Total hip arthroplasty, or total hip replacement (THA), is a common surgical procedure that replaces a damaged hip joint with an artificial implant. This intervention effectively relieves chronic pain and restores mobility for individuals suffering from conditions like severe arthritis. While the surgery is a major step toward recovery, success depends on a rehabilitation program. A tailored exercise regimen is necessary to rebuild strength, regain range of motion, and safely return to daily activities. The exercises prescribed will vary based on the patient’s specific health status and the surgical approach used.
Immediate Post-Surgery Movements
The initial phase of recovery begins immediately after surgery, focusing on gentle movements to promote circulation and prevent complications. The primary goal of these exercises is to activate the muscles around the hip without placing stress on the new joint.
Ankle pumps are the most frequently prescribed exercise, involving rhythmic flexing and pointing of the feet. This movement helps prevent deep vein thrombosis (DVT) by stimulating blood flow in the lower legs, which is slowed by immobility following surgery. Patients are encouraged to perform these pumps frequently, often 10 to 30 times every hour while awake.
Another set of gentle contractions are quad sets and gluteal sets, which are isometric exercises performed while lying down. Quad sets involve tightening the muscle on the front of the thigh, pushing the back of the knee down against the bed. Gluteal sets are performed by squeezing the buttock muscles together. These static contractions help the body reconnect with these large muscle groups and prevent weakening during recovery.
Early Recovery and Mobility Exercises
As the initial post-operative pain subsides, the rehabilitation shifts toward regaining basic mobility and range of motion. Movements in this phase remain slow and controlled. Assistive devices, such as a walker or cane, are required for any movement out of bed, including initial gait training.
Heel slides are a foundational exercise where the patient slides the heel of the operated leg toward the buttocks, gently bending the knee and hip. This focuses on controlled hip and knee flexion and must be performed carefully to avoid bending the hip past the established safety angle. Supine hip abduction involves sliding the operated leg out to the side while keeping the knee and toes pointed toward the ceiling. This movement strengthens the outer hip muscles important for walking, while avoiding rotation that could compromise the joint.
Supported standing exercises are gradually introduced to prepare for independent movement, including standing knee raises, also known as marches. While holding onto a stable surface for balance, the patