Life after removal of a hip endoprosthesis. Step-by-step rehabilitation after hip replacement surgery is the key to success. Dangerous situations for people undergoing rehabilitation

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 using conservative treatment methods 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 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.

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.

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. 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 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, 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: 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 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 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.

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 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 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 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 - 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, 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 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, 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 re-replacement 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.

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.

In joint replacement surgery, ligaments are removed. The joint replacement is held in place by muscles that need training to improve function. After surgery, the patient should remember the list of prohibited movements in the operated joint and carry out a set of rehabilitation measures.

World practice has established that the most adequate way to treat affected hip joints in a severe stage is their total endoprosthetics - replacing the damaged parts with two components of an artificial joint.

This removes the ligaments. The joint replacement is held in place by muscles that need training to improve function.

Some movements must be performed with great care:

bending,

Rotation,

Adduction (adduction of muscles when crossing legs).

The patient should remember the list of prohibited movements in the operated joint.

The convalescence period is usually 12 months. During this time at successful operation and adequate motor mode, the patient’s static-locomotor functions are completely restored.

At the outpatient stage of motor rehabilitation physical exercise - essential component recovery, especially in the first 3 months after surgery. They are performed slowly, calmly, without excessive effort. Sudden movements are not allowed.

Exercises after hip replacement

Several exercises immediately after sleep are useful:

1. Take a sitting or lying position on your back with your legs extended in front of you:

Rotate your foot, alternately pulling your toe up and down, but not sharply. This exercise improves blood circulation in the leg;

Bend your affected leg at the knee. The heel should always touch the floor and slide along it. Do not bend your hip joint more than 90 degrees. Extend your leg so that your heel slides on the floor. Relax your leg completely. Repeat the exercise 5-6 times;

Legs are extended, toes point straight up. Move your affected leg to the side as far as possible. Return it to the starting position, completely relax. Repeat the exercise;

Tighten your quadriceps (legs extended, toes pointing). In this position, count to 5. Relax your leg completely. Repeat the exercise.

2. Take a supine position. Try to touch as many points as possible on the surface, but do not strain. This relaxes many of the muscles involved in the hip joint.

3. Stand with your hands on a table or a stable chair with a high back. Raise the knee of the affected leg towards the chin (bend the hip joint, but no more than 90 degrees). Lower your leg to the floor and relax it completely. Repeat the exercise. Then do it with your healthy leg.

4. Keep your torso straight. Move your sore leg as far back as possible. Return to your previous position, completely relax. Repeat. Then perform the exercise with your healthy leg.

5. Keep your torso straight. Move your affected leg as far as possible to the side. Return it to its previous position, completely relax. Repeat the exercise. Then do it with your healthy leg.

The complex can be performed 3-4 times a day, for 10-15 minutes.

To avoid problems after surgery, ensure restoration of the function of the operated joint and prevent displacement of the prosthesis, patients should follow additional measures precautions:

Don't let it fall. In the first weeks after surgery, this can lead to damage to the joint or dislocation of the head of the prosthesis and require repeated intervention.

Avoid the following body positions:

• sit diagonally; sitting, lean to one side;
• cross your legs (do not cross with your operated leg conditional line middle of the body);
• bend the hip joint more than 90 degrees;
• excessively turning the feet in or out;
• rotate the body with fixed legs.

Excessive risk of prosthesis dislocation represents simultaneous flexion of the hip in the operated joint by more than 90 degrees with internal rotation and adduction.

You cannot sit in one position for more than 20 minutes. In this case, the hip joints should be higher (or at the level) of the knees, and the feet should be on the floor, the distance between them should be 15–20 cm. You should not use chairs that are too soft and low. The height of the chair (bed) is considered ideal if the patient’s legs are at right angles when sitting. The chair should be high, durable, with a back and armrests. You need to stand up using the armrests.

Go to bed like this: sit on the bed, raise your legs and turn them with your torso towards the middle of the bed.

It is advisable to sleep on your back. The operated leg in the supine position should be abducted 20 degrees from midline, toes point straight up.

It is not recommended to sleep on the side of your healthy leg, since during sleep flexion, adduction and internal rotation of the operated leg may occur - and there is a danger of dislocation of the prosthesis. To prevent unwanted adduction of the leg during sleep when turning in bed on the side and stomach through the healthy leg, it is necessary to place a bolster or pillow between the thighs - until the doctor cancels this requirement.

The load on the operated leg should be gradual and increase under the supervision of a doctor. Excessive contributes to loosening of the endoprosthesis structure.

It is prohibited to take analgesics during physical therapy exercises.

It is not recommended to drive a car in the first 1.5–2 months after surgery. When boarding, move the seat back as far as possible, turn your back to it, sit down and, raising your knees, smoothly turn your legs and body at the same time towards the middle of the cabin. For convenience, you can put a plastic bag on the seat. When leaving the car, repeat the procedure reverse order. You need to stand up with one hand on the back of the seat and the other on the control panel.

Avoid lifting and carrying heavy objects. If such a need arises, then they can only be moved over short distances; It’s better to use a satchel or backpack, with them the load will be distributed evenly.

The first 3–6 weeks after surgery, patients systematically expand daily activities. It should include:

• regaining the ability to sit, stand, and go up and down stairs;
• walking, initially around the house and then outside;
• walks with a gradual increase in mobility and duration;
• special exercises to restore mobility, to strengthen the hip joint (several times a day);
• homework.

After discharge from the hospital (up to approximately 6 weeks after surgery), patients are recommended to use crutches or two canes to move. In the future, if the patient walks confidently and without lameness, he can get by with just a cane (it must be held in the hand opposite to the sore leg). I have been using a cane for walking for almost six months.

• walk slowly, avoid uneven and slippery surfaces;
• steps should be the same in length, the time of support on each leg should be the same. First, lower the heel of either foot to the floor;
• when walking with canes, place your foot at the same time as the cane that is in the opposite hand;
• when walking on steps: before moving up the stairs, both legs stand at the same level (on the same step);
• when walking up: healthy leg, sore leg, canes (cane);
• when walking down: canes (cane), sore leg, healthy leg;
• hold on to the railing. If they are not there, then use a crutch (cane) on the side of the healthy leg.

