Life with a new hip joint. Rehabilitation at home after hip replacement: recovery periods Sports after hip replacement

Memo for the patient

Before and after complete replacement (endoprosthetics) hip joint

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 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 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. 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 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 intended 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 the period 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 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 down reverse side knee joint to 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 vein thrombosis lower limbs!!!

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 must 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 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 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 sedentary lifestyle life, the use of steroid hormones, smoking, 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.

Endoprosthetics is an operation aimed at replacing a joint and restoring a person’s mobility. Implants made today from such modern materials, like titanium, ceramics and various stainless steel alloys, successfully replace a person’s “native” joints and, after endoprosthetics, last up to 20-30 years. The choice in favor of such an operation is often made by those for whom it is important not only to restore the former functionality of the joints and body mobility, but also to return to their previous physically active lifestyle. Thus, professional and amateur athletes are often interested in the possibility of endoprosthetics, for whom the issue of returning to their favorite activity is of fundamental importance.

Of course, even taking into account all the achievements of modern implantology, it must be admitted that a person will not be able to engage in absolutely any sport - unless, of course, he wants to preserve the functionality of his body. However, the majority of patients - especially those who led an active lifestyle before the endoprosthesis surgery - are allowed to exercise certain types sports, subject to a number of precautions. Thus, she does not give up on returning to sports and even achieving high results and winning professional awards. The main thing is that the type of sport that the patient is involved in is not included in the list absolute contraindications, and he himself strictly followed all recommendations for rehabilitation after surgery and further techniques physical activity. Moreover, speaking about rehabilitation, it is worth noting that athletes, as people with higher physical fitness, go through this postoperative period more easily and quickly regain the shape they were in before the operation.

What you can and cannot do after endoprosthetics

Before we begin listing the indicated recommendations, it is first worth clearly highlighting the list of sports that rarely imply successful rehabilitation after surgery. So, these include:

skiing;
horseback riding;
various martial arts;
contact sports (football, hockey, basketball, handball);
figure skating;
acrobatics;
Weightlifting;
jumping (including with a parachute).

These limitations are related to the biomechanics of the artificial joint and the role of the joint in the body as a whole. Since practicing the listed disciplines after endoprosthetics creates frequent and heavy dynamic loads on the joints, they can lead to loosening of the implant at its border with the bone, its wear, or even destruction and displacement. As a result, this may lead to the need for revision endoprosthetics - that is, replacing an already installed implant with a new one.

However, by the phrase “not recommended” we mean the ability to engage in some of these sports if they do not have a physical impact on the replaced joint. However, football, hockey, handball and contact wrestling still remain in the category of absolute contraindications.

But you can and even need to engage in sports such as cycling, swimming, golf, tennis. Sports or regular active walking can also be performed without restrictions. It is worth noting that history includes a considerable number of athletes who, even after endoprosthetics, continued to engage in these sports, achieving high athletic success. Moreover, athletes from other disciplines also achieved success - the clearest example This is the Russian figure skater, Olympic champion Alexei Yagudin. It was he who made the decision to return to big sport after he was fitted with a titanium hip joint.

How to exercise

So, you are convinced that your discipline is not hockey, not football, not handball or contact wrestling, and at the same time you are determined to do what you love again and even achieve heights in it. How to behave correctly, and what needs to be taken into account in order to avoid injuries and premature wear of the joint?

The first thing in such a matter is rehabilitation. It is proper rehabilitation after surgery that is the key to a high quality of life in the future. Its key stage is early activation. Just by starting to move, you can not only speed up the recovery process, but also prevent possible complications, because a person’s lack of mobility causes problems such as pneumonia and even blood clots in the veins. In addition, early activation will help strengthen muscles. Rehabilitation includes not only normal everyday movement, but also exercise therapy - a set of activities determined by the doctor based on the characteristics of your case.

The second stage is a gradual increase in sports loads while observing certain restrictions. It must be borne in mind that the endoprosthesis is a mechanism, not a real joint, and in order to maximize the life of such an implant, excessive frequent and heavy physical stress should be avoided, as well as bending the limb more than 90 degrees, especially too early. It takes 4-6 months for a protective capsule to form around the artificial joint, and until then it is especially susceptible to damage and dislocation during such movements.

Returning to sports, it’s worth:

exclude crossing of limbs, in one of which an artificial ceramic or metal joint is implanted;
do not perform jumps or sharp landings on the surface;
minimize rotation of the operated limb around its axis;
wear comfortable and low shoes, the sole of which provides good grip on the surface (if we are talking about hip or knee prosthetics);
take place regularly preventive examinations see a doctor and take pictures of the operated part of the body;
warn the dentist about the presence of a prosthesis before dental treatment;
try to avoid by all means severe injuries the area where the implant is directly installed.

Endoprosthesis replacement surgery is a decisive step towards returning to full, happy life. If you love sports, but have problems with a joint, there is no need to rush to give up both. A high-quality artificial joint, if you follow simple recommendations, will allow you not only to play your favorite sports, but even to grow in them, conquering new heights. This is evidenced not only by eloquent statistics, but also real examples from life.

The operation is over. Now a lot depends on you. Try to accurately and carefully follow all the doctors’ recommendations - this is very important for your speedy recovery.

After the operation, the leg is fixed in abduction position in a special “boot”. Both legs are bandaged with elastic bandages, which, in combination with physical exercise, will help prevent vascular disorders. As soon as you finally wake up from anesthesia, start doing simple breathing exercises(deep inhalation and extended exhalation) and movements of the toes and ankle joints of both legs (you will be taught how to do this before surgery). Repeat them many times throughout the day.

When you are transferred to the ward (usually on the 2nd day), proceed to more wide complex exercises, performing them once under the guidance of a physical therapy instructor and 2-3 times a day on your own.

Mandatory exercises:

free movements of the healthy leg (bending at the knee, lifting up, abducting to the side)
flexion and extension in ankle joint the operated leg until a feeling of fatigue appears in the lower leg muscles.
tension in the thigh muscles of the operated leg, as when trying to extend it maximally at the knee joint. Voltage duration 1-3 sec.

Periodically during the day, change the position of the operated leg in the knee joint by placing a small roller under it for 10-20 minutes. After 2-3 days, the “boot” is usually removed. Make sure that your leg remains most for a while she was in a position of some abduction, and her toes were directed straight up. From 2-3 days you will probably be allowed to sit up in bed, helping yourself with your hands, and then sit on the bed with your legs down. You need to sit with your torso tilted back, leaning on a pillow placed under your back. Make sure that your hip joint is higher than your knee joint.

A few days after surgery, you will be allowed to stand up at your bedside. The first time this is done with the help of a doctor or physical therapy instructor. They will explain to you how to walk and use crutches correctly, and to what extent you can put weight on the operated leg. If you are standing steadily by the bed, the next day you can (with your doctor's permission!) take a few steps, always leaning on crutches or a walker. Remember that both crutches must be brought forward at the same time, standing on your healthy leg. Then they place the operated leg forward and, leaning on crutches and partially on the operated leg, take a step with the non-operated leg. Standing on it, they again bring the crutches forward.

When turning in bed on your side, and later on your stomach (from 5-8 days), be sure to use a bolster (or pillow), placing it between your thighs. This will prevent unwanted adduction of the leg.

After day 7 the leg is usually bandaged elastic bandage just on daytime: the bandage is applied in the morning before getting up, and removed at night.

Motor mode for 3 months after surgery.

Recovery period after total endoprosthetics hip joint lasts several months. Its duration depends on age, general condition Your health and degree motor disorders before surgery, which are determined by the functionality of the other hip joint, knee joints and spine. However, in any case, even if you get the desired result immediately after the operation, you must continue to rehabilitation treatment and strictly adhere to the following recommendations.

Motor mode.

Gradually increase the duration of walking with additional support from crutches. When walking, try to keep your back straight, look forward, place your foot straight in front of you or move it slightly to the side. Bend the knee joint when the leg is suspended, and extend it when the leg rests on the floor. It is better for you to walk several times a day, but at the same time - no more than 30 minutes, gradually increasing the pace and distance of walking. You should not climb more than 1 flight of stairs in the first 2 months after surgery.

Rest.

It is better to rest lying on your back 3-4 times a day. You can lie on your side, but continue to use a bolster or pillow between your thighs as you did before in the hospital. Do not sleep on a bed that is too soft or low; it is advisable that it is higher than knee level (when you are standing).

Dressing.

You should dress while sitting on a chair. Use assistance when putting on socks, stockings, and shoes, as tilting your torso downward will cause excessive flexion in the new hip joint. Do not stand on one foot when putting on the other, and do not turn your foot when putting on the boot.

Sitting.

When sitting, your hip joints should be higher than your knees. To do this, you need to sit on a hard chair with a pillow under your buttocks.
Do not sit in a low chair or lean back, because You will have to bend forward to stand up, and this is wrong. When sitting, your feet should be on the floor, with a distance of 15-20 cm between them. Do not sit cross-legged or cross-legged, and you should not sit without getting up for more than 40 minutes.

Other types of physical activity.

Use outside help or special devices to get objects from the floor that are lying on a chair that is far away from you. Do not reach objects that are behind you or to the side by turning your torso while keeping your legs fixed. To pick up these items, first turn to the right side, standing facing the object. Do not lift heavy objects.

