Maximize the Benefits of Hip Replacement with Rehabilitation

Thousands of Americans decide to undergo hip replacement each year. And as Baby Boomers age, the number of total hip replacements is expected to increase by more than 60% in the next 30 years.

How can someone work toward the best result possible? Patients should plan for the days following surgery as closely as they select their surgeon and hospital. PM&R physicians specialize in helping individuals regain function after an event such as hip replacement surgery. Here are some of their recommendations.

Being physically fit before the hip replacement will make post-operative recovery easier and shorter. Surgery reduces a person's strength, motion, and endurance. So, the stronger muscles are beforehand, the easier it will be to exercise and get around after surgery.

But exercise may be difficult for those with pain before the surgery. PM&R physician Victoria Brander, MD, director of the Arthritis Center at the Rehabilitation Institute of Chicago and assistant professor of physical medicine and rehabilitation, Northwestern University Medical School in Chicago, suggests exercising in a warm pool. "The warmth and buoyancy of the water helps provide pain free exercise." Or, a PM&R physician can develop a series of exercises to perform at home to help maintain strength and flexibility despite a painful hip.

In the Hospital

The rehabilitation performed in an acute care hospital after surgery is fairly standard. Most hospitals have established protocols to care for people after joint replacement surgery. Dr. Brander outlines what a patient can expect in the days following surgery.

• Day One After Surgery: Physical therapy begins. The therapist will help you dangle your leg at the side the bed and you will try to stand with a walker or crutches. You should sit in a chair for about an hour. The therapist will help you begin exercising in bed using exercises such as ankle pumps, heel slides, and others.

• Days Two - Three: You will begin to stand and walk in your room. You'll have help with stretching and strengthening exercises. You will also begin to sit in a chair for one hour, twice a day.

• Days Four - Five: Therapy will progress vigorously until you are ready for discharge. You should be walking smoothly with a walker or crutches, getting from your bed to a chair or to the toilet, dressing, and bathing.

Before leaving the hospital, Dr. Brander cautions patients to be sure they understand what they should not do and know how to perform their home exercise program.

After the Hospital

It is critical to plan, in advance, the post-operative treatment and rehabilitation for when a patient will leave the hospital. Older or less mobile people may want to transfer from the hospital to a rehabilitation unit where they can stay until they are able to care for themselves (usually about ten days). The hospital may have such a unit, or have a relationship with a nearby rehabilitation facility.

Make sure the rehabilitation facility chosen has three important features:

1. A hip replacement patient will need to see a PM&R physician regularly. In traditional rehab facilities PM&R physicians typically see their patients every day or several days a week. Consider a facility where rehabilitation is run by a PM&R physician who sees patients frequently. Some units in nursing homes only have a physician visit once a week.

2. Choose a facility that offers therapy every day. Many facilities do not offer therapy on Saturdays and Sundays. Those facilities are not acceptable for hip replacement patients who need inpatient rehabilitation.

3. The therapy and nursing care received in rehabilitation should follow protocols of care that are established for joint replacement patients. It is important to go to a facility that has expertise in joint replacement rehabilitation. The surgical wound must be cared for, splints and other devices have to be applied appropriately, and therapy must follow the specific instructions of the patient's physician.

After returning home, many patients make arrangements for home assistance services such as an attendant to help with bathing, a nurse to draw blood or help with surgical dressing changes, and physical and occupational therapists to help regain independence. These issues can be discussed with a social worker or discharge planner at the hospital or doctor's office.

A Lifetime of Exercise

Six weeks after surgery, pain should be nearly gone. Many can walk fairly far with a cane. There will still be some physical limitations that will interfere with day-to-day functioning. In most circumstances, these problems can go away through an ongoing, supervised, customized exercise program.

A PM&R physician can provide specific exercises to help with any common physical limitations caused by a prosthetic hip. These exercise programs are effective because they are customized based on a careful history and physical examination (by the orthopedic surgeon or PM&R physician) and then referral to a physical therapist.

Dr. Brander says, "I have seen many of my patients with joint replacements return to the same physical activities they had enjoyed years before the surgery. To reach that goal, they had to dedicate themselves to working hard during their physical therapy and exercises program."