Activity Immediately Following Surgery

There are different ways to surgically reconstruct hips, so the instructions you will follow after surgery will depend on your doctor and the way the surgery was done.

Precautions: Follow your doctor's instructions regarding the amount of weight you can put through your operated hip.

Avoid activities that put a strain on the surgical area. During your activities, let pain guide your decisions. If you feel pain with any activity, stop or alter what you are doing because pain at this stage is an indicator of strain or irritation.

Exercises: Any exercises you do should be done only at the direction of your doctor or therapist. The choices of exercise used after surgery will depend upon the type of procedure used. You may be given a few exercises that you can do for your knee, ankle, and foot. Gently bending and straightening your ankle can keep your calf muscle flexible while "pumping" away excess swelling. Some exercises are used to help control pain and help with movement in the knee and hip. Low grade exercises for the thigh muscles can usually begin right away. Extra pain felt after these or other exercises will indicate whether you are overdoing it. You may need to change the number of repetitions, the amount of pressure, or the how often you are doing the exercises.

Inpatient Physical Therapy During Your Hospital Stay

Your physical therapist may schedule to see you in the hospital on the same or next day after surgery. The first visit gives your physical therapist an idea of how well your hip is moving and how well you remember and are practicing your hip precautions. It is also a time to see how well you can move while in your hospital bed, your safety when getting up and sitting on the edge of the bed, and whether you can begin to walk using a walking aid and putting the right amount of weight through your foot. As you gain more confidence and endurance with walking, your therapist will begin to train you how to go up and down stairs using your walking aid.

You may also begin doing a few exercises in your hospital room the first visit. You could begin a series of strengthening exercises for the thigh and leg muscles. As your condition improves, you may be transported by wheelchair to the physical therapy gym for your treatment sessions.

While you are in the hospital, your therapist may see you for therapy up to two times each day. You can expect to stay in the hospital at least three to four days after surgery.

You may be released to go home when you can use your hip precautions with all activities. Your therapist will check to see that you can get in and out of bed safely, walk with the right amount of weight on your hip using a walking aid, go up and down stairs safely, and do your exercises by yourself.

After You Leave the Hospital

Once discharged from the hospital, you may be seen in the home for treatment. This is to make sure you are safe in and around your home. You could be seen for at least one home visit for the safety check and to review your exercise program.

Outpatient Physical Therapy

On your first outpatient visit, your physical therapist will want to gather some more information about the history of your condition. You may be given a questionnaire that helps you describe day-to-day problems you are having because of your condition. The information you give will help measure the success of your treatment. You may also be asked to rate your pain on a scale of one to ten. This will help your therapist gauge how much pain you have now and how your pain and symptoms change once you've had treatment. Your therapist will probably ask some more questions about your condition to get an idea how your hip has been feeling since your surgery:

• How is your hip feeling since the surgery?
• Where do you feel your pain now?
• Are you getting any more swelling?

Once all this information has been gathered, your condition will be evaluated. The main parts of the evaluation are listed below and may be done in the order chosen by your therapist.

Posture/observation: Your physical therapist will check your overall posture, including the alignment of your low back, pelvis, and your knees and ankles. These have a significant role in the health of your hip. Your therapist will also check the surgical area to make sure the incisions are healing. By comparing each side, your therapist can determine if there is extra swelling, bruising, or a loss in the size of your muscles.

Gait analysis: By watching you walk back and forth, your therapist can make sure your walking aid is adjusted for you and that you are using it safely. The amount of weight you put through your leg will depend on your doctor and the type of procedure done (cemented or not).

Range of motion (ROM): Your therapist will check the ROM in your hip. This is a measurement of how far you can move your hip in different directions. Measurements could include forward and back (flexion/extension), side to side (abduction/aduction), and rotating (internal or external rotations). Movement will be limited to the precautions depending on whether you had a posterior or anterior surgical approach. Your ROM is written down to compare how much improvement you are making with the treatments.

Strength: Your therapist will test the strength of your muscles. You could be asked to hold against resistance as your therapist tests the muscles around the hip and knee. Other muscles that may be checked include the buttocks and calf muscles. These measurements are compared to your other side. Weakness in key muscles will be addressed with a strengthening program.

Girth: Using a tape measure, your therapist may compare the circumference of your thigh, knee and calf. This can give an indication of swelling or whether your muscles have lost size (atrophied) from a lack of use or from having pain.

Manual examination: You may be given a manual examination of the hip. Your therapist will carefully move your leg in different positions to make sure that the hip and other joints are moving smoothly. Your therapist will also look at the flexibility of the muscles and tendons around your hip. This type of exam can help guide your therapist to know which type of treatments will help you the most.

Palpation: Palpation is when your therapist feels the soft tissues around the sore area. This is done to check the skin for changes in temperature, to see how much swelling you have, to pin-point areas of soreness, and to see if there are tender points or spasm in the muscles around the hip joints. This can help your therapist get a good idea about which treatments will help you the most.