Physical Therapy for Total Hip Replacement

The main goal of rehabilitation following a total hip replacement, also known as an arthroplasty, is to protect the reconstructed area and progressively maximize functional movement. Each patient will progress at a different rate depending on their comorbidities, presurgical range of motion (ROM), age, and rehabilitation compliance. It should be emphasized that the completion of the criteria is more important than the timeline that is outlined in each stage. One can only safely progress to the next stage if all criteria are met, if not then the patient will remain in that particular stage.

 

There are variations to each patient’s recovery, some may be discharged the same day while others may need to stay up to three (3) days in the hospital. This will depend on health status and ability to complete ambulation with an assistive device. It is worth noting that if there is limited flexibility and motion in the knee before surgery, there will be limitations afterward.

 

Physical Therapy for Total Hip Replacement: Discharge to 6 weeks

The main areas of focus during the first phase after a THA are managing pain, decreasing swelling, maintaining skin integrity at the incision site, restoring and promoting muscle strength throughout the lower extremity (glutes, quads, hamstrings, hip flexors), and promote functional mobility. It is integral to follow a home program that pays particular attention to improving strength and mobility during this time. Movement will promote increases in range of motion which will in turn decrease swelling and relieve pain in the area (by increasing blood flow and nourishment to the area).

 

An important goal during this phase is to decrease the need for an assistive device as quickly as possible, working from a walker or crutches to a cane to no assistive device. This will allow you to work on body awareness (proprioception), balance, strength, and returning to a normal gait pattern. The sooner the glutes, quads, hamstrings, and other muscles around the hip are able to activate and controllably contract, the sooner the assistive device can be removed from ambulation training. Heel slides and ankle pumps are exercises used to initiate muscle activation and promote range of motion to prevent pooling of blood in the lower extremities. Muscle contraction provides the necessary venous pressure to pump blood back to the heart.

 

Benchmarks: Reduced swelling, reduced pain, deep vein thrombosis (DVT) prevention, improve pain free range of motion (ROM), promote muscle activation, wean from assistive device, follow dislocation precautions

 

Physical Therapy for Hip Replacement: Weeks 6-8

The physical therapist will continue to focus on strengthening the quads, hamstrings, glutes, and other hip muscles while still adhering to dislocation precautions provided by the surgeon. Strengthening these muscles will help to improve walking ability and progression from a walker or crutches to a cane (either single point or quad). By the end of week 6 it is possible you will be able to walk without an assistive device on flat ground. Mini squats will be done to increase strength of the quads and glutes, as strength progresses the depth of the squats will increase and allow you to work the muscles through a greater range leading to increases in strength and range of motion. Core strengthening will be started as well, this will ensure that the pelvis is stable and provide greater control through the lower extremities.  Resistive exercises will be initiated as tolerated, as long as all criteria are met for the first phase. Balance and proprioceptive exercises will also be initiated during this phase, starting with double leg standing and progressing to single leg on a stable surface.

 

More aggressive ROM exercises can be used during this phase, hip range of motion should be within normal ranges at the end of this phase. A tool frequently used in PT is a stationary bike, as this is recommended for cardiovascular exercise and a way to increase hip flexion and extension range of motion. Biking usually progresses from gently rocking back and forth to rotating in a full circle.

 

Benchmarks: Normal ranges for hip range of motion, 4/5  lower extremity is on the MMT scale, normal gait pattern, symmetrical squat, single leg stance, step up and downs with good motor control 

 

Physical Therapy for Hip Replacement: Weeks 9-12

Physical therapy may be dropped down to 1x per week during this phase, it may also remain at 2, depending on the patient’s strength, endurance, and compliance with home program.

The PT will focus on strength through double leg and single leg exercises as well as single plane and multi plane activities. That essentially means forward/backward, side/side, and eventually twisting and rotating movements. This phase is going to be focused on sport and work specific exercise, this may include plyometrics such as hopping, agility such as changes in direction, and balance exercises. Balance will be progressed from stable to compromised surfaces to promote proprioceptive/somatosensory input (being able to tell where your body is in space/being able to intake information from the environment you’re in and your body being able to respond appropriately) and increase strength and stability through the hip.

 

Patients are encouraged to continue their fitness activity outside of the clinic to help aid in their rehabilitation.

See also: