Hip Replacement: Movement, Rehabilitation, and Long-Term Activity

How do you move after a hip replacement?

Immediately following a hip replacement, movement is carefully guided by healthcare professionals, emphasizing early, controlled mobilization while strictly adhering to specific hip precautions to protect the new joint and facilitate optimal recovery.

Understanding Hip Replacement Recovery

Total Hip Arthroplasty (THA), commonly known as hip replacement surgery, is a highly effective procedure for alleviating pain and restoring function in individuals with severe hip joint damage. While the surgery itself replaces the damaged bone and cartilage with prosthetic components, the subsequent journey of movement and rehabilitation is crucial for achieving the best long-term outcomes. The primary goals of post-operative movement are to prevent complications (like blood clots), restore range of motion, strengthen surrounding musculature, and progressively return to functional activities.

Immediate Post-Operative Movement (Hospital Phase)

Movement begins remarkably soon after surgery, often within hours. This early mobilization is critical for circulation, reducing the risk of deep vein thrombosis (DVT) and improving lung function.

• Early Mobilization: Under the supervision of nurses and physical therapists (PTs), patients are typically encouraged to sit up, stand, and take a few steps with assistance on the same day or the day after surgery.
• Weight-Bearing Status: Your surgeon will specify your weight-bearing status, which is often "weight-bearing as tolerated" (WBAT) with the aid of a walker or crutches, meaning you can put as much weight on the leg as comfortable.
• Hip Precautions: These are critical movement restrictions designed to prevent dislocation of the new hip joint. While specific precautions can vary based on the surgical approach (anterior vs. posterior), common restrictions include:
  • Avoiding excessive hip flexion (bending the hip beyond 90 degrees).
  • Avoiding hip adduction (crossing the operated leg past the midline of the body).
  • Avoiding hip internal rotation (turning the toes inward).
  • For anterior approach, precautions may include avoiding hip extension and external rotation.
• Physical Therapy Guidance: A physical therapist will teach you safe ways to move, including:
  • Bed mobility: Log-rolling to get in and out of bed.
  • Transfers: Safely moving from bed to chair, or chair to toilet.
  • Gait training: Learning to walk with assistive devices, focusing on a heel-to-toe pattern and proper weight distribution.
• Pain Management: Adequate pain control is essential to allow for effective participation in early movement and therapy.

Early Rehabilitation: The First Weeks at Home

Upon discharge, movement continues to be a primary focus, gradually increasing in complexity and duration. Adherence to your physical therapy program is paramount during this phase.

• Continued Hip Precautions: These must be diligently followed in all activities of daily living (ADLs).
• Activities of Daily Living (ADLs) Adaptations:
  • Sitting: Use high chairs or cushions to keep hips above knees. Avoid low, soft seating.
  • Bending: Avoid bending at the waist. Use assistive devices like a reacher or long-handled shoehorn.
  • Toileting: Use a raised toilet seat.
  • Showering: Use a shower chair and grab bars.
  • Stairs: Lead with the unoperated leg going up ("good goes to heaven"), and lead with the operated leg going down ("bad goes to hell"), using handrails.
  • Getting in/out of a car: Back up to the seat, sit down, and pivot the entire body with both legs together.
• Home Exercise Program: Your PT will prescribe specific exercises, typically focusing on:
  • Gentle range of motion: Ankle pumps, knee bends, hip abductions (sliding leg out to side).
  • Isometric strengthening: Gluteal sets (squeezing buttocks), quadriceps sets (tightening thigh muscles).
  • Walking: Progressively increasing distance and reducing reliance on assistive devices as tolerated.
• Avoidance of Twisting and Pivoting: These movements can place undue stress on the new joint and should be avoided. Turn your whole body, not just your trunk.

Strengthening and Mobility: Beyond the Initial Weeks

As pain subsides and initial healing progresses (typically 6-12 weeks post-op), the focus shifts towards more active strengthening, balance, and regaining functional mobility.

• Progressive Strengthening: Exercises will target key muscle groups around the hip, including:
  • Hip abductors: Essential for stability during walking (e.g., side-lying leg lifts, standing hip abductions).
  • Hip extensors: Gluteus maximus for power (e.g., glute bridges, gentle squats).
  • Quadriceps and hamstrings: For overall leg strength.
  • Core stability: Crucial for overall balance and transferring forces through the pelvis.
• Balance Training: Incorporating exercises that challenge balance helps prevent falls and improves proprioception (the body's sense of its position in space).
• Gradual Increase in Activity: Your PT will guide you in safely increasing the duration and intensity of your walks and incorporating more dynamic movements.
• Return to Driving: Typically allowed once off pain medication, able to operate pedals safely, and can comfortably get in and out of the car (usually 4-6 weeks post-op, check with your surgeon).

Long-Term Movement and Activity Considerations

Most individuals can return to a wide range of activities after a hip replacement, but some modifications and precautions are generally recommended for the longevity of the implant.

• Recommended Activities:
  • Walking: Excellent for cardiovascular health and joint mobility.
  • Swimming/Water Aerobics: Low-impact, excellent for full-body conditioning.
  • Cycling: Stationary or outdoor cycling on flat terrain (adjust seat height to avoid excessive hip flexion).
  • Golf: Often permissible with modifications (e.g., using a cart, avoiding deep rotation).
  • Low-impact aerobics/Elliptical training: Good cardiovascular options.
• Activities to Approach with Caution or Avoid:
  • High-impact sports: Running, jumping, contact sports, aggressive racquet sports (tennis, squash) can accelerate wear on the implant.
  • Activities with high risk of falls: Skiing, rock climbing, skateboarding.
  • Deep bending or twisting: Yoga poses or exercises that violate hip precautions should be modified or avoided.
• Listen to Your Body: Pain is a signal. Avoid pushing through pain, especially new or increasing pain around the hip.
• Regular Follow-ups: Adhere to your surgeon's schedule for post-operative check-ups to monitor the implant and overall recovery.

Key Precautions and Red Flags

Understanding potential issues and how to respond is vital for a safe recovery.

• Continued Adherence to Precautions: Even months or years after surgery, avoiding extreme positions that violate your specific hip precautions is generally advised, especially for posterior approach patients.
• Signs of Complications: Seek immediate medical attention if you experience:
  • Sudden, severe pain in the hip or leg.
  • A popping sound or feeling, especially if accompanied by pain and inability to bear weight (could indicate dislocation).
  • Increasing redness, swelling, or pus from the incision site (signs of infection).
  • Fever or chills.
  • New or worsening calf pain, tenderness, or swelling (could indicate DVT).

The Role of the Rehabilitation Team

Your successful return to movement is a team effort.

• Orthopedic Surgeon: Oversees the surgical procedure and overall recovery plan.
• Physical Therapist (PT): Guides your exercise program, teaches safe movement patterns, and progresses your strength and mobility.
• Occupational Therapist (OT): Helps you adapt daily activities and environments to maintain hip precautions and optimize independence.
• Nurses: Provide immediate post-operative care, pain management, and early mobility assistance.

Conclusion

Moving after a hip replacement is a carefully orchestrated process that begins almost immediately after surgery and progresses through distinct phases. By diligently adhering to hip precautions, consistently engaging in your prescribed rehabilitation exercises, and working closely with your healthcare team, you can safely and effectively regain functional movement, reduce pain, and return to a fulfilling, active lifestyle with your new hip joint. Patience, consistency, and a commitment to the rehabilitation process are the cornerstones of a successful recovery.