Six Tips for a Safe and Swift Hip Replacement Recovery

Total HipOver fifteen plus years working in the out-patient physical therapy setting, it has always befuddled me why patients with such a massive surgery as a total hip replacement are not routinely sent to out-patient physical therapy after discharge from a hospital or rehab facility. The few times I have seen patients after this procedure, these patients are not doing as well as they could be with the help of a physical therapist to reduce pain and swelling, work on scar mobility to reduce scar sensitivity and pain, and to improve hip strength and balance. Simply sending these patients home with a few exercise sheets never gets the patients where they need to be no matter how good they are at doing the exercises. They simply don’t have the correct exercises that are graded and difficult enough to get them back to normal strength and balance.

If you have had a total hip replacement and are still struggling with pain, scar soreness, weakness, and impaired balance, ask your physician to send you to out-patient physical therapy to help you with these issues. If you think you have just a few areas to work on and you’d like to try it on your own, here’s some things for you to work on:

6) Ice to control swelling. Patients have this idea that ice is only necessary for the first 24-48 hours after surgery. While this advice may be fine for say, stubbing your toe, I assure you that the massive procedure that is a total hip replacement disturbs so much tissue that your body will be sending inflammatory mediators to your hip for at least 4-6 weeks after surgery. Plus, every time you work out with your home exercise program, or after your first trip grocery shopping or to the mall, you will stir up a bit more swelling, requiring ice to keep the area calmed down and pain-free. Ice several times per day for 15 minutes after activity or after doing your home exercise program for as long as you feel pain and swelling or are trying a new, more strenuous activity, to keep swelling and pain from returning.

5) Mobilize your scar. Once your scar has fully healed and no scab is remaining, you can work on your scar to reduce pain and improve tissue extensibility (tissue stretch during normal body movements).  How to perform your own scar mobilization?  Check out this article for details.

4) Strengthen your glut max: You may have received a home exercise program in the hospital or rehab center, but chances are these are not the only exercises you need to be doing to ensure full recovery of function back to pre-surgery levels. Strengthening the gluteus maximus, your powerhouse muscle, will help you get up out of chairs, out of your car, and up stairs with ease. Here’s how you do it:

Glut Max Strengthening in Prone

Glut Max Strengthening in Prone

1. Using the floor, table, or firm bed, lay on your stomach, with a pillow under your stomach.

2. Squeeze your gluts together as hard as you can.

3. Keeping your knee straight, lift one leg up off the table, only high enough for your thigh to be off the surface. DO NOT lift so high that you extend through your spine. Slowly and smoothly lower your leg back to the start position.

4. Maintain the glut squeeze as you repeat step 3 with the opposite leg.

5. Re-squeeze the gluts again, and repeat steps 3-4; do 2-3 sets of 10-15 reps, daily, or 3-4x/wk.

*If you do not feel comfortable lying on your stomach, you can perform this exercises in standing in front of your kitchen sink, doing the glut squeeze and leg lift backward with your knee straight as above.

3) Strengthen your glut med: This is another critical exercise missing from your discharge home exercise program. The gluteus medius is a very important muscle for restoring hip and pelvis stability, and improves stability of any activity on one foot- reaching, weight shifting, walking, stair ambulation, and helps to prevent falls by improving your balance.

Gluteus Medius Strengthening in Sidelying

Gluteus Medius Strengthening in Sidelying

Start Position: Lay on your side, with your hips and knees bent to about 90 degrees, and your feet directly on top of each other. Roll your hips as far forward as possible.

Exercise: Keeping your feet together, tip your top knee up toward the ceiling without rotating your hip back. You will not be lifting your knee more than 6 inches. Slowly and smoothly lower your raised leg back down to rest on the bottom leg.

Optional: You may want to keep your hand on your hip (as shown) to help you feel your gluteus medius muscle tighten under your fingers, and to assist you in keeping your hips from rotating backward.

Basic: perform 2-3 sets of 10-15 reps, daily or 3-4x/wk

Advanced: hold the top leg for 3-5 seconds during each rep, then slowly lower.

2) Speaking of balance, start practicing balance exercises in front of your kitchen sink. Start on two feet, placing them close to each other working on balance, then hold this position while slowly turning your head side to side. Once this becomes easy, try balancing with one foot ahead of the other- this is called a tandem stance position. Switch which foot is in front, and try to hold this position for 30-60 seconds. Once this becomes easy, try balancing on 1 foot at a time, eventually adding slow head turns once this becomes an easy task. If you have significant balance challenges and these exercises make you feel nervous, ask your physician if you can attend out-patient physical therapy to work on your balance with the assistance of a physical therapist. 

1) Follow your precautions… for life! Invest in a reacher, shoe horn, and get help with tougher reaches outside in the yard or for cleaning in your home to allow you to safely following your precautions. Orthopedic surgeons will tell you that even ten years out after surgery, patients still can ruin their replacement as it dislocates out the back of the hip from forward bending and rotating. Specific precautions vary depending on the approach the surgeon took with your replacement, so be sure to ask specifically what they are and how to follow them prior to discharge.