Total hip replacement surgeries have come a long way since the first recognized attempt at replacing this ball-in-socket joint back in 1891. At that time, ivory was used in conjunction with nickel-plated screws to replace the arthritic hip joint. Thankfully, the materials that are used these days have advanced by leaps and bounds as the metals, ceramics, and polymers can often last the patient 15-20 years before needing to be replaced.
Often times a total hip replacement surgery can successfully revitalize a person’s life as he/she can return to participating in activities that used to cause debilitating hip pain with every step. However, in order to optimize the recovery after the surgery, there are specific physical therapy exercises before a hip replacement surgery that should be performed in order to strengthen the muscles that support the hip joint.
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When to Consider a Total Hip Replacement Surgery?
Patients often ask me, “How do I know when I should get hip replacement surgery?” My typical response to this common question addresses 3 areas of concern:
Does your hip pain cause you to limp when walking?
- If yes, then it’s probably time to replace the joint as limping over time will lead to increased joint degeneration of the joints both above and below the hip joint (think the knee and the lumbar spine).
Does your hip pain prevent you from performing activities of daily living? (i.e. getting up from a chair or off of the toilet, walking up/down stairs, etc.)
- If yes, then a hip replacement surgery will absolutely be able to help return you to independent function.
Does your hip pain prevent you from doing the activities that make you happy? (i.e. playing with your grandchildren, gardening, taking walks outside)
- If yes, hip replacement surgery can help improve your quality of life by giving you back the ability to participate in activities that provide you joy.
Can Hip Injections Help Prevent Surgery?
Corticosteroid injections can help to DELAY the time until a total hip replacement surgery (a.k.a. total hip arthroplasty) is required, but these injections should be considered as only a band-aid type of solution. Corticosteroids are powerful anti-inflammatories and they can be very effective in reducing pain caused by joint osteoarthritis (the medical term for run-of-the-mill joint arthritis).
Most doctors are only willing to give one corticosteroid injection every 3-months due to other complications that can occur if multiple injections are given too close together in time. However, with each successive injection, the effectiveness of corticosteroids decreases, so eventually the injections will stop providing pain relief. Once the injections stop relieving the hip pain, the only solution left is to have a hip joint replacement surgery.
Some patients choose to forgo the temporary relief provided by injections and they simply decide to go-ahead with the hip replacement. It’s certainly a personal decision and each person must weigh his/her circumstances to determine the right choice.
Pre-hab Exercise Program Prior to the Hip Surgery
It is very important to begin physical therapy exercises BEFORE a hip replacement surgery. We refer to this time period as pre-operational or pre-hab for short. Pre-hab programs should be initiated approximately 6-8 weeks prior to the hip replacement surgery to provide ample time to prepare the body for the upcoming surgery. Participation in pre-hab physical therapy programs has been proven to reduce the time for patients to achieve functional milestones after joint replacement surgery.
The exercises in this pre-hab program should focus on increasing the strength of the supporting hip muscles and improving leg muscle flexibility.
How to Prepare for a Total Hip Replacement Surgery
There are several considerations that one must consider prior to hip replacement surgery.
Declutter your home (remove any tripping hazards)
- Many of us have rugs, dog or children’s toys, clothing, etc. lying about in our homes. These objects become tripping and slipping hazards after joint replacement surgery when you’ll be medicated, weak, and not feeling well.
Make plans for assistance in the home for the first 1-2 weeks post-operatively
- For the first couple of weeks after surgery, you WILL NEED help around the home. This includes help with bathing (use a shower chair), cooking, dressing, and other basics around the home. If you live alone, you can speak with your surgeon about going to an inpatient rehab facility during this time period where you will receive daily physical therapy and nursing support.
Plan for alternative transportation for 4-6 weeks post-operatively
- You will not be permitted to drive while actively taking opioid pain medications. Also, if you have surgery on your right hip (the side used to press on the brake and gas pedal), plan for 4-6 weeks until the surgeon clears you to drive by yourself.
Purchase a walker and a single-point cane
- Most surgical centers require that you bring your own walker with you to surgery as they will not provide you with one. Most patients usually purchase a rolling walker (a walker with wheels on the front legs), however, if you are a fall risk and have difficulty with balance, I recommend that you purchase a regular non-wheeled walker as this type is much more stable. Go ahead and also purchase an adjustable single-point cane as you will quickly transition from the walker to the cane within 2 or 3 weeks after surgery.
9.6- ROLLING WITH WHEELS
- FOLDING WALKER
- QUALITY CONSTRUCTION
- 5″ WHEELS, VINYL CONTOURED HAND GRIP
- SAFE AND EASY OPERATION
9.5- NON-WHEELED
- FOLDING WALKER
- QUALITY CONSTRUCTION, YET LIGHTWEIGHT
- PREMIUM FEATURES
- SAFE & EASY TO USE
4.9- ERGONOMIC AND SMOOTH OFFSET HANDLE
- ANTI-CORROSION ALUMINUM CANE
- ADJUSTABLE HEIGHTS AND WEIGHT CAPACITY
- ANTI-SLIP RUBBER CANE BASE
Arrange sleeping and waking hours to be on the same floor of the home
- If possible, arrange so that you can sleep, eat, bathe, etc. all on the same floor as it will be very difficult for you to maneuver up and down the stairs for the first few weeks after hip surgery.
Install grab bar handles near the shower and toilet
- Installing grab bar handles in the bathroom will significantly help with getting into/out of the shower or up and down from the toilet, which can be very difficult after a hip joint replacement.
