatomy of the hip joint. So, the hip joint is a ball-and-socket joint where the thigh meets the pelvic bones. It is surrounded by cartilage, muscles, and ligaments that allow it to move freely and painlessly. In a healthy joint, smooth cartilage covers the head of the femur and acetabulum pelvic joint With the help of the surrounding muscles, you can not only support your weight while supporting your leg, but also move. In this case, the head slides easily inside the acetabulum.

In a diseased joint, the affected cartilage is thinned, has defects and no longer serves as a kind of “lining”. The articular surfaces, altered by the disease, rub against each other during movements, stop sliding and acquire a surface like sandpaper. The deformed head of the femur turns with great difficulty in the acetabulum, causing pain with every movement. Soon, in an effort to get rid of the pain, the patient begins to limit movements in the joint. This in turn leads to weakening of the surrounding muscles, “shrinking” of the ligaments, and even greater limitation of mobility. After some time, due to the “crushing” of the weakened bone of the femoral head, its shape changes, and the leg shortens. Bone growths (so-called “spikes” or “spurs”) form around the joint.

What kind of operations are used for severe joint destruction? The simplest, most reliable, but not the best is to remove the joint (resection) followed by the creation of immobility at the site of the former mobile joint (arthrodesis). Of course, by depriving a person of mobility in the hip joint, we create many problems for him in Everyday life. The pelvis and spine begin to adapt to the new conditions, which sometimes leads to pain in the back, lower back, and knee joints.

Radically break this whole chain disease processes Only surgery to completely replace the diseased joint can. For this purpose, the orthopedic surgeon uses a hip joint endoprosthesis ( artificial joint). Like a real joint, the endoprosthesis has a spherical head and an imitation of the acetabulum (“cup”), which are connected to each other and form a smooth joint with ideal gliding. A ball-shaped head, often metal or ceramic, replaces the femoral head, and a cup, often plastic, replaces the damaged acetabulum of the pelvic bone. The stem of the artificial joint is inserted into femur and fits securely in it. All parts of the artificial joint have polished surfaces for perfect gliding during your walking and any movements of your leg.

Of course, an artificial joint is a foreign body for your body, so there is a certain risk of inflammation after surgery. To reduce it you need:

cure bad teeth;
cure pustular skin diseases, minor wounds, abrasions, purulent nail diseases;
cure foci of chronic infection and chronic inflammatory diseases, if you have them, follow their warning.

We remind you once again that an artificial joint is not normal joint! But, often, having such a joint can be much better than having your own, but sick!

Currently, the quality of artificial joints and the technology for their installation have reached perfection and have reduced the risk of various postoperative complications up to 0.8-1 percent. Despite this, certain complications are always possible, associated with the already described inflammation of the tissues around the joint or with early loosening of the elements of the endoprosthesis. Strict adherence to the doctor’s recommendations will reduce the likelihood of such complications to a minimum. At the same time, it is difficult to demand from the surgeon one hundred percent guarantees of the ideal functioning of the implanted joint, since its function depends on a number of reasons, for example: advanced disease, condition bone tissue at the site of the proposed operation, concomitant diseases, previous treatment.

Typically, the service life of a high-quality imported endoprosthesis is 10-15 years. In 60 percent of patients it reaches 20 years. IN last years A new generation of artificial joints has appeared (with the so-called metal-to-metal friction pair), the estimated life of which should reach 25-30 years. namely, the “estimated lifespan”, since the period of observation of these joints for the most part does not yet exceed 5-6 years.

There are many different designs of hip replacements, but right choice Only an orthopedic traumatologist who deals with this problem can make the joint that you need. As a rule, the cost of a modern imported endoprosthesis ranges from 1000 to 2500 US dollars. Of course, this is a lot of money. But, in our opinion, life without pain and the ability to move are sometimes worth it.

So, we tried to openly talk about the problem of replacing a diseased joint with an artificial one. The final choice is yours. But let you be reassured by the fact that every year more than 200 thousand patients around the world choose endoprosthetics surgery.

By choosing to have a total hip replacement, you have taken the first step in returning to the pain-free and limited mobility you lived before your illness. The next step will be a period of postoperative rehabilitation. The purpose of the brochure that you are holding in your hands is to help you take this step correctly and as successfully as possible. To do this, you will have to change some old habits and behavioral patterns, and apply certain forces to restore walking and normal movement in the joint. We hope that your family, friends, medical workers. We will try to help you too.

You always need to remember that an endoprosthesis, unlike a natural joint, has a limited range of safe movements and therefore requires special attention, especially in the first 6-8 weeks. Since during the operation not only changed bone structures, but also altered ligaments, cartilage, scar joint capsule, the stability of the operated joint in the first days is low. Only your correct behavior will allow you to avoid the danger of dislocation and form a new normal joint capsule, which, on the one hand, will ensure reliable protection from dislocation, and on the other hand, will allow you to return to normal life with full range of motion in the joint.

First days after surgery

As we just said, the first days after surgery are the most important. Your body is weakened by the operation, you have not yet fully recovered from anesthesia, but in the first hours after waking up, try to remember more often about the operated leg and monitor its position. As a rule, immediately after surgery, the operated leg is placed in an abducted position. A special pillow is placed between the patient’s legs to ensure moderate separation. You need to remember that:

In the first days after surgery it is necessary to sleep only on your back;
You can only turn on the operated side, and then no earlier than 5-7 days after the operation;
when turning in bed, you must place a pillow between your legs;
You can sleep on the non-operated side no earlier than 6 weeks after the operation; if you still cannot do without turning onto the healthy side, then it must be done very carefully, with the help of relatives or medical staff, constantly holding the operated leg in a state of abduction. To protect against dislocation, we recommend placing a large pillow between your legs.
During the first days, you should avoid a large range of motion in the operated joint, especially strong flexion in the knee and hip joints (more than 90 degrees), internal rotation of the leg, and rotation in the hip joint.
When sitting in bed or going to the toilet in the first days after surgery, you need to strictly ensure that there is no excessive flexion in the operated joint. When you sit on a chair, it should be high. A regular chair should be cushioned to increase its height. Low, soft seats should be avoided.
In the first days after surgery, it is strictly forbidden to squat, sit with crossed legs, or “cross” the operated leg over the other.
Try your best free time devote to physical therapy exercises.

The first goal of physical therapy is to improve blood circulation in the operated leg. This is very important to prevent blood stagnation, reduce swelling, and speed up healing postoperative wound. The next important task of physical therapy is restoring the strength of the muscles of the operated limb and restoring the normal range of motion in the joints and the support of the entire leg. Remember that in the operated joint the friction force is minimal. It is a hinge joint with ideal gliding, so all problems with limited range of motion in the joint are solved not through its passive development like rocking, but through active training of the muscles surrounding the joint.

In the first 2-3 weeks after surgery, physical therapy is performed while lying in bed. All exercises must be performed smoothly, slowly, avoiding sudden movements and excessive muscle tension. During physical therapy exercises, it is important to correct breathing- inhalation usually coincides with muscle tension, exhalation - with their relaxation.

First exercise- For calf muscles. Bend your feet toward and away from you with slight tension. The exercise should be performed with both legs for several minutes up to 5-6 times within an hour. You can start this exercise immediately after waking up from anesthesia.

A day after surgery, the following exercises are added. Second exercise- for the thigh muscles. Press the back of your knee joint into the bed and hold this tension for 5-6 seconds, then slowly relax.

Third exercise- sliding your foot along the surface of the bed, lift your thigh towards you, bending your leg at the hip and knee joints. Then slowly slide your leg back to the starting position. When performing this exercise, you can first help yourself with a towel or elastic band. Remember that the angle of flexion in the hip and knee joints should not exceed 90 degrees!

Fourth exercise- placing a small pillow under your knee (no higher than 10-12 centimeters), try to slowly tense your thigh muscles and straighten your leg at the knee joint. Hold the straightened leg for 5-6 seconds, and then also slowly lower it to the starting position. All of the above exercises must be done throughout the day for a few minutes 5-6 times per hour.

Already on the first day after surgery, provided there are no complications, you can sit up in bed, leaning on your hands. On the second day, you need to start sitting up in bed, lowering your legs from the bed. This should be done towards the non-operated leg, gradually abducting the healthy leg and pulling the operated leg towards it. In this case, it is necessary to maintain a moderately apart position of the legs. To move the operated leg, you can use devices such as a towel, crutch, etc. When moving the operated leg to the side, keep your body straight and make sure that there is no external rotation of the foot. Sit on the edge of the bed, keeping your operated leg straight and in front. Slowly place both feet on the floor.

You must immediately remember that before sitting down or standing up, you must bandage your legs with elastic bandages or put on special elastic stockings to prevent thrombosis of the veins of the lower extremities!!!

First steps

The goal of this rehabilitation period is to learn how to get out of bed, stand, sit and walk so that you can do this safely yourself. We hope that our simple tips will help you with this.

As a rule, you are allowed to get up on the third day after surgery. At this time, you still feel weak, so in the first days someone must help you, supporting you. You may feel a little dizzy, but try to rely on your strength as much as possible. Remember, the faster you get up, the faster you will begin to walk. The medical staff can only help you, but nothing more. Progress is entirely up to you. So, you should get out of bed in the direction of the non-operated leg. Sit on the edge of the bed, keeping your operated leg straight and in front. Before standing up, check that the floor is not slippery and that there are no rugs on it! Place both feet on the floor. Using crutches and your non-operated leg, try to stand up. Caring relatives or medical staff should help you in the first days.

When walking in the first 7-10 days, you can only touch the floor with your operated leg. Then slightly increase the load on your leg, trying to step on it with a force equal to the weight of your leg or 20% of your body weight.

After you have learned to stand and walk confidently without outside help, physical therapy should be expanded with the following exercises performed in a standing position.

Knee lift. Slowly bend the operated leg at the hip and knee joints at an angle not exceeding 90 degrees, while raising your foot above the floor to a height of 20-30 cm. Try to hold the raised leg for a few seconds, then also slowly lower your foot to the floor.
Taking your leg to the side. Standing on your healthy leg and holding the headboard securely, slowly move your operated leg to the side. Make sure your hip, knee and foot are pointing forward. Maintaining the same position, slowly return your leg to the starting position.
Taking the leg back. Leaning on your healthy leg, slowly move your operated leg back, placing one hand on the back of your lower back and then making sure that your lower back does not sag. Slowly return to the starting position.

So, you walk quite confidently on crutches around the ward and the corridor. But this is clearly not enough in everyday life. Almost every patient needs to walk up stairs. Let's try to give some advice. If you have had one joint replaced, then when moving up, you should start lifting with the non-operated leg. Then the operated leg moves. The crutches move last or simultaneously with the operated leg. When going down stairs, you should move your crutches first, then your operated leg, and finally your non-operated leg. If you have both hip joints replaced, then when you lift, the more stable leg begins to move first, then, as described earlier, the less stable leg begins to move. When descending, you should also lower your crutches first, then your weak leg, and finally your strong leg.

We remind you once again that during this period:

It is advisable to sleep on a high bed;
You can sleep on your healthy (non-operated) side no earlier than 6 weeks after surgery;
You should sit in high chairs (like bar stools) for 6 weeks after surgery. A regular chair should be cushioned to increase its height. Low, soft seats should be avoided. It is important to follow all of the above when visiting the toilet.
It is strictly forbidden to squat, sit cross-legged, or “cross” the operated leg over the other;
get rid of the habit of picking up from the floor fallen objects- this should be done either by those around you or by you, but always with the help of some kind of device such as a stick.

Current control

An endoprosthesis is a rather complex and “delicate” design. Therefore, we strongly recommend that you do not abandon the monitoring regimen recommended by your doctor for the behavior of the new artificial joint. Before each follow-up visit to the doctor, it is necessary to take an x-ray of the operated joint, it is advisable to take blood and urine tests (especially if after the operation you had some kind of inflammation or problems with wound healing).