For the patient to stay at home during the recovery phase after surgery, it is required:

• securely fastened grab bars in the shower or bathtub;
• bench for shower or bath;
• railings along all steps;
• raised toilet seat;
• for washing - a sponge with a long handle;
• devices that help you put on and take off clothes, socks and shoes without excessive bending of the hip joint. Let's say a shoe horn with a long handle. Or this device: attach 2 clothespins to two straps or suspenders (40 cm each) and secure them to the edge of the underwear; insert your legs into the holes of trousers, shorts, skirts, etc. and use the device to pull the clothes up to the level of your hands;
• a firm seat cushion (will allow you to keep your knees below your hip joints in a chair, sofa or car).

You will have to remove all electrical cords and moving rugs from the path of movement around the house.

The service life of modern endoprostheses exceeds 15 years, Therefore, patients need to learn how to correctly balance their life needs with the technical capabilities of an artificial joint. This will help delay the time of replacing an expensive product.

A hip fracture is a huge problem for older people. This injury is one of the main reasons that lead to disability at this age. The only treatment that can put a person back on his feet is hip replacement with proper subsequent rehabilitation. And then we will describe in detail each of its nuances.

When surgeons replace a person’s own damaged hip joint with a metal structure, they have to move muscles and ligaments and injure some capillaries. In order for all these structures to subsequently form a strong frame around the new joint, preventing it from dislocating, moving, or pressing on the nerves, you need to follow certain rules and perform exercises.

How does healing occur?

The hip joint is the most large joint throughout the body: it needs to support all the weight and, in addition, perform about 40% of all movements that a person makes. This is mainly the movement of the hip back and forth and to the sides, as well as its rotation. This joint is also involved in the rotation of the entire body.

All movements are possible thanks to a large number muscles. They fan out from the hip joint, attaching to its structures. Nerves and blood vessels pass between the muscles. And so that femur did not “jump out” of the acetabulum, it is secured by the same “fan” of ligaments. Between individual ligaments and muscles there are formations that resemble small joint capsules. They are needed to reduce friction of structures when performing movements.

When a joint “becomes unusable” and needs to be replaced, that is, prosthetics, surgeons do the following. In order to get to the joint, 2 large muscles (medium and gluteus maximus), attached to the femur, are released from the fascia. They are moved aside and separated with a blunt instrument, that is, the muscle bundles, although not cut, are separated. Then one mucous bursa is dissected and an incision is made in the gluteus minimus muscle, and then in the articular bursa. The femur is cut at the level of its neck, after which it is removed from the soft tissues of the thigh. An artificial joint is placed and fixed in place of the removed bone. All muscle incisions are sutured.

To provide normal function a new joint, it is necessary for the muscles that were cut and separated to grow together well and correctly. They will do this if:

• The sheath of the muscle fibers will not be damaged: directly below it lie satellite cells (companions), which turn into new muscle cells. If the shell is damaged, instead muscle fiber a scar forms;
• normal blood supply to the cut or pulled apart fibers will be restored;
• new branches of nerves will appear in this area;
• damaged muscles will be constantly under tension.

These conditions will be met if:

1. the load will be temporarily taken over by those muscles of the same thigh that were not damaged;
2. The muscles of the foot and lower leg will work, improving blood circulation in this leg.

What you need for a successful recovery

In order for rehabilitation after hip replacement to be successful, you must follow these rules:

• forget about laziness if you want your relative to recover in less than a year, and not stretch this process out for an indefinite period of time, simultaneously “earning” depression;
• start off rehabilitation measures it is necessary immediately after restoration of adequate consciousness on the first postoperative day. The first steps are absolutely simple;
• a set of measures is important: it is not that today only breathing exercises are performed, and tomorrow - exercises for the muscles of the operated leg, and every day - a variety of actions;
• the actions performed must be consistent: on the first day after the operation you can perform one type of load, then another, but there should be no “jumps”;
• rehabilitation measures must be carried out continuously. Long breaks are unacceptable.

What are the consequences of lack of proper rehabilitation?

If rehabilitation after endoprosthetics is not carried out at all or is carried out without the necessary sequence, the injured muscles lose their tone, and scars may form at the incision sites. If the limb is not strained, the ligaments will also heal in a stretched position. This will lead to:

• dislocation of the head of the prosthesis;
• bone fracture near the prosthesis;
• inflammation of one or more nerves located near the prosthesis.

Planning of rehabilitation measures

The rehabilitation period after endoprosthetics lasts about a year. Conventionally, it is divided into 3 periods:

Early period: from the first day after surgery to 3 postoperative weeks. It is conventionally divided into 2 motor modes:

• Gentle: 1-7 days of the postoperative period. At this time, inflammation of the wound caused by the operation occurs;
• Toning: 7-15 days. At this time, the postoperative wound heals.

Both of them are fully supervised by a doctor rehabilitation medicine.

Late period. It is carried out first in the physical therapy room of a polyclinic at the place of residence, where a person should go immediately after discharge from the hospital. Then the set of exercises continues to be performed at home. It is optimal if the relatives of the operated patient help to develop the joint, encourage him and prevent him from missing classes.

Divided into 2 motor modes: 1) early recovery: 15-60 days, when “utilization” occurs bone structures; 2) late recovery: from 45-60 to 90 days, when the internal structure of the femur is restored.

Remote period: 3-6 months when the femur takes its final shape and structure. It is advisable to carry it out in specialized sanatoriums or hospitals.

The individual training program is drawn up either by a rehabilitation doctor or by a physical therapy doctor at the hospital where the operation was performed. Before developing a set of exercises, they must familiarize themselves with the medical history, which describes the nuances of the operation, talk with the patient, find out about his state of health and previous diseases. Also, the rehabilitation medicine doctor should look at the range of motion in the operated limb and exercise tolerance.

Preoperative rehabilitation

If a lot of time has passed from the onset of the hip joint disease to the completion of its prosthetics, then rehabilitation should begin even before the operation. This is explained by the fact that due to long-term pain, a person spares his leg, as a result, the muscles of this limb become hypotrophied, which leads to:

• limited mobility in the hip joint;
• pelvic tilt to one side;
• walking disorder;
• reducing the severity of the forward convexity of the spine;
• the appearance of scoliosis.

Therefore, in the preoperative period, such people who have been suffering from coxarthrosis for a long time, mainly elderly and senile people, need to be prepared. For this:

• provide training in the use of crutches to form a correct gait without relying on the sore leg;
• perform electromyostimulation of both gluteal areas and thighs on both sides. It involves applying electrodes of a special apparatus to the motor areas the right muscles, after which, under the influence of current, they contract;
• perform exercises: flexion and extension of the foot, getting out of bed so that excessive flexion in the hip joint does not occur;
• teach deep and diaphragmatic breathing;
• carry out therapy to improve the condition cardiovascular systems s.

Rehabilitation in a hospital - an early stage of rehabilitation measures

This stage, although it takes place entirely in the hospital, always raises many questions. And doctors, who are constantly busy, do not always answer them completely and intelligibly. Therefore, we will look at each step in detail.

Period goals

At this stage you need:

1. create conditions for the formation of new vessels that will nourish the joint;
2. provide conditions for healing of the suture;
3. avoid complications: thrombosis, stroke, congestive pneumonia, bedsores, wound suppuration;
4. learn to get up, sit up in bed, and walk correctly.

What to do on the first day?

Rehabilitation after hip replacement begins from the first minutes after a person wakes up from anesthesia. It consists in:

• moving the toes of the affected leg: every 10 minutes;
• flexion and extension of the toes of the operated leg: 6 approaches per hour;
• pressing both heels on the bed for 6 times. Toes point up, feet parallel to each other;
• movement of the arms: rotation of the hands, bending of the elbows, raising of the shoulders, swinging the arms;
• tension (without bending or other movement) of the buttocks, thighs and lower legs - but only on the healthy side. This is called isometric tension.

After 2-3 hours, the ankle joint of the operated leg should be involved in movement: here light flexion-extension, rotation of the foot clockwise and counterclockwise are performed.

Monitor the urination of the operated relative: he should urinate in the next 1-2 hours after the operation. If he cannot do this even with the water tap on (not yet in the toilet, but on a duck or a vessel), be sure to tell the medical staff on duty. The patient will be given a urinary catheter and urine will be drained.

Breathing exercises

The first breathing exercise is performed as early as possible in a lying position. The patient lies with his arms either along the body or placed to the sides. A deep breath is taken - the stomach is “like a ball.” Exhale - the stomach relaxes.

When the patient is allowed to sit down (see how to sit in the section “16 important rules of the early period”), breathing exercises expand. To do this, you need either balloons, which a person will inflate once every 3 hours. On the first day, you can “make do” with a tube lowered into a glass of water: you will need to blow air through it.

Vibration massage

In a sitting position, with the patient's head tilted, perform vibration massage of the chest. To do this, apply camphor oil to the skin of the chest from the back and rub your back in a circular motion. Then place the palm of one hand on your back, on the side of the spine, and with the fist of the other hand, perform light blows on your palm. "Work through" chest it is necessary in the direction from bottom to top.

Psychological moments

Loving relatives should not wait until their elderly, operated parent expresses a desire to begin performing simple exercises - they need to do it themselves, with his limbs. Elderly people often lie in apathy for a long time after stress, one of which is surgery, and may even fall into depression. In the process of exercising with them, when a stream of impulses arrives from the working muscles to the brain, endorphins are produced, and this mood will pass.

Anesthesia

The surgeon who performed the operation, in his prescription sheet, which he writes to the nurses, indicates the prescribed drugs (antibiotics, blood-thinning drugs) and the frequency of their administration. As for painkillers, it is prescribed: on demand, but not more than such and such an amount per day. Therefore, the nurse will ask the patient whether to administer the drug or not. And when the pain intensifies, you should not endure it, but call it for your elderly relative.

Prevention of thrombosis

This is a very important aspect, and here's why. The veins of the lower extremities have great distensibility: if a person lowers his legs below the level of the heart, almost ½ of all available blood remains in these veins. In order to reach the heart, this blood must rise against gravity, so it does this slowly, and the leg muscles “pump” it upward.

If a person moves little and sits almost all the time, all the conditions are created in the veins of the legs for the formation of blood clots there. The risk of blood clots increases with varicose veins when “sacs” appear in the veins, convenient for blood clots to settle. These blood clots can “fly off” and enter the arteries of the lungs or brain along with the bloodstream, but this is partially prevented by the muscles of the lower leg, which have a certain tone even during rest and sleep.

During anesthesia - general or spinal - these muscles are artificially relaxed to the maximum possible state. There is nothing holding the wall of the veins together, and if there were blood clots there, they “come off” and “hang” freely in the blood. The person gets to his feet and the blood clot begins its journey. It may hit a large branch pulmonary artery, which is deadly, can clog one of the arteries of the brain. This is why the risk is very high in elderly people after endoprosthetics.

Fortunately, it can be reduced. For this:

1. Before the operation, you need to buy elastic bandages, which are given to the operating room with the patient. When the surgeon completes the operation, his assistants bandage both legs: this creates a semblance of that muscle tone that is always present in the lower leg muscles.
2. Before sitting up in bed or standing up after surgery, you need to make sure that your relative's legs are well bandaged.
3. When preparing for surgery, you must take a blood test for coagulation (coagulogram), and if the results are higher than normal, you must undergo a course of treatment. For this purpose, antiplatelet agents (Aspirin and the like) may be prescribed, as well as local treatment (treating the legs with heparin gel or Lyoton). There is no need to undergo surgery until the INR reaches 0.9-1 units.
4. In the postoperative period, it is necessary to administer blood-thinning drugs (Clexan, Enoxyparin and others) for at least 10 days, and better yet, up to 14 days under the control of a coagulogram and clotting time (this test is taken from a finger prick).

