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What is the rehabilitation following hip replacement?

Q: I am 34 years old woman with sickle cell disease. I recently had a total hip replacement and dislocated two days after the surgery. I was then rushed to the hospital and the hip was put back in place but was asked to wear a brace. I wore that for about 6 weeks and that actually did all the precautions for me. Now my problem is that I can’t bend my hip more than 40 degrees. My hip is very stiff and I can’t even put on my clothes. Life is very difficult now and even though I go for therapy every other day, this is not really helping much. I can’t even open my legs to put a pillow in between. I went to see my doctor for aspiration and the result is negative, the x-rays according to the doctors look great so they don't really know where the problem is. I am very depressed and have lost weight. Is there anything I can do to ease this stiffness and be able to climb stairs?

A:Rehabilitation following total hip replacement (THR) involves therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Specific exercises are to be done several times a day to restore movement and strengthen the hip joint. Following surgery, the aim is to concentrate on improving the skills you have already started to work on. These include the exercises, getting off and back onto the bed, walking independently with the crutches, managing the toilet and washing and sitting out in the chair. When fit enough, the patient can begin to dress, bathe and manage functional activities. Appropriate weight-bearing activities are the most useful way of improving muscle power and walking pattern. It takes about 3 months for the new tissue to form around the hip joint, which helps hold it in place but till then the risk of dislocation is there. The normal hip, in contrast to the artificial hip, is a deep and stable joint with very strong ligaments and much greater force is required to dislocate it. The new joint, in comparison, is shallower and the local anatomy altered so it is more prone to dislocation. Your stiffness will be helped by the following exercises and activities. The exercises should be done four times a day in a set of ten repetitions each. Tie one end of a rubber around the ankle of the operated leg and the opposite end to a stationary object such as a locked door or heavy furniture. Hold on to a chair or support for balance. Stand with your feet slightly apart. Bring your operated leg forward keeping the knee straight. Allow your leg to return to its previous position. Stand sideways from the door and extend your operated leg out to the side. Allow your leg to return to its previous position. Face the door or heavy object to which the tubing is attached and pull your leg straight back. Allow your leg to return to its previous position. Cycling (twice a day for 10 to 15 minutes 3-4 times a week) helps regain muscle strength and hip mobility. Adjust height such that the bottom of your foot just touches the pedal with your knee almost straight. Initially pedal only backwards till you are comfortable and only then do forward pedalling. After about 4 to 6 weeks, you can increase the tension on the cycle. Walking use a cane till you have regained your balance. Begin with a 5 or 10 minutes walk 3 or 4 times a day and as your strength and endurance improves, increase it to 20 or 30 minutes 2 or 3 times a day. Once you have fully recovered, regular walks, 20 or 30 minutes 3 or 4 times a week, will help maintain your strength. You need to consult a good physiotherapist/occupational therapist who can lead you through the protocol so that an active exercise regimen and rehabilitation programme can be followed.

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