The period of life has been lengthened, we are a generation that lives by far the longest. It is caused by the development of medicine and broadly understood civilization, which allow for the rapid detection of disease changes and their effective treatment.
However, the fact that we live longer and how we live (sedentary lifestyle, lack of physical activity, stress, poor diet) unfortunately has a negative impact on the condition of our movement system and the development of various pain ailments. This is a huge challenge for modern medicine, which strives to restore the patients’ fitness, reduce pain and, as far as possible, recover the function.
One of the greatest achievements of medicine in the last century is arthroplasty (a procedure involving the removal of a diseased segment and the implantation of an artificial replacement element – a prosthesis), which gives patients the ability to function without pain and suffering.
Indications for hip arthroplasty
Similarly to the knee joint, the basic indications for arthroplasty are strong pain-free pain and loss of joint function.
The disorder of hip joint function is most often found in:
- rheumatic disease
- osteoarthritis of the hip
- past injuries and fractures within the pelvis and femur (especially the proximal end)
- necrosis of the femoral head
and then there are difficulties in walking up the stairs, standing up from a sitting position and constant pain accompanying the simplest activities of everyday life.
Hip arthroplasty – what is the procedure?
The hip arthroplasty involves the removal of damaged joint surfaces within the proximal femur (femoral head) and acetabulum of the joint. Depending on the extent of the changes, the exchange includes one or both surfaces.
1. total arthroplasty – replacement of both femoral head and acetabulum. The prosthesis consists of a mandrel that is placed within the femur and metal or ceramic head of the femur. The second element of the prosthesis is a metal cup with an insert.
2. The procedure in the early post-operative period (day 0-4) includes mainly:
- anticoagulant prophylaxis
- postural positions of the operated lower limb
After the arthroplasty, the position of lying down is recommended, with proper protection of the lower limb against excessive attachment and rotation, the limb should be placed in an intermediate position.
- lying down behind – lower limb in a slight flexion in the hip joint (about 20?) and visiting (about 30?)
The main goal of the exercises conducted in the early period is to prevent complications from the respiratory and circulatory systems, as well as accelerate the healing processes of tissues (through better blood circulation). The exercises are focused on strengthening muscle strength (isometric exercises) and improving the ranges of mobility (active exercises).
Sample exercises in the early postoperative period:
- in the position of lying down with the upright lower limb, push the limb into the bed while flexing the dorsal foot – maintain the position of 7 seconds and relax. Exercise repeat 10 times.
- in the position of lying down with the straight lower limb, slowly move the foot on the ground towards you (bending up to 90?), then return to the starting position. Exercise repeat 10 times.
- in the lying position with the back with the upright lower limb and the towel under the knee joint, slowly push the knee joint into the towel while lifting the foot above the ground – maintain the position of 7 seconds and relax. Exercise repeat 10 times.
- in the lying position with the back with the straight lower limb, slowly move the limb to the side (abduction) on the ground, keeping the foot in the intermediate position, then return to the starting position. Exercise repeat 10 times.
- in the position of lying down with the legs straightened up, pull the stomach and squeeze the buttocks – maintain the tension 7 seconds and relax. Exercise repeat 10 times.
Exercises in the position of lying down are performed primarily in the first days after the procedure, in the following days you go to higher and higher positions (position sitting on the beds, sitting down with down legs), continuing the exercises from the initial stage. Depending on the individual possibilities on day 2 or 3, the patient is upright, and 3-4 days are the time for learning to walk with the balcony and then on the crutches with relief of the lower limb. In the first days, continuous passive movement on the rail is also introduced, which has a positive effect on increasing the ranges of mobility, healing of the post-operative wound and reduction of increased muscle tone.
Walking with crutches with relief of the lower limb, depending on the type of endoprosthesis, lasts for 1.5 months (cement endoprosthesis), even up to about 3 months (cementless endoprosthesis).
3. Proceedings at a later postoperative period
4-5 days after the procedure, the patient himself assumes a sitting position (flat and with down legs), and also himself gets up from the bed. The next few days are the time when the walk on crutches is improved, with gradual increase in loads and difficulties. The patient learns to walk the stairs, moves sideways, backwards, and overcomes various obstacles. In the period of 5-6 days there are exercises with resistance of elastic band and proprioception exercises.
In the absence of complications about 7 days after the procedure, the patient is discharged home, and the rehabilitation procedure is outpatient. The next day is a continuation of the previous exercises and:
- active exercises in ever-larger ranges of mobility
- in a standing position while holding a chair, lift the lower limb towards the chest (do not raise the knees above the waist-90?). Exercise repeat 10 times.
- in a standing position while holding a chair, raise the straight lower limb to the side. Exercise repeat 10 times.
- in a standing position while holding a chair, raise the straight lower limb backwards. Exercise repeat 10 times.
- strengthening exercises
- in a standing position while holding a chair, with a flexible tape on the lower limbs, do the following:
- move the slightly raised forelimb forward, keeping the muscle tone control the back of the limb to the starting position
- lift the limb to the side, keeping the muscle tone, control the limb back to the starting position
- lift the operated leg back, keeping the muscle tone, control the limb’s return to the starting position
- in the lying position sideways on the unoperated side, raise the straight lower limb to a height of about 20 cm and then move the forelimb (slightly bent) and backward. Exercise repeat 10 times.
- in the recumbent position with bent lower limbs and dorsiflexed feet (foot supported on the heel), raise the hips above the ground and maintain the position for 5 seconds, then loosen and put the hips. Exercise repeat 10 times.
- in a standing position with the upper limbs raised slightly, perform semi-squat with keeping the position for 2-3 seconds, then slowly return to the starting position. Exercise perform 10 times.
- proprioception exercises
- in a standing position, with feet set wide, move to the fingers with the simultaneous transfer of upper limbs above the head, keep the position of 5 seconds. Exercise repeat 10 times.
- in a standing position lift the lower limb unoperated towards the chest, maintain the position 3-5 seconds, then lift the lower leg operated. Exercise repeat 10 times for each limb.
- in a standing position with closed eyes (close to a chair or wall), transfer the weight of the body once to the left, once to the right. If the exercise is not difficult, at the same time transfer the weight of the body to one foot, tear off the other.
- exercises in neuromuscular paving aimed at eliminating the habit of limping and re-education of the correct walking pattern. Techniques are used to learn how to control the correct pelvic position, as well as the science of controlling the support phase in the lower limb of the operated one and exercises in the support and transfer phases.
In addition to exercises directed directly at the operated hip joint, the role of the shoulder girdle, postural muscles and the unoperated lower limb play an important role in the treatment process.
An excellent supplement to therapy are such forms of movement as:
- riding a stationary bicycle (with gradual extension of duration and load)
- swimming (crawl, back) and doing exercises in the water