The first follow-up examination usually occurs 3 months after the operation. During this visit, it is important to find out how the joint “stands”, whether there are any dislocations or subluxations in it, and whether it is possible to begin to put full weight on the leg. The next control is in 6 months. At this moment, as a rule, you already walk quite confidently, fully loading the operated leg. The purpose of this examination is to determine what and how has changed in the condition of the bones and muscles surrounding the joint after normal load, whether you have osteoporosis or some other bone tissue pathology. Finally, the 3rd control - one year after joint replacement. At this time, the doctor notes how the joint has grown in, whether there is a reaction from the bone tissue, how the surrounding bones have changed and soft fabrics, muscles in the process of your new, better life. In the future, visits to your doctor should be made as necessary, but at least once every 2 years.

REMEMBER! If pain, swelling, redness and increased skin temperature appear in the joint area, if the body temperature increases, you need to contact your doctor URGENTLY!

Your artificial joint is a complex structure made of metal, plastic, ceramics, so if you are going to travel by plane, take care to obtain a certificate of the operation performed - this may be useful when going through control at the airport.

Avoid colds chronic infections, hypothermia - your artificial joint can become that “ weak point", which will undergo inflammation.

Remember that your joint contains metal, so deep heating and UHF therapy on the area of the operated joint are undesirable. Watch your weight - everyone extra kilos will accelerate wear and tear on your joint. Remember that no special diets for patients with a replaced hip joint. Your food should be rich in vitamins, all necessary proteins, mineral salts. No one food group has priority over the others, and only together can they provide the body with complete, healthy food.

The “failure-free” service life of your new joint largely depends on the strength of its fixation in the bone. And it, in turn, is determined by the quality of the bone tissue surrounding the joint. Unfortunately, in many patients who have undergone endoprosthetics, the quality of bone tissue leaves much to be desired due to existing osteoporosis. Osteoporosis refers to the loss of bone mechanical strength. In many ways, the development of osteoporosis depends on the age, gender of the patient, diet and lifestyle. Women over 50 years of age are especially susceptible to this disease. But regardless of gender and age, it is advisable to avoid the so-called risk factors for osteoporosis. These include a sedentary lifestyle, the use of steroid hormones, smoking, and alcohol abuse. To prevent the development of osteoporosis, we recommend that patients avoid highly carbonated drinks such as Pepsi-Cola, Fanta, etc., and be sure to include foods rich in calcium in their diet, for example: dairy products, fish, vegetables. If you have symptoms of osteoporosis, you should urgently discuss with your doctor the optimal ways to treat it.

Avoid lifting and carrying heavy weights, as well as sudden movements and jumping on the operated leg. Walking, swimming, gentle cycling and gentle skiing, bowling and tennis are recommended. Usually when full recovery limb function, patients have a desire to continue playing their favorite sports. But, taking into account the peculiarities of the biomechanics of an artificial joint, it is advisable to avoid those types of sports activities that involve lifting or carrying heavy objects, or sharp blows to the operated limb. Therefore, we do not recommend sports such as horse riding, running, jumping, weightlifting, etc.

If this does not contradict your aesthetic views and does not affect the attitude of others towards you, use a cane when walking!

If you dance, do it calmly and slow dancing. Forget about squat dancing and rock and roll.

Normal sex is allowed 6 weeks after surgery. This period is required for the healing of the muscles and ligaments surrounding the operated joint. The following picture illustrates the recommended positions and, conversely, those that should be avoided by a patient after total hip arthroplasty.

We recommend making some simple adaptations to make your daily life easier. So, to avoid excessive hip flexion when bathing, use a sponge or washcloth with a long handle and a flexible shower. Try to buy shoes without laces. Put on your shoes using a horn with a long handle. Some patients with an advanced process continue to have certain difficulties when putting on socks. For them, we recommend using a simple device in the form of a stick with a clothespin at the end when putting on socks. You need to wash the floor with a mop with a long handle.

