Hip Replacement Rehab and Therapy

Hip replacement surgery is a procedure performed to allow patients to return to their normal active lifestyle without pain resulting from a hip replacement. Surgeons, therapists, and patients are all interested in getting people back to activity as quickly and as safely as possible.

The day of hip replacement surgery used to be thought of as a day to relax, but as more surgeons are trying to get patients back to activity as quickly as possible, therapy often begins on the day of surgery. Patients begin simple exercise activities including ankle pumps, leg lifts, and heel slides. Most often patients will get up and out of bed—the goal should be to get into a chair and even do some walking.

Patients used to spend a week or longer in the hospital. Today, the average length of hospitalization is about 2-3 days. Some patients are leaving even sooner; in fact, same day (outpatient) hip replacement is becoming a reality. During your hospitalization, you will work with physical and occupational therapists. The physical therapist will work on mobility, strengthening, and walking. The occupational therapist will work with you on preparing for tasks such as washing, dressing, and other daily activities.

Therapy progresses at a different pace for each patient. Factors that will affect the rate of your progression include your strength before surgery, body weight, and ability to manage painful symptoms. The type and extent of surgery can also affect your ability to participate in physical therapy. Lastly, recovery and time in the hospital is largely related to how well prepared patients are heading into surgery. Participation in preoperative joint replacement education sessions (now very common at joint replacement centers) and preparing your home and support structures to help you once you have had surgery can make the recovery much faster. We know that patients who are well-prepared tend to move much more quickly through the earliest phases of rehabilitation.

Patients are usually discharged 2 to 3 days after hip replacement surgery, although shorter hospitalizations are becoming more common. It is important that discharged patients be able to safely get into their homes and perform regular activities, such as getting to the bathroom and preparing food. For people interested in faster discharge, there are a few steps you can take to try to make sure your hospitalization is as short as possible. Probably the most important factor is the amount of preoperative understanding and arrangements that have been made prior to having surgery. For example, patients who have physical therapy arranged, their house set up, and all of their equipment purchased or rented (including walkers, crutches, elevated toilet seats, or any other equipment necessary) prior to surgery are more likely to be discharged quickly. In addition, anesthesia can perform nerve blocks allowing for earlier mobility after surgery. Avoiding medications that cause sedation or nausea can also help get people moving more quickly.

If patients are not progressing to the point that they can safely return to their home environment, inpatient rehabilitation may be recommended. This allows for further work with the therapists and 24-hour support services. Most patients should be able to return to their home setting, and inpatient rehabilitation is generally reserved for patients facing a complicated recovery. Patients who return home often have home services arranged including a visiting therapist and/or nurse.

While being in a rehabilitation facility may seem beneficial, there are drawbacks. First, having to function around your home can be good therapy, rather than having someone do the work for you. For example, having to get out of bed, get into the kitchen, and prepare something to eat, can be a good thing for moving your recovery along. Second, we always worry about infection risks after joint replacement, and healthcare settings, including rehab centers, can be a source of infection. Getting away from healthcare settings can be good for a post-surgical individual.

After hip replacement surgery, some precautions may be necessary to protect the newly implanted hip. These restrictions are known as "hip precautions." Hip precautions prevent you from placing your hip in a position where the ball could potentially come out of the socket—a problem called a hip dislocation.

Because of newly designed implants, and new surgical techniques (such as anterior hip replacement), these precautions are becoming less commonly recommended. Your therapist will be able to help ensure you have the proper treatment for the surgical procedure you had performed.

Most patients will continue to work with physical therapists upon discharge from the hospital. Some surgeons don't routinely recommend formal physical therapy after hip replacement, but there have been shown to benefit. Foremost, patients tend to regain better strength after hip replacement. Because most patients with arthritic hips do not move normally, the majority of patients undergoing hip replacement have weakness of the muscles surrounding the joint. A physical therapist can help you regain normal strength of the muscles, and improve your gait following surgery.

Walking: Most patients take their first steps after surgery with the aid of a walker. Patients with good balance and a strong upper body may opt to use crutches. Transitioning to a cane depends on two factors. First, restrictions from your surgeon -- not all surgeons allow full weight to be placed on the leg in the early weeks after surgery. Second, your ability to regain strength.

Usual time to return: 2 to 4 weeks with a cane; 4 to 6 weeks unassisted

Stairs: Many patients have to navigate stairs in order to enter or get through their homes. Therefore, your therapist will work with you to get up and down steps using crutches or a walker.

Usual time to return: 1 week with crutch/walker; 4 to 6 weeks unassisted

Driving: Return to driving depends on a number of factors, including the side of your operation and the type of vehicle you have (standard or automatic). Patients need to be able to safely and quickly operate the gas and brake pedals. Under no circumstances should patients drive when taking narcotic pain medications.

Usual time to return: 4 to 6 weeks

Sex: Patients can resume sexual activity once comfortable. It is important that you maintain your usual hip precautions to avoid dangerous positions. If you have questions about sexual positions, ask your surgeon or your physical therapist.

Usual time to return: 4 to 6 weeks

Work: Return to work depends on the activity that you have to do at your job. Patients who work in a seated position, with limited walking, can plan on returning within about 4 weeks from the time of surgery.

Patients who are more active at work may need more time until they can return to full duties. Laborers should consider their work obligations before undergoing hip replacement. For example, patients may not be able to return to activities such as roofing after hip replacement.

Usual time to return: 4 to 10 weeks, depending on work obligations

Rehabilitation following total hip replacement can vary depending on a number of factors. However, there are some average timeline stick can provide a useful guide that will help you plan for your recovery following hip replacement, and also help you determine how your recovery is comparing to other people who undergo this same surgical procedure. There may be specific circumstances that affect the activities that you were able to perform following surgery. You should discuss the specifics of your rehabilitation protocol with your surgeon as here she may need to modify your recovery protocol depending on specific circumstances.