Diet

In the first days, when postoperative intestinal atony is possible, the diet should contain only liquid and semi-liquid, easily digestible foods. These are vegetable soups with pureed vegetables and meat, second broths, slimy porridges with chicken meat ground in a blender or lean beef.

Further, the diet is expanded, but in order to avoid exacerbation of diseases digestive tract, this should not include smoked meats, fried dishes and those containing marinades and hot sauces. Overeating sweets with such a sedentary lifestyle is also not recommended - fermentation processes in the intestines will intensify.

When can you sit and stand up?

The doctor should say this based on the specific situation. In some cases, this can be done after 6-8 hours, but usually only the next day.

16 Important Early Rules

1. For the first 5 days, sleep only on your back.
2. At the end of the first day, you can turn on your side, but only with the help of a health care worker and only on your healthy side.
3. Lying on your side, place a small pillow between your legs to keep your gluteal muscles toned at all times. Do not bend the affected leg more than 90°: the knee of this leg is below waist level - not level and not higher.
4. When lying on your back, do not place your legs on top of each other or very close: a small wedge-shaped pillow should be placed between them.
5. When lying on your back, place a small cushion under your knee: this will help relieve pain. Place another roller or rolled towel on the outside of the operated thigh - it will prevent the leg from hyperextending. These rollers need to be removed periodically. It will be possible to completely get rid of them only after 1-1.5 months.
6. To understand whether your foot is lying correctly, use the big toe test. To do this, put thumb on the operated leg, closer to it outer surface. If the knee is on the outside of the big toe (that is, the right knee is even more to the right or the left is even more to the left), then everything is correct and the leg muscles are not overstrained.
7. You will be able to turn onto your stomach after 5-8 days.
8. There should be no sharp turns or rotations in the hip joint.
9. It will be impossible to squat for a long time.
10. Before lying on your back or sitting down, you need to spread your legs slightly to the sides.
11. You can only sit on chairs of a design that will not allow your knees to be higher than the level of your navel, but will ensure a right angle between the seat and the hip joint.
12. Hospital shoes must be flat.
13. When changing into street shoes, the operated person needs help. If this is not possible, he should do it himself only with the help of a spoon.
14. You will need to sit up in bed using your hands.
15. If you need to get something from the foot end of the bed (for example, a blanket), it is better to ask for help, since you can sit down, but you cannot bend down below the level of the navel. If there is no one to help, you will have to take what you want by getting out of bed.
16. Walk - only without relying on the operated limb.

What to do on the second day after surgery?

Breathing exercises, vibration massage and drug treatment carried out to the same extent. It is on this day that most operated people are allowed to stand up for the first time. How to do this - read the section below.

The following are added to the exercises described above:

Initial position	Description of the exercise
Lying on your back, cushion between your knees	Bend both legs at the knee joints at an angle of at least 90 degrees, rest your feet on the bed. Next, sliding movements are performed on the bed: in one direction - pause - in the other - pause.
Same	Raise your hands up, bend them into fists, stretch your hands behind your head while take a deep breath. As you exhale, lower your arms and unclench your fists
Same	Raise one leg up at an angle of 10-15 degrees. As you inhale, raise your head and look at your foot. As you exhale, relax. Repeat the same with the other leg.
Same	Using sliding movements, as in the first exercise, imitate walking with your feet
Same	Having bent your leg at the knee joint, tilt it in outside, fix it, return it to its previous position, and then, with a sliding movement, lay it on the bed. Repeat with the other leg.
Same	As you inhale, raise your arms to the sides behind your head and stretch; as you exhale, rise up and reach for your feet with your hands, looking at your fingertips

After the operated person has stood confidently, without dizziness, there is no need to immediately go far. It is better to prepare for walking with exercises. To do this, you need to turn around to face the headboard, leave the crutches and hold on to the headboard. Now, standing on your healthy leg, perform the following exercises:

1. Abduction and adduction of the operated leg to the healthy one. To do this, you need to bend it slightly at the knee.
2. Gently move the affected leg back and forth. This exercise should not cause pain.

After this, you need to sit, do arm swings and breathing exercises, and then lie down and relax. It is better to postpone getting up again for 1-2 hours. You will have to go to the toilet on a boat or a duck.

From the second day, physiotherapy is usually prescribed in the amount of 3-5 procedures: UHF, magnetic therapy, diadynamic currents. This is very important: the procedures will help quickly eliminate swelling and pain in the limb. Physiotherapeutic procedures are carried out in the ward using a portable device.

How to get up?

You need to follow the algorithm:

1. Check if you have an elastic bandage, compression stockings or tights if prescribed by your doctor. The patient should not wear such underwear himself: there is a risk of hyperextension of the operated joint.
2. Call the nurse.
3. Together with the nurse (she will help a little and control the extension of the leg), helping yourself with your hands, you need to sit down with your legs hanging off the bed:

a) Using your hands, you first need to hang the operated leg from the bed;

b) Dangle your healthy leg;

c) Take a crutch in the hand on the side of the operation performed;

d) Place the other hand (opposite to the operated side) on the health worker’s shoulder;

e) Stand up, leaning more on the crutch, less on the nurse, and under no circumstances standing on the sore leg.

1. You can sit in bed for a while, but to do this you need to put several pillows under your back.
2. Make sure that the hip joint is always higher than the knee.
3. If you don't feel dizzy, you can try standing up. This requires the help of a nurse, as well as crutches or a walker.

How to walk?

The healthy leg is positioned slightly behind the crutch line or slightly in front of it. Now a step is taken with crutches, and the operated leg comes out to the line of the crutches and is placed on the floor, but the body weight is not transferred to it. The body is straight, the foot does not turn outward.

After this, the healthy leg takes an extension step. Then the movements are repeated: step with crutches - step with the healthy leg. For the first time, this is monitored by a physical therapy instructor, who comes up to the ward specifically for this purpose.

Third to seventh day

During this period, breathing exercises and vibration massage continue to be performed. Drug treatment is the same and the diet is the same. But the need for painkillers is already beginning to decline.

You can already sit up in bed without outside help, but only with the help of your hands and support (a bed frame or “reins”). It is recommended to walk first for 10, then 15 minutes twice a day, only while supporting yourself on a crutch.

New exercises and physical procedures are being introduced.

Isometric tension

From 3-5 days, they gradually begin to perform isometric tension exercises: they strain the foot on the operated side for 1-1.5 seconds, then relax it; strain the lower leg for 1-1.5 seconds - relax the leg, then do the same manipulation with the sore thigh and buttock. All joints of the leg are motionless. After this, the same exercise (but only with a longer duration of tension) is performed on the healthy side.

Isometric tension exercises are performed 3 times a day. Gradually, the time of muscle tension in the affected leg is increased to 3 seconds, then to 5 seconds.

Electromyostimulation

Elderly and long-term ill people begin to undergo the electromyostimulation procedure on a healthy leg from the 3rd day. It is performed 3-5 times a day, for 15 minutes, and should improve the preparation of the leg for the increased load on it.

On the operated limb, this manipulation is performed only after the sutures are removed: in a clinic or, by agreement, at home.

Changes in body position

From 5-8 days you should try to lie on your stomach so that you get 5-10 turns per day. The legs in this position should be slightly apart at the hips. To do this, place a small pillow between them.

Healthy leg massage

Manual treatment of the soft tissues of the non-operated limb helps improve blood circulation and muscle function. This way the healthy leg will get less tired due to the increased load on it.

Massage is indicated for everyone who has undergone surgery, but first of all it should be performed by those whose second hip joint has also undergone degenerative processes. Otherwise, there is a high risk of undergoing endoprosthetics of a second joint while still recovering from one operation.

Exercises

Initial position	Exercise
Lying on your back, legs straight, a cushion between them	Extend and lower your legs for 5-6 approaches.
Same	Imitate walking with your feet for 10 minutes. You need to repeat this exercise 5-10 times a day.
Same	The operated leg is straight and lies relaxed. Bend your healthy leg at the knee, lean on its foot and try to raise your pelvis as high as possible, holding it in this position for 5 seconds. Slowly lower your pelvis. You need to perform 5-10 approaches 5-8 times a day.
Same	Raise your straight legs one at a time
Same	Gradually, using your hands, lift your torso
Same	Bend one leg slightly at the knee and press that heel into the bed. Place your foot in a sliding motion. Do the same as with the other leg.
Sitting on the bed, legs dangling. The back is straight	Straighten your knees and hold your shins in this position for about 5 seconds. You should gradually try to reach 10-20 approaches, repeating 5-6 times a day. This is possible if there is no deterioration in the heart and respiratory systems.
As in the previous exercise	As you exhale, make a movement as if you are pushing your torso up
As in the previous exercise	Bend your knees

Tonic period

It begins on the 7th day and is ideally carried out in a special rehabilitation department, under the supervision of a rehabilitation physician and exercise therapy instructor.

In this period motor mode is expanding: a person can already train to walk 3-4 times a day. As soon as he can move at a calm pace more than three times a day for 15 minutes, exercise on an exercise bike is included in the rehabilitation program. They are carried out for 10 minutes once a day, then for 10 minutes twice, starting at a speed of 8-10 km/h with a gradual addition of power load. Cycling exercises are performed under the control of pulse and blood pressure.

The exercises are performed the same as in the previous period, only the number of their approaches increases.

During the same period, they are taught to walk up stairs.

How to walk up the stairs

1. Grab the railing with your unaffected side.
2. When going up, the healthy leg steps first, then the sore leg, then the crutch (at this stage these are both crutches folded together).
3. During the descent: the crutch walks, then the operated leg, then the healthy leg.

When are the stitches removed?

This is done for 12-14 days. 1-2 days after removing the stitches, you can take a full shower.

When discharged

If the postoperative period is uncomplicated, discharge is carried out on days 14-21. If the patient is severely weakened or this is the custom in this hospital, he may be transferred to the rehabilitation department for another 1-2 weeks.

Preparing the home before the arrival of an operated relative

To prevent injury to the operated leg, before discharging an elderly relative home, you need to prepare the apartment (house):

Bed	It is advisable to purchase a functional bed in which you can raise the headrest and also change the height (using a lever). Standard models of such beds are equipped with wheels, therefore, when buying a used model, it is important to check that the brake works well, otherwise the operated relative risks falling. It is optimal if the bed is equipped with an over-bed frame with a hanging triangle, which you can grab and sit on
Floors	Before arriving, remove any carpet runners that could be caught on by a crutch. If the floor is cold, it is better to lay a carpet that will be “stretched” so that it cannot get caught
Toilet	One seat is not enough to ensure an angle of less than 90 degrees between the hip and torso. Therefore, you need to purchase an additional semi-rigid pad
Handrails	They need to be driven into the walls: on the wall near the bathtub, on both sides of the toilet, in the corridor where a person puts on his shoes (he cannot sit on a low chair for a year)
Bathroom	A person will have to wash while sitting throughout the year, so the shower or bathtub should have either a chair with non-slip legs or a board attached so as to ensure a hip flexion angle of less than 90 degrees
Chairs	They must be rigid or semi-rigid, of sufficient height
Railings along the stairs	If they were not there, they will need to be installed

Late recovery stage

The late period of rehabilitation after hip replacement begins on the 15th postoperative day.

From the very beginning of the period, a massage of the sore leg is included: the soft tissues of the operated hip are worked out with careful, non-traumatic movements that should not cause pain.