When traveling in a car, try to move the seat back as far as possible, taking a semi-reclining position. And finally, I would like to warn against one more dangerous misconception. Remember that your artificial joint will not last forever. As a rule, the service life of a normal endoprosthesis is 12-15 years, sometimes it reaches 20-25 years. Of course, one should not constantly think about the inevitability reoperation(especially since most patients will be able to avoid it). But at the same time re-replacement joint or, as doctors call it, revision endoprosthetics far from a tragedy. Many patients are terrified of repeat joint surgery and try to endure the pain they experience, but do not consult a doctor, hoping for some kind of miracle. This should not be done under any circumstances. Firstly, not all pain and discomfort in the joint require mandatory surgical intervention, and the sooner the doctor becomes aware of them, the greater the chances of getting rid of them easily. Secondly, even in case of fatal loosening of the joint, the previously performed operation is much easier for the patient and the surgeon and leads to a faster recovery.

We hope that the artificial joint has relieved you of the pain and stiffness you previously experienced with your own painful joint. But the treatment does not end there. It is very important that you take proper care of your new joint and remain fit and on your feet at all times. Taking into account some of the precautions we discussed above, you can fully recover and return to your normal active life.

Memo for the patient

Before and after total hip replacement (endoprosthetics)

Instead of a prologue or what is endoprosthetics

Constant pain in your hip joint, which arose after an injury or disease of the joint, has recently become unbearable... It is difficult to remember at least one day when you did not feel it. All tested remedies that relieved pain before now provide only a short-term effect. Movements in the joint have become limited and painful. You began to notice that your leg cannot be fully straightened, it has become shorter. The attending physician at the clinic is less optimistic in his forecasts; he responds to persistent demands to reliably relieve you of pain either with silence or with poorly concealed irritation... What to do?

Our goal is not to scare you or throw you into panic. On the contrary, we will try to help you choose the right path for recovery.

So, all attempts to reliably get rid of pain using conservative treatment methods were unsuccessful. But even the thought of the possibility of surgical treatment seems terrible to you. Moreover, you hear a wide variety of, sometimes contradictory and frightening, opinions about the results of operations...

To better understand possible operations, let's try to imagine the anatomy of the hip joint. So, the hip joint is a ball-and-socket joint where the thigh meets the pelvic bones. It is surrounded by cartilage, muscles, and ligaments that allow it to move freely and painlessly. In a healthy joint, smooth cartilage covers the head of the femur and the acetabulum of the pelvic joint. With the help of surrounding muscles, you can not only support your weight while supporting your leg, but also move. In this case, the head slides easily inside the acetabulum.

What kind of operations are used for severe joint destruction? The simplest, most reliable, but not the best is to remove the joint (resection) followed by the creation of immobility at the site of the former mobile joint (arthrodesis). Of course, by depriving a person of mobility in the hip joint, we create many problems for him in everyday life. The pelvis and spine begin to adapt to the new conditions, which sometimes leads to pain in the back, lower back, and knee joints.

Sometimes operations are used on muscles and tendons, which, when crossed, reduce pressure on the articular surfaces and, thereby, somewhat reduce pain. Some surgeons use corrective operations to expand the crushed head, thereby moving the load to undamaged areas. But all these interventions lead to a short-term effect, only for a while, reducing pain.
Only an operation to completely replace the diseased joint can radically interrupt this entire chain of painful processes. To do this, the orthopedic surgeon uses a hip replacement (artificial joint). Like a real joint, the endoprosthesis has a spherical head and an imitation of the acetabulum (“cup”), which are connected to each other and form a smooth joint with ideal gliding. A ball-shaped head, often metal or ceramic, replaces the femoral head, and a cup, often plastic, replaces the damaged acetabulum of the pelvic bone. The stem of the artificial joint is inserted into the femur and securely fixed in it. All parts of the artificial joint have polished surfaces for perfect gliding during your walking and any movements of your leg.

Of course, an artificial joint is a foreign body for your body, so there is a certain risk of inflammation after surgery. To reduce it you need:

cure bad teeth;
cure pustular skin diseases, minor wounds, abrasions, purulent nail diseases;
cure foci of chronic infection and chronic inflammatory diseases, if you have them, monitor their prevention.

We remind you once again that an artificial joint is not a normal joint! But, often, having such a joint can be much better than having your own, but sick!

