Postoperative care begins with a team of heath professionals within the hospital. Those closely involved with the postoperative total hip patient are:
After surgery, vital signs and sensation in the lower extremities are observed and checked by the nursing staff and documented for the physician. Antibiotics are frequently administered every eight hours, for two to three days, to reduce the risk of infection.
The surgical incision is observed closely for:
- Excessive drainage
- Proper initial healing
- The need for changing of sterile dressings
The respiratory therapist is vital at this stage for:
- Instruction in coughing and deep breathing exercises to help prevent complications, such as congestion or pneumonia.
- Instruction in the use of a bedside device called an incentive spirometer to assist in deep breathing exercises. Use of this device and deep breathing exercises are important in minimizing the risk of lung complications by removing excess secretions that may settle in the lungs during surgery.
Shortly after surgery the physical therapist addresses:
- Circulation - The acute care physical therapist in the hospital instructs the patient in early stage exercises such as moving the ankles up and down to promote circulation and prevent clots.
- Range of motion - The physical therapist will instruct the patient to perform exercises to improve upon hip range of motion.
- Mild strengthening - Following surgery, the total hip patient will work with the hospital physical therapist to improve range of motion to the hip as well as initiate muscle strengthening. This will progress the patient into becoming independent in walking, going up and down stairs, getting in and out of bed, and doing exercises to improve the range of motion and strength of the hip. This initial rehabilitation generally takes 5-7 days. During this time, patients may experience discomfort may be experienced while walking and exercising. To address this problem, pain medication will be ordered by the doctor as needed.
- Gait training - The physical therapist assists the patient in walking short distances using crutches or a walker. This not only promotes range of motion and strength but is also important for endurance and stamina. Weight bearing will depend on the nature of the implant fixation. If cement was used on both the socket and the
femurside, weight bearing as tolerated using a walker will be instituted. If the joint is cementless, weight restrictions will be recommended for 4 to 6 weeks. It is critical for patients to adhere to the weight bearing status given to them following surgery.
The occupational therapist is involved in evaluating and addressing how independently and safely the patient functions in activities of daily living such as dressing, bathing, and caring for his or herself following hip surgery. Issues such as how safely and independently the patient is able care for himself is evaluated. The occupational therapist teaches patients how to use equipment that prevents excessive bending of the new hip.
How To Information:.
Standard exercises that are used for early postoperative hip replacement are:
Heel Slides (Knee Flexion) - This exercise will promote muscle activity of the hamstrings as well as help increase the amount of knee flexion. The patient is lying in bed on his or her back, with legs straight and together and arms at the sides. The patient slides the foot of the surgical limb toward the buttock to a point where a mild stretch is felt. The patient holds this position to a count of 10 then slowly returns to the starting position. The physical therapist will record the amount of flexion and extension for a daily report on the patient's progress to be reviewed by the physician.
Active Abduction - The patient places a smooth surface such as a plywood sheet under his or her legs. The patient begins with the legs together then moves the operative leg out to the side as far as tolerated keeping toes pointed toward the ceiling. The patient then returns to the starting position, progressing to 20 repetitions, 2 times a day.
Quadriceps Setting - The patient is lying in bed on his or her back, with legs straight and together and arms at the side. The patient tightens the quadriceps muscles while pushing the back of the knee downward into the bed. This is a good beginning exercise as it not only initiates the needed muscle contraction but also is helpful in increasing extension of the knee. The patient holds this muscle contraction for 5-10 seconds, relaxes for a short period of time and repeats 10-20 times for each leg. It is optimal to exercise both legs as both legs will be in a weakened state after surgery. The patient is encouraged to do this exercise several times every hour, however, the amount of discomfort will determine how many repetitions each patient can perform.
Terminal Knee Extension - This exercise also helps promote muscle activity and increases knee extension. The patient is lying in bed on his or her back, with a pillow or towel rolled up into a bolster under the surgical knee to place the knee joint at approximately 40 degrees from full extension. The patient is then instructed to tighten the quadriceps muscle and straighten the knee by lifting the heel off the bed. The patient is instructed to hold this muscle contraction for 5-10 seconds, then to slowly lower the heel to the bed. This exercise is to be repeated 10-20 times.
Gluteal Setting - The patient lies either on his or her back or sits with legs straight and in contact with the bed. The patient is then asked to tighten the buttocks in a pinching manner and hold the isometric contraction for 5 seconds, relax 5 seconds. The exercise is repeated 20 repetitions, 2 times a day.
Isometric Hip Abduction - The patient is instructed to keep the legs straight, together, and in contact with the bed. Next a loop or belt is positioned around the thighs just above his or her knees. The patient then slowly spreads their legs against the belt. This is held for 5 seconds, followed by relaxing for 5 seconds. The patient progress to 20 repetitions, 2 times a day.