Hip replacement: movements to avoid and rehabilitation

fisioterapista che esegue esercizi di recupero per la mobilità dopo intervento di protesi all'anca

Hip replacement requires a specific rehabilitation programme, which aims at eliminating the source of the pain but also to completely restore joint mobility and resume walking properly.

The hip is the proximal joint of the lower limb, defined as ball and socket joint (or spheroidal joint) from an anatomical point of view, as it is one of the joints with the most degree of mobility. The hip, or in medical terms known as the coxofemoral joint, joins the leg to the pelvis and is made up of the femoral head, which connects to the ilium (hip bone) in a cavity called the acetabulum. The hip bone complex also includes the joint capsule, various ligaments and muscles, and the synovial bursa.

In functional terms, the hip can perform three different types of movement:

  1. Flexion and extension of the femur
  2. Adduction and abduction of the femur
  3. Internal and external rotation of the femur

Hip replacement: when surgery is necessary

The main disorder that leads to hip replacement surgery is coxarthrosis (hip arthrosis). Pain is the dominant symptom, which is usually dull and insidious, and becomes acute under load and during abduction and intrarotation movements. It frequently affects the groin area and can spread to the rear area of the thigh including the gluteus, in the antero-medial zone up to the knee or laterally to the knee.

When opting for hip replacement surgery, the age of the patient is undoubtedly an essential factor to assess when recommending the implant, as its lifetime could be limited over time due to wear of the materials.

Hip replacement rehabilitation: what to do before and after the operation

When hip replacement surgery is needed, it is important to work together with your orthopaedist and physiotherapist to decide on the correct rehabilitation programme, aimed not only at eliminating the source of pain, but also fully restoring joint mobility and returning to walking correctly.

Pre-surgery rehabilitation

Pre-surgery rehabilitation is aimed at reducing, even if only partially, the symptoms of joint pain. Depending on the disorder causing the joint problems and the decision to intervene with hip replacement, the pre-surgery rehabilitation programme includes functional rehabilitation activities, stretching and physical therapies, and in some cases hydrokinesis therapy, a rehabilitation practice that involves water activities aimed at avoiding stress on the joint with the body weight.

The rehabilitation programme is then planned according to the individually assessed case, examining joint balance, i.e. the rigidity of both hips, the knees and the spine, as well as muscular stiffness (in particular hypotrophy of the gluteus and thighs) and postural rigidity.

Post-surgery rehabilitation

In the post-surgery phase, the correct hip rehabilitation programme must also take into account the surgical access route, the type of operation, the prosthetic used and the immediate post-operative progress. Post-operative rehabilitation must be constant, progressive and with special attention to proprioceptive training, based on the stimulation of the neuro-motor system in its entirety. Rehabilitation normally starts the day after surgery, focussing on:

  • Postural training, to counter incorrect attitudes acquired when the disorder started.
  • Strengthening of hypotrophic muscles and relaxation of contracted muscles

The complete rehabilitation programme is divided into an initial phase focussed on isometric contractions of the quadriceps, the gluteus maximus and gluteus medius muscle and the triceps surae, with active and manually assisted mobilisation of the hip (within certain limits, and always gradual). Another essential factor is proprioceptive rehabilitation, to retrieve correct control of the lower limb.

In the second phase, rehabilitation exercises for hip replacement focus on rehabilitation for walking, first with the aid of a walking frame, parallel bars and crutches, through to the recovery of correct steps and normal autonomy.

Hip replacement: movements to avoid after surgery

In the first few days after surgery, special care must be taken with certain movements because the hip prosthetic is at the risk of dislocation.
The movements to avoid depend on the type of operation performed. In particular, after posterior hip replacement operations, flexion and internal rotation movements should be avoided. On the other hand, if an anterior hip replacement operation has been performed, external hip rotation and extension movements should be avoided. For example, extra care should be taken when sitting down on excessively low seats or when crossing the legs, both when sitting or lying on the bed.

What are the recovery times and how long does rehabilitation last after a hip replacement operation?

The length of the rehabilitation plan varies greatly: recovery times depend on age, the pre-operative physical conditions of the patient, and the final objectives of the surgery. Discharge from hospital normally occurs a few days after the operation, and rehabilitation lasts on average at least 2- 3 months, considering a frequency of three sessions per week. At the end of the plan, the patient should have regained a satisfactory level of independence in movement to enable walking well, without pain or the use of supports such as crutches or similar.

The Physiotherapist’s advice for rehabilitation after hip replacement surgery

After a hip replacement operation, it is advisable to follow and extensive rehabilitation programme that is continuous over the following few months, but which is also maintained over the subsequent years. In fact, a certain level of weakness in the operated joint persists even two years after the operation, and is often the cause of falls among older patients.

To deal with the operation in the best way and speed up recovery times, our physiotherapists advise the following:

  • Follow a preoperative rehabilitation programme: when conditions allow this, before the operation it is strongly recommended to follow a programme to strengthen muscles and work on general joint mobility. This helps to speed up recovery times after the operation.
  • Take note of exercises to avoid after the operation: the first few weeks after the operation are the most delicate, both physically and mentally. It is therefore important not to overdo or rush things, avoiding movements that risk dislocation and keeping a positive attitude during the rehabilitation process.
  • Don’t stop physiotherapy when you have recovered mobility: keep the coxofemoral joint active all the time, through constant physical exercise that reinforces the muscles of the lower limbs. The ideal exercises after hip replacement operations are using exercise bikes, swimming and the gym.