9.6- 2 PACK
- 16″ LONG EACH
- ANTI-RUST STAINLESS STEAL WITH CHROME FINISH
- NON-SLIP KNURLED SURFACE
- STYLISH END COVERS CONCEAL MOUNTING HARDWARE
- Installing grab bar handles in the bathroom will significantly help with getting into/out of the shower or up and down from the toilet, which can be very difficult after a hip joint replacement.
Use a raised toilet seat
- A raised toilet seat can also help by temporarily elevating the height of the toilet seat making it much easier to both sit down and stand back up.
9- ADDITIONAL 5″ IN TOILET SEAT HEIGHT
- ADJUSTABLE WIDTH ARMS
- FOAM PADDED ARM RESTS
- UNIVERSAL FIT
- LIGHTWEIGHT & DURABLE
Use a shower chair in the tub/stand-up shower
- After surgery, you will not be able to stand independently while bathing due to hip pain and weakness. Use a shower chair to allow yourself to sit reducing the risk of falling.
9.3- SIT, SHOWER & RELAX
- DURABLE & SECURE – WEIGHT CAPACITY 350 LBS
- COMFORTABLE
- VERSATILE & EASY TO USE
- LIGHTWEIGHT & PORTABLE
Schedule your first physical therapy appointment for after the surgery
- Now is the time to go ahead and schedule your first post-operative physical therapy appointment. You can ask your surgeon, but traditionally your first appointment should be scheduled for when you are 1 week post-op from a hip replacement surgery.
What to Expect After a Hip Replacement Surgery?
After the surgery, most people will be discharged from the surgical center later on the same day. Total hip replacements are considered outpatient procedures, or “same-day” surgeries. You will need to be picked up from the surgical center by someone who is willing to care for you for the first couple of weeks while you are still recovering.
Pain Medications
- Initially, you won’t be able to feel much in the entire surgical leg. This is because the medical team gives you what is called a Femoral Nerve Block. This blocks the pain nerves from communicating with your brain, so you have no perception of the pain. However, the nerve block will wear off after 24-48 hours, and you will need to make sure that you are already taking your prescribed opioid pain medications (i.e. Oxycodone) before the nerve block wearing off. If you delay your oral pain meds, you risk “falling behind” on your pain and you do not want that to occur! As always, be sure to follow the recommendations of your doctor or pharmacist in regard to the pain medication schedule.
Ankle Pumps!
- Risk of Deep Vein Thrombosis (DVT), which is essentially a blood clot, is heightened significantly after hip surgery. These most commonly occur in your lower legs because of stagnant blood pooling in the legs. To prevent DVTs, it is imperative that you stand and move around at least once per hour and perform ankle pumps several times throughout the day.
- Perform: 30 repetitions (5-6x/day)
Standard Hip Precautions
The following standard hip precautions are to be followed until 6-weeks after surgery (unless otherwise instructed by your medical professionals):
- No crossing of the legs (no hip adduction and/or internal rotation)
- No hip flexion beyond 90 degrees (be careful when tying your shoes)
- Traditionally, hip precautions used to be observed in all patients who had undergone a posterolateral approach during the total hip replacement.
- However, newer surgical approaches have been developed where the standard hip precautions are no longer required, so be sure that you clearly understand your surgeon’s instructions post-operatively. You can also ask your physical therapist if you’re not sure.
The 9 BEST Exercises Before a Hip Replacement Surgery!
Recumbent Bike (Stationary Bike)
- Perform: 10-15 mins, building up to 30 mins eventually with mild resistance (1x/day)
Hip External Rotator Stretch
- Use both hands to gently pull your knee towards the opposite shoulder.
- You should feel a stretch in the buttock area.
- Perform: 30 sec holds x 3 reps (1x/day)
Supine Marching
- Tighten your abdominals while pressing your low back flat against the surface.
- Slowly lift one bent leg towards your chest, then lower. Alternate marching side to side.
- Perform: 3 sets x 10 reps (1x/day)
Single Knee to Chest
- You should feel a stretch in the glute muscles (buttock).
- Perform: 10 sec holds x 10 reps (1x/day)
Straight Leg Raise
- Engage your core by contracting your abdominal muscles.
- Lift the injured leg towards the ceiling while striving to keep the knee completely straight. Pause. Then lower.
- Perform: 2-3 sets x 10 reps (1x/day)
Dual-Leg Bridging
- Bend both knees equally to a position that the injured knee can tolerate.
- Engage your glute muscles by squeezing your buttocks.
- Lift your hips towards the ceiling. Pause, then lower.
- Perform: 2-3 sets x 10 reps (1x/day)
Side-Lying Clamshells
- Squeeze your glutes as your raise your upper leg towards the ceiling while simultaneously opening your knees similar to opening a clamshell, pause, then lower.
- Perform: 2 sets x 15 reps (1x/day)
Side-Lying Hip Abduction
- Squeeze your upper buttock muscle while lifting your top leg (knee straight) directly upwards.
- You should feel this exercise activating and isolating your glute complex.
- Perform: 2-3 sets x 10 reps (1x/day)
Sit to Stand from Chair
- Perform a 1/2 depth squat (mini-squat) by sitting your hips back as if you were going to sit down on a chair.
- Do not allow your knees to go in front of your toes.
- Modification: For poor balance, hold onto the edge of a dining room table or kitchen countertop.
- Perform: 2-3 sets x 10 reps (1x/day)