Prohibitions during this period:

1. You still cannot bend your leg so that the angle between the thigh and the body is less than 90°.
2. The operated leg should not be turned inward (so that the big toe is pointing towards the opposite heel) and placed (and placed) close to the healthy leg.
3. Sleeping on your healthy side is prohibited.
4. You should not put your body weight on your sore leg.
5. Sitting on a low chair is contraindicated.
6. Exercises that are accompanied by pain are prohibited. When exercising and walking, only a slight feeling of discomfort is acceptable, which goes away after a 2-3 minute rest.
7. Long-term (more than 40 minutes) sitting, as well as sitting with crossed legs, are contraindicated.
8. Relatives should help you put on compression garments or elastic bandages. Otherwise, the artificial joint, which has already begun to fix itself, may dislocate, which will result in a new operation.
9. Walking without support is contraindicated.

It is already possible to wash the dishes yourself and prepare “quick” meals while leaning on a crutch.

More complex ones are added to the exercises from the previous period:

1. I.p. lying on your back. With your knees bent, perform movements that imitate riding a bicycle.
2. I.p. on the back. Bend your leg at the knee, pull it towards your stomach, and fix it with your hands for 5 seconds. Repeat with the other leg.
3. I.p. lying on your stomach. Bend and straighten your knees to avoid pain.
4. I.p. on the stomach. Raise your straight legs one at a time.
5. IP: facing the headboard of the bed, holding it with your hands. Slowly lift one leg or the other.
6. I.p. Same. Standing on one leg, move your other leg to the side. Repeat the same with the other leg.
7. I.p. Same. Bend your knees one by one and take them back in this position. The hip joint should extend slightly.

A month after walking confidently with a crutch, you can try replacing the crutch with a cane.

Long-term rehabilitation period

It starts 90 days after surgery. After 4-6 months it will be possible to walk without a crutch or cane (the doctor will tell you the exact figure). Breathing exercises are no longer carried out during this period, but exercise therapy and physiotherapy are integral components of recovery.

• pearl or oxygen baths;
• applications of paraffin or ozokerite to the area of ​​the operated joint;
• underwater shower-massage;
• laser therapy;
• balneotherapy.

Add new ones to the previous exercises:

Initial position	Performance
Lying on your back	Cross your legs and turn them at a slight angle in one direction, then in the other direction.
Same	Do “scissors” with straight legs, either bringing your legs together or spreading them apart
Same	With the toe of one straight leg, touch the area on the outside of the other leg (your thighs will lie on top of each other)
Same	Raise one straight leg to the maximum possible position - lower it. Do the same with the other leg.
Same	Bend one leg at the knee and slide it up, then down. Repeat with the other leg
Same	Bend one leg at the knee, pull it towards your chest and hold it with your hands. Repeat with the other leg
Same	You need to bend the knee joint and pull two legs towards your chest, but without using your hands
Sitting on a gymnastic mat, with your hands supported behind your back	Raise your knees bent
Sitting on a chair	As you slide one foot over the other, pull your knee toward your chest. Repeat the same with the other leg
Standing near a chair	Place your healthy leg, bent at the knee, on a chair. Now lean towards that knee joint
Standing near a chair	Hold the back of a chair and do squats
Standing without support	Do squats
Standing sideways near the headboard	Carefully, holding onto the bed, squat, but so that the angle between the thigh and body is less than straight
Standing near a step platform (a stable wide block) 100 mm high	Step onto and off the step platform with your good foot first. Tempo: slow, repeat 10 times
Standing near the headboard, with an elastic band on the operated leg, above ankle joint. The tourniquet is attached to the bed leg	Bend your leg, fixed with a tourniquet, at the knee and stretch it forward. Then turn sideways so that you can swing your leg to the side. Slow pace, repeat 10 times

Thus, if you follow all the rules discussed in detail above, rehabilitation after hip replacement Although it will take a long time, it will go quite smoothly. Do not forget to also provide psychological support to the elderly relative who has undergone surgery.

Content

A patient who has recently had an endoprosthesis installed requires special care and assistance. It is important to help him as soon as possible restore motor functions at home. To do this, they perform therapeutic exercises daily and adhere to a number of rules to avoid complications.

Rehabilitation periods after hip replacement

Hip replacement surgery is prescribed for femoral neck fractures, coxarthrosis, osteonecrosis, rheumatoid arthritis. If previously these diseases meant disability, now, thanks to successful treatment, the patient can restore the functional activity of the joints. To speed up the rehabilitation period at home after hip replacement, you need to follow all the doctor’s recommendations and regularly perform special physical exercises for your legs. Each recovery period requires compliance with certain rules.

Early period

Immediately after hip replacement surgery, the patient will be under the supervision of a doctor. During this period, it is important to systematically monitor body temperature, change bandages on time, and monitor the functioning of the respiratory and cardiovascular systems. Swelling in the leg is relieved with an ice compress. If necessary, the doctor may prescribe a blood transfusion and medication with blood thinners (this helps prevent thrombosis). To prevent the development of complications, antibiotics are prescribed on the second day after surgery.

Pain occurs after the installation of an artificial joint. However she is normal consequence operations. Usually, pain syndrome relieved with painkillers or injections. Some patients have an intravenous catheter placed through which the analgesic is administered. The duration of use of painkillers and the dosage of medications are adjusted by the doctor.

During the first day after hip replacement, patients are in a supine position. To avoid dislocation, you should not bend the leg with the prosthesis more than 90 degrees. To avoid injury, patients are placed with a special cushion between their lower extremities. In addition, immediately after the operation, the patient in a supine position is recommended to move the operated leg slightly to the side. During the first period of rehabilitation, it is strictly forbidden to independently take the blanket lying at the bottom of the bed.

Late period

After early rehabilitation, the patient begins a longer recovery period, which lasts for several months. At this time, you should gradually increase the duration of walking with support. In this case, you need to keep your back straight and look ahead. The daily maximum is 30 minutes of walking. It is only allowed to increase the speed of movement and distance. For 2 months after hip replacement, you should not climb stairs higher than 1 flight.

Rehabilitation at home after hip replacement involves good rest. It is better to lie on your back, but if you are more comfortable lying on your side, place a soft cushion or pillow between your knees. You should sleep on a hard orthopedic mattress; the height of the bed should be at least knee-high. It is better to dress during rehabilitation while sitting on a chair and using loved one. Putting on socks or shoes on your own is prohibited - this leads to excessive flexion of the hip joint.