Currently, the quality of artificial joints and the technique of their installation have reached perfection and have reduced the risk of various postoperative complications to 0.8-1 percent. Despite this, certain complications are always possible, associated with the already described inflammation of the tissues around the joint or with early loosening of the elements of the endoprosthesis. Strict adherence to the doctor’s recommendations will reduce the likelihood of such complications to a minimum. At the same time, it is difficult to demand from the surgeon one hundred percent guarantees of the ideal functioning of the implanted joint, since its function depends on a number of reasons, for example: the advanced stage of the disease, the condition of the bone tissue at the site of the proposed operation, concomitant diseases, and previous treatment.

Typically, the service life of a high-quality imported endoprosthesis is 10-15 years. In 60 percent of patients it reaches 20 years. In recent years, a new generation of artificial joints (with the so-called metal-to-metal friction pair) has appeared, the estimated life of which should reach 25-30 years. namely, the “estimated lifespan”, since the period of observation of these joints for the most part does not yet exceed 5-6 years.

There are many different designs of hip joint endoprostheses, but the correct choice of the joint you need can only be made by an orthopedic traumatologist who deals with this problem. As a rule, the cost of a modern imported endoprosthesis ranges from 1000 to 2500 US dollars. Of course, this is a lot of money. But, in our opinion, life without pain and the ability to move are sometimes worth it.

You always need to remember that an endoprosthesis, unlike a natural joint, has a limited range of safe movements and therefore requires special attention, especially in the first 6-8 weeks. Since during the operation not only altered bone structures are removed, but also altered ligaments, cartilage, and the scar capsule of the joint, the stability of the operated joint in the first days is low. Only your correct behavior will allow you to avoid the danger of dislocation and form a new normal joint capsule, which, on the one hand, will provide reliable protection against dislocation, and on the other hand, will allow you to return to normal life with a full range of movements in the joint.

First days after surgery

In the first days after surgery it is necessary to sleep only on your back;
You can only turn on the operated side, and then no earlier than 5-7 days after the operation;
when turning in bed, you must place a pillow between your legs;
You can sleep on the non-operated side no earlier than 6 weeks after the operation; if you still cannot do without turning onto the healthy side, then it must be done very
carefully, with the help of relatives or medical staff, constantly holding the operated leg in a state of abduction. To protect against dislocation, we recommend placing a large pillow between your legs.
During the first days, you should avoid a large range of motion in the operated joint, especially strong flexion in the knee and hip joints (more than 90 degrees), internal rotation of the leg, and rotation in the hip joint.
When sitting in bed or going to the toilet in the first days after surgery, you need to strictly ensure that there is no excessive flexion in the operated joint. When you sit on a chair, it should be high. A regular chair should be cushioned to increase its height. Low, soft seats should be avoided.
In the first days after surgery, it is strictly forbidden to squat, sit with crossed legs, or “cross” the operated leg over the other.
Try to devote all your free time to physical therapy exercises.

The first goal of physical therapy is to improve blood circulation in the operated leg. This is very important to prevent blood stagnation, reduce swelling, and speed up the healing of postoperative wounds. The next important task of physical therapy is restoring the strength of the muscles of the operated limb and restoring the normal range of motion in the joints and the support of the entire leg. Remember that in the operated joint the friction force is minimal. It is a hinge joint with ideal gliding, so all problems with limited range of motion in the joint are solved not through its passive development like rocking, but through active training of the muscles surrounding the joint.

In the first 2-3 weeks after surgery, physical therapy is performed while lying in bed. All exercises must be performed smoothly, slowly, avoiding sudden movements and excessive muscle tension. During physical therapy exercises, proper breathing is also important - inhalation usually coincides with muscle tension, exhalation with muscle relaxation.

First exercise- for the calf muscles. Bend your feet toward and away from you with slight tension. The exercise should be performed with both legs for several minutes up to 5-6 times within an hour. You can start this exercise immediately after waking up from anesthesia.
A day after surgery, the following exercises are added.

Second exercise- for the thigh muscles. Press the back of your knee joint into the bed and hold this tension for 5-6 seconds, then slowly relax.

