Exercises After Hip Replacement

Exercises after hip replacement surgery form an important part of the recovery and rehabilitation process. The success of total hip replacement has resulted in not only more patients getting a hip replacement but a younger population getting replacement surgery.

The younger age group may have a higher level of functional goals as compared to the elderly population. Regardless of age, a thorough post operative exercise protocol is necessary to prevent range of motion and strength related issues after total hip replacement.

A progressive rehabilitation is recommended after the surgery as patients may be wary of any activity after the surgery. During the initial postoperative period, patients may complain of pain and swelling of the hip region secondary to the surgery.

Following resolution of the initial pain with medications, icing and rest a physical therapy protocol is initiated to increase flexibility, strengthen the muscles and improve balance and activities of daily living such as walking, stairs, etc.

X-ray showing a total hip replacement.

Certain precautions need to be followed before resumption of the exercise program. The precautions may be different depending upon the type of approach used in the surgery and the stability of the surgery.

Certain common precautions after posterior approach include, avoiding bending at the hip past 80 degrees (such as sitting on a very low chair), avoiding inward movement of the toes (such as while tying shoe laces) and avoiding to cross the affected side over the normal side (as while sleeping on the normal side).

Precautions advised after an anterior approach include avoiding excessive backward bending at the hip and avoiding excessive outward movement of the toes. These movements may lead to dislocation of the artificial joints especially in the immediate postoperative period.

Exercise after hip replacement not only reduces the incidence of dreaded blood clots but improves circulation of the legs, helps strengthen the muscles and increases flexibility. The increase in blood supply following surgery helps in early healing of the incision and tissues.

While initiating exercise it is important to repeat them regularly 3-4 times a week and to do progressive reputations and sets. During the early post operative period, majority of the exercises may be performed even while lying down.

• Tighten your buttocks and hold them in contraction for a count of 5-6 seconds. Release and repeat the contractions at least 10-15 times a day.
• Bend your knees while maintaining the feet on the bed as the heel progressively touches your buttock. Try to hold it for a few seconds and then release and repeat.
• While lying down, try to push your knee against the bed, you will feel your thigh muscles contracting as you do so. Keep the thigh muscles contracted for a few seconds. Release and repeat multiple times during the day
• Quadriceps muscles may also be strengthened with straight leg raises. Try to tighten the thigh muscles and lift your leg a few inches off the bed. Hold the leg for a few seconds and then repeat.
• Try to move the leg away from the body to the side as far as you can and then bring the leg back. Repeat multiple times during the day.
• Ankle pumps consist of pressing the ankle down with your toes pointing. The exercise is recommended immediately after the surgery and advised to be repeated multiple times a day.

Intraoperative image showing a total hip replacement.

Standing exercises may be started after the patient is comfortable walking and has adequate balance. Standard exercises are advised to be done in presence of your therapist. Some of the standing exercises are :

• Stand with the support of the back of a chair and try to lift your one knee up until your waist level. Try to hold your knee at the level and then slowly bring it down.
• Quadriceps exercises may also be performed in a sitting position in a chair. Try to straighten your leg while sitting in a chair. Hold your straight leg while contacting the thigh muscles and then slowly bring the leg back.
• Similarly, standing with support of a chair, try to lift your leg to the side as far as possible and then bring it slowly back.
• Hip extension exercise consists of trying to bend your hip back and then bring it to a neutral position. However hip extension exercises may not be recommended when the hip replacement is done via an anterior approach.
• Heel rises is done with help of your therapist and consists of holding the hands of your therapist and trying to lift your heels off the ground. Hold the lifted heels in position for a few seconds and then bring them back slowly.

Soreness as a result of exercise is normal. However, any kind of pain is abnormal and it is advised to discontinue exercise for at least 2 days and then start gradually again.

Besides exercises, special emphasis is placed on walking and gait training. The therapist works to assess your walking pattern and to help you learn proper walking techniques. The patients are advised to walk the first day following surgery.

An assistive device in the form of a walker may be used. The patients are advised to always keep the walker in front of them at a comfortable distance to prevent inadvertent falls. The patients are also advised to first touch their heel and then rest of the foot while walking.

Walking training is followed by training in balance and activities of daily living such as climbing up and down the stairs. After the initial postoperative exercise training and gait training, advance training may include elastic bands to increase resistance training.

Gradually progressive exercises after a total hip replacement has shown to improve function and decrease pain after the surgery. Participation in exercises lead to early resumption of the activities the patients enjoy. The exercise program is specially tailored according to the patients needs and the type of the surgery.

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