Functional recovery period

Rehabilitation after hip replacement ends after three months, but the functional restoration of the leg must continue. If the specified period has passed, and the pain in the leg does not go away or there is discomfort when walking, you should use a cane. Despite the fact that a person can already return to work and drive a car, active sports are allowed only after 8-12 months.

In some cases, the rehabilitation period at home may be extended by a doctor. This decision is influenced by the patient’s age, medical history, systemic pathologies, and hypersensitivity to medications. To speed up recovery after hip replacement, exercise therapy prescribed by your doctor should be performed at home. Also, it helps a lot massotherapy and kinesitherapy. If possible, the patient should rest at least once a year in a sanatorium or specialized medical center.

What rules to follow in the postoperative period

Regardless of whether the hip replacement surgery was total or partial, a person must adhere to a number of rules to quickly restore motor function:

• You can sit down and stand up on the second day after surgery (for this you need to use handrails);
• on day 5, it is allowed to climb several steps of the stairs, and the first step must be taken with the healthy leg (vice versa when descending);
• physical activity should be increased slowly, sudden movements are prohibited;
• you cannot sit at home on low chairs/armchairs or lift objects from the floor without the help of outside devices;
• you need to keep your body weight normal;
• It is allowed to sleep on your back or side with a cushion between your knees;
• Driving is allowed after at least 2 months of rehabilitation at home;
• it is necessary to adhere to a balanced diet (the amount of food with iron should be increased, drink a lot of water);
• Sexual relations can be resumed 2 months after hip replacement.

Recovery after hip replacement at home

Because the most of rehabilitation takes place at home, it is worth knowing what aspects are important for speedy recovery motor function of the leg. Occupies an important place physiotherapy. If during exercise you feel pain or severe discomfort, it is better to interrupt the exercise and consult a doctor. Every day for 3 months of rehabilitation at home you need to bandage the operated limb elastic bandage– this will help relieve swelling.

At first it is allowed to move around at home only with the help of crutches, later you can switch to a cane. Doctors recommend using it for six months. In this case, the cane must be placed simultaneously with the operated leg. You can’t lean forward while moving, and if it’s difficult for you otherwise, slow down and take small steps. Housework is allowed. The only condition is that you can work if there is no load on the sore limb. It is strictly prohibited to lift any weights during rehabilitation at home.

How to walk on crutches correctly

A few days after endoprosthetics, the doctor allows you to get out of bed. The first time this happens with the help of a physical therapy instructor, who explains to the patient the rules of movement and use of crutches. The walking method looks like this:

• when climbing stairs, the movement begins with the healthy leg;
• the movement is as follows: lean on crutches and move your healthy limb to the step;
• then push off the floor with your crutches and transfer your body weight to this leg;
• tighten the operated limb while moving the crutches to the upper step;
• when moving down the stairs, everything happens the other way around - first place the crutches on the step;
• leaning on them, move the sore leg down, leaving the emphasis on the healthy one;
• Place your healthy leg on the same step and lean on it.

An effective set of exercises after hip replacement

Without physical therapy, rehabilitation at home after hip replacement is impossible. There are no universal exercises for restoring the functionality of a limb: each period of rehabilitation involves performing movements of varying complexity. The training program is selected by the doctor. On the first day of rehabilitation, the patient is allowed to do the following exercises at home:

• alternately pulling your toes towards you with your legs extended;
• circular movements of the feet;
• squeezing/unclenching toes.

Later the exercises become more complicated and look like this:

• in a standing position, the prosthetic leg is moved forward 25-30 cm and returned to its original position (10-15 repetitions);
• the leg is raised with the knee bent to a height of 30 cm (10 times);
• the leg is moved to the side as much as possible and returns back, the patient holds onto a chair or handrail, stands with a straight back (6-7 times);
• raising the leg up without bending the knee (up to 10 repetitions).

Video

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Rehabilitation after hip replacement at home is a mandatory stage of recovery. During endoprosthetics, the ligaments are removed, followed by the implantation of an artificial substitute that holds the muscles in place. In order for them to perform this function well, muscle tissue must be carefully trained.

This may take several months, but it all depends on the quality of training and the perseverance of the person himself. It is especially important to undergo high-quality rehabilitation after endoprosthetics of the leg joints, namely the knee or hip. In this case, you can move on with your life without feeling discomfort.

A person must understand that rehabilitation after surgery (hip replacement) includes daily training. They consist exclusively of permitted movements. Some actions cannot be performed after joint replacement until full recovery body.

What is forbidden to do after surgery to remove the hip joint?

Any surgical intervention is a huge stress for the body. If a person has damage to the joint tissue, then the best option it will be removed. There is no better way to solve such problems yet. If the hip joint is severely affected, specialists most often prescribe a procedure total endoprosthetics. IN in this case the damaged parts are replaced with artificial ones, which take root well in the human body.

Joint replacements can stay on in the right place, if they are held securely by the muscles. To ensure the strength of this connection, you need to train and strengthen muscle functions. All this is possible by undergoing high-quality rehabilitation after hip replacement. It is best to undergo it under the supervision of a specialist. Not all movements are acceptable for a person who has undergone joint surgery. Ignoring at this moment can lead to dire consequences.

People who live with artificial joints must be very careful when bending, straightening, rotating, or crossing their legs. It is especially important to refrain from such movements in the first few months after surgery. When conducting quality training and proper recovery You can achieve good results in just three months. However, most often it takes a year to fully restore body functions. During this time, the motor capabilities of the operated limb are completely restored.

After the body has fully recovered, you can lead a normal life. Some people lead very active lifestyles and are successful in sports. However, in the first stages, when the process of rehabilitation after endoprosthetics occurs, sudden movements are not permissible. Muscle training occurs in a slow and calm manner.

Morning activities

Rehabilitation after knee or hip replacement takes place under the supervision of a specialist. Most often, the patient is prescribed exercise therapy and other similar procedures.

However, to develop muscles faster, you can exercise on your own at home. High level shows effectiveness morning exercises, which in this case is carried out even before the person starts breakfast. Some people do these exercises while lying down, without getting out of bed.

First you need to lie down and stretch your legs in front of you. Then alternate rotation is carried out with the toe pulled forward. Each leg should move smoothly and slowly. Sudden movements are not allowed. During rotation, only the top part Feet. The heel should touch the floor or bed.

After performing the rotation, that is, warming up, you can move on to more serious exercises. First you need to move your operated leg to the side and then bring it back. This needs to be done 5-6 times. Then the quadriceps femoris muscle is trained. To do this, you need to stretch your leg and point your toe towards you. The limb should be in tension for several seconds, and then the muscles gradually relax. You need to repeat this exercise about 10 times every morning.

In a lying position, you also need to undergo complete muscle relaxation. To do this, you need to lie on your back and try to touch the surface with the maximum number of points of your body. After a good relaxation, you can move on to the next procedures.

In a standing position, you need to firmly grasp any support and slowly put your leg bent at the knee forward. We are talking only about the limb on which the operation was performed. It cannot be used as a support. When performing this exercise, it is prohibited to bend the hip joint more than 90 0.

Next, you need to move your leg back as far as possible. possible distance. The torso should be straight. You cannot overexert your limbs. The whole process should be carried out as carefully and slowly as possible. When the leg returns to its normal position, it is necessary to give it some time to relax. These movements must be performed 10-15 times.

Morning procedures are very simple and do not take much time. Everything takes no more than 15 minutes. At the same time, they are well suited for recovery after hip replacement, as they allow the muscles to prepare for the work done during the day.

Dangerous situations for people undergoing rehabilitation

Life after hip surgery changes somewhat. A person must be more careful not to aggravate the situation with his health. It is especially important to take care of yourself in the first months after replacing a joint with an artificial one. After the functions of the operated part of the body are restored, you can lead a more active lifestyle, but this is all in the future, and in the first stages additional measures will not be superfluous.

A fall will be especially dangerous for a person who has recently undergone surgery on the hip or knee joint. Any injuries can lead to displacement of the artificial prosthesis. In this case, the situation can only be corrected repeated operation, and this is a huge stress for the body.

In addition, a patient undergoing rehabilitation after knee replacement must temporarily abandon certain body positions. If the operation was performed on the hip joint, the patient is contraindicated to cross lower limbs and bend your legs so that the joints turn out more than 90 0. You cannot sharply turn the body if the lower limbs are in a static position. In addition, it is forbidden to turn the feet in and out, as in dance positions - in the first or fifth.

For a patient who has recently undergone hip surgery, it is important to move periodically - this not only helps to train the muscles, but also prevents muscle tissue and joints from stagnating.

You cannot sit in one position for more than 20 minutes. The sitting posture must be correct. The legs are straight, and the hip joints are at the same level as the knee or slightly higher. The feet should be firmly planted on the floor at a distance of 15 cm.

For sitting, it is better to choose a chair or a chair of medium hardness. You should avoid spending time on low and very soft chairs. It is better to choose a chair with a back and armrests, which are needed for support when standing up.

How should a patient undergoing rehabilitation behave?

The main task of a person who has undergone hip replacement surgery is to gradually train the muscle tissue around the prosthesis. This can be achieved easily gymnastic exercises at home and with exercise therapy techniques.

In order to enhance the effect of classes and not minimize the entire achieved result, you need to behave correctly. First of all, this concerns rest. The first time after surgery, the patient should forget about significant physical activity. You need to pay enough attention to rest.

In addition, you need to watch your movements. This applies to sitting, going to bed, and even just standing. If you have to stay in one place for a long time, it is better to sit down. If this is not possible, you need to place your feet shoulder-width apart and straighten your body. This is the most gentle vertical pose for the hip and knee joints.

You need to go to bed very carefully, without sudden movements. It is better to sleep on your back with the operated leg slightly to the side. The toes of the limb should be directed upward during sleep. Sleeping on your side is not prohibited, but it is better to avoid this position. This is especially true when the healthy limb is located below. To avoid harming yourself and dislocating the prosthesis during sleep, use a special cushion or pillow. They are placed under the leg until the attending physician considers that the artificial joint has taken root well enough and is no longer in danger.

Physical activity during recovery

The operated limb should return to normal gradually. All loads during rehabilitation after hip replacement are carried out only after the doctor’s approval. If you immediately begin to actively engage, this may weaken the prosthesis, and it will not perform its functions. Exercises are performed in a gentle manner, with a gradual increase in load.

It is very important to avoid pain during rehabilitation exercises. If the patient feels severe discomfort, it is necessary to reduce the load level. You should not take painkillers during exercise.

For the first 2-3 months, a person who has undergone surgery should not drive. Driving a vehicle will place unnecessary stress on the hip joint. You can move around by car, but you need to get in and out of the car very carefully so as not to dislocate the joint.

For the first few months after surgery, lifting weights is out of the question. If there was emergency To carry something urgently, you need to use a backpack or cart. It is important that the weight is distributed evenly throughout the body.

Daily activities can be carried out as normal after surgery. But this will be preceded by a long recovery period. The expansion of permissible actions occurs gradually and systematically. For example, to begin with, a person trains to sit and stand up. Then the skills of moving up and down stairs are resumed. At first, the patient is allowed to move only indoors. After the muscles become more trained, you can take walks outside. It is very important to follow all doctor’s recommendations and conduct daily workouts to strengthen your muscles.

Endoprosthesis replacement surgery is quite complex. After hip replacement, a person spends about 6 weeks in a rehabilitation center. Then he is discharged home, but the rehabilitation process does not end there.

At first, you need to use a cane or crutches while walking. In the future, you can get rid of this device, but only after the person begins to move confidently. This usually takes about six months.

Until the prosthesis takes root completely, you need to walk correctly. Movements should be slow and even. The steps are the same and precise. It is important to avoid slippery surfaces to avoid slipping and falling. If a cane is used, it should be held on the same side as the operated leg.