Third exercise— sliding your foot along the surface of the bed, lift your thigh towards you, bending your leg at the hip and knee joints. Then slowly slide your leg back to the starting position. When performing this exercise, you can first help yourself with a towel or elastic band. Remember that the angle of flexion in the hip and knee joints should not exceed 90 degrees!

First steps

The goal of this rehabilitation period is to learn how to get out of bed, stand, sit and walk so that you can do this safely yourself. We hope that our simple tips will help you with this.

After you have learned to confidently stand and walk without assistance, physical therapy should be expanded with the following exercises performed in a standing position.

Knee Raise. Slowly bend the operated leg at the hip and knee joints at an angle not exceeding 90 degrees, while raising your foot above the floor to a height of 20-30 cm. Try to hold the raised leg for a few seconds, then also slowly lower your foot to the floor.
Taking the leg to the side. Standing on your healthy leg and holding the headboard securely, slowly move your operated leg to the side. Make sure your hip, knee and foot are pointing forward. Maintaining the same position, slowly return your leg to the starting position.
Taking the leg back. Leaning on your healthy leg, slowly move your operated leg back, placing one hand on the back of your lower back and then making sure that your lower back does not sag. Slowly return to the starting position.

We remind you once again that during this period:
It is advisable to sleep on a high bed;

You can sleep on your healthy (non-operated) side no earlier than 6 weeks after surgery;

You should sit in high chairs (like bar stools) for 6 weeks after surgery. A regular chair should be cushioned to increase its height. Should

Avoid low, soft seats (chairs). It is important to follow all of the above when visiting the toilet.

get rid of the habit of picking up fallen objects from the floor - either those around you or you should do this, but always with the help of some kind of device such as a stick.

Current control

The first follow-up examination usually occurs 3 months after the operation. During this visit, it is important to find out how the joint “stands”, whether there are any dislocations or subluxations in it, and whether it is possible to begin to put full weight on the leg. The next control is after 6 months. At this moment, as a rule, you already walk quite confidently, fully loading the operated leg. The purpose of this examination is to determine what and how has changed in the condition of the bones and muscles surrounding the joint after normal load, whether you have osteoporosis or some other bone tissue pathology. Finally, the 3rd control - one year after joint replacement. At this time, the doctor notes how the joint has “grown”, whether there is a reaction from the bone tissue, how the surrounding bones and soft tissues, muscles have changed in the process of your new, higher quality life. In the future, visits to your doctor should be made as necessary, but at least once every 2 years.

REMEMBER! If pain, swelling, redness and increased skin temperature appear in the joint area, if the body temperature increases, you need to contact your doctor URGENTLY!

Tips for the future

Avoid colds, chronic infections, hypothermia - your artificial joint may become the “weak spot” that will become inflamed.

Remember that your joint contains metal, so deep heating and UHF therapy on the area of the operated joint are undesirable. Watch your weight - every extra kilogram will accelerate the wear and tear of your joint. Remember that there are no special diets for hip replacement patients. Your food should be rich in vitamins, all necessary proteins, and mineral salts. No one food group has priority over the others, and only together can they provide the body with complete, healthy food.

Avoid lifting and carrying heavy weights, as well as sudden movements and jumping on the operated leg. Walking, swimming, gentle cycling and gentle skiing, bowling and tennis are recommended. Usually, with complete restoration of limb function, patients have a desire to continue playing their favorite sports. But, taking into account the peculiarities of the biomechanics of an artificial joint, it is advisable to avoid those types of sports activities that involve lifting or carrying heavy objects, or sharp blows to the operated limb. Therefore, we do not recommend sports such as horse riding, running, jumping, weightlifting, etc.

If this does not contradict your aesthetic views and does not affect the attitude of others towards you, use a cane when walking!

If you dance, do it calmly and slowly. Forget about squat dancing and rock and roll.

When traveling in a car, try to move the seat back as far as possible, taking a semi-reclining position. And finally, I would like to warn against one more dangerous misconception. Remember that your artificial joint will not last forever. As a rule, the service life of a normal endoprosthesis is 12-15 years, sometimes it reaches 20-25 years. Of course, you should not constantly think about the inevitability of repeated surgery (especially since most patients will be able to avoid it). But at the same time, repeated joint replacement or, as doctors call it, revision endoprosthetics is far from a tragedy. Many patients are terrified of repeat joint surgery and try to endure the pain they experience, but do not consult a doctor, hoping for some kind of miracle. This should not be done under any circumstances. Firstly, not all pain and discomfort in the joint require mandatory surgical intervention, and the sooner the doctor becomes aware of them, the greater the chances of getting rid of them easily. Secondly, even in case of fatal loosening of the joint, the previously performed operation is much easier for the patient and the surgeon and leads to a faster recovery.

Patient information for the first 6 months after hip replacement.

In order to achieve a good result, not only optimal surgery is important, but also initial rehabilitation with the help of a physiotherapist.

On this information sheet you will find numerous instructions and answers to your questions.

To prevent joint dislocation, avoid the following movements for 6 months after surgery:

Prohibited movements

. do not do itAddition: - do not move the operated leg inward

Don't cross your legs

. don't do Rotation: - do not turn the operated leg inward/outward (depending on how the operation was performed!)

.do not bend the hip joint more than 90°- this corresponds to a right angle between the torso and leg. (this means don't bend over)

On the back

. At first, lie on your back, place a pillow or a blade between your legs, so that your legs are always apart and knee cap looked straight at the ceiling

. The bedside table should be on the side of the operated leg

When is it okay to lie on your side?

. approximately 4-6 weeks after surgery you can lie down gently on the operated side

. After about 6 weeks you can turn to your healthy side

Attention! Important! Put it down Always pillow between your legs!

. when you sit, your legs should be apart and the angle at the hip joint should not be less than a right angle. Always sit higher.

. try not to sit on low and soft chairs, sofas. Don't cross your legs.

Advice: Use a thick cushion or wedge if the seat is very low.

How to dress correctly?

. When you put on pants, put on the operated leg first; when undressing, take off the clothes from the healthy leg first.

→ use a gripping device for this

. put on or take off shoes using a long shoehorn with inside. Tie your laces in advance or replace the laces with elastic laces or an elastic band.

The easiest way to put on socks is to use a sock putter or ask for socks to be put on.

Stand and walk

. turn/rotate with small steps and with your whole body, lift your leg before taking a step

. do not make sudden movements (for example: if you are called or the phone suddenly rings)

. Try to always wear stable shoes, such as boots or sneakers

Gait and climbing stairs:

The correct type of walking with crutches that suits you will be developed with the help of your physiotherapist. We recommend that you use two crutches for some time, as consequences that are difficult to correct may occur. How long you need to use crutches depends on your gait and muscle strength. Your doctor or physical therapist will give you their recommendations.

When climbing stairs, hold on to the railing with one hand and the crutch with the other hand. If there is no railing, then you use two crutches.

1.Climbing to the top: Place your healthy leg on the top step, then place your operated leg and crutch on the same step.

2.Descent down: Place both crutches and your operated leg on the bottom step and place your healthy leg next to them.

Advice: Crutches and the operated leg are always at the same level.

Sports after joint replacement.

Suitable sports may include, for example: walking, cycling, swimming (check with your doctor).

Prohibited sports include, for example: tennis, alpine skiing, and all ball sports.

When can you drive a car?

Please contact your doctor with this question.

How to bend over?

Rest one hand on a stool or table that is on the side. Extend your feathered leg as far back as possible and bend your torso forward. Thus, if you stretch your free hand forward, you can pick up an object lying on the floor.

Application of ice: Apply ice in bags for about 7-10 minutes, when the time is up, remove the ice and take a break for at least 20 minutes so that the skin accepts normal temperature. This process can be repeated 2-3 times a day. (Long and prolonged cooling leads to negative influence on the healing/recovery process)

Exercises in the first days after joint replacement.

At the bottom worthwhile exercises will help you get back into shape faster. To ensure that you perform the exercises correctly, do them first with your physiotherapist.

Do the exercises 2-3 times a day for 10 minutes. Attention! Be attentive to pain and try to adapt the amount of exercise to your well-being!

Leg movement.

Move your toes up and down as much as possible. The legs remain motionless.