You can shower, but take precautions to avoid slipping on wet floors or in the bathtub, and use extra help when washing your legs below the knees. Remember that your new joint should not bend more than 90-500. It is undesirable to sit on a low seat in the toilet room. To correct this situation, you can place an inflatable ring or install a special attachment.

You can cook food, dust, wash dishes. But do not use a vacuum cleaner, do not make the bed, do not use a mop to wash the floors, and do not perform tasks that require significant physical effort.

Special therapeutic exercises.

To improve the function of your new joint, you should continue to perform physical exercise exercises that you learned in the hospital, gradually complicating them and increasing the number of repetitions of each exercise. Exercises will help you restore mobility in the joint and prepare your muscles for movement without additional funds supports.

Here is a list of basic special exercises.

Starting position lying on your back:

Alternate bending of the legs at the knee joints without lifting the feet from the floor (bed).
Alternately moving your legs to the side while sliding along the floor.
Simulation of cycling.
Placing a pillow (roller) under the knees, alternately extending the legs at the knee joints
Bend your knees, alternately straighten your legs and return to the starting position.
Alternately pulling bent legs to the stomach with the help of hands.

Starting position lying on your side (on the non-operated side) with a pillow (cushion) between your thighs:

Straight leg raise (hip abduction)
Moving the straight leg back (hip extension)

Starting position lying on your stomach:

Bending the legs at the knee joints
Extension of the legs at the knee joints while resting on the toes with simultaneous tension of the gluteal muscles.
Straight leg raise back

Starting position: standing on your healthy leg with your hands resting on the back of the chair:

Straight leg raise forward
Same aside
Same back

When performing the exercises, you should not feel pain, repeating these movements at a slow pace from 5 to 8 times. Alternate these exercises with hand movements and breathing exercises.

Long-term period after surgery (more than 3 months).

3 months have passed since the operation. You need to conduct a control X-ray examination, after which the orthopedic doctor will decide on the possibility of expansion motor mode, and for some professions a return to previous job. However, in order to further - in long-term period after surgery – to avoid possible serious complications, You need to know and adhere to a number of recommendations.

Motor mode

If there is no discomfort in the joint, you can no longer use crutches, but switch to a cane - it must be taken in the hand on the side opposite to the operated leg. It is important that the cane is selected correctly - in accordance with your height. You can check this in the following way: while standing, take the cane in your hand; if it suits you, then at the moment of support, the elbow is slightly bent, and the shoulder girdle does not rise up.

On average, 6-8 months after surgery, you can begin walking with a cane, even without preliminary consultation with a doctor. Remember that it is better not to overload the new joint, for example by long walking (walks, excursions, long trips, etc.). In the future, if such a need arises, unload it with a cane.

In any case, if discomfort appears in the joint and you begin to limp, take the cane in your hand. This will relieve the joint from overloads that arise due to lameness.
Don't forget that you have a limit permissible loads. You should not lift or carry weights weighing more than 20 kg, you should not increase your body weight more than yours. age norm. Know that when lifting an object weighing 20 kg, a force equal to 70 kg will act on the joint. Make every effort (diet, etc.) to reduce your own weight if it is above normal.

Additional physical activity.

At your own discretion, if the set of exercises that you did after the operation became too easy to perform, you can expand and complicate it. As before, most exercises should be done in a lying position. While standing, add exercises such as half-squats - at first, leaning on the back of a chair, then with your hands on your belt.

3-4 months after surgery, begin training to transfer your body weight to the operated leg. When trying to stand on your operated leg, first use both hands, then one, and finally no hands. When performing exercises while standing on your operated leg, continue to lean on the back of the chair as you did before. In the future, it is recommended to engage in swimming, skiing - this means skiing on flat terrain, not water or skiing. It's good to ride a bike. Do not get carried away with jumping, running, gymnastics, acrobatics, etc.

Other types of physical activity.

In everyday life, you will sometimes encounter a number of situations in which unpleasant sensations in the joint or its overload may occur.

You cannot sharply turn your leg inward and perform swinging movements.
You should not turn around while standing on your operated leg; instead, it is better to take a small step in the right direction.
It is undesirable to bend forward with the operated leg straightened.
You should avoid sudden movements (jogs, etc.) with the operated leg.
It is not recommended to drive a car earlier than 3-4 months after the operation, and more late dates When driving, you need to stop and get out of the car every 1.5-2 hours.

You can start working no earlier than 3 months after the operation, provided that the work does not involve standing on your feet for a long time.

You should not put your artificial joint at risk.

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.

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.

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, and medical workers will help you through this thorny path to recovery. 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 provide reliable protection against 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

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!

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.

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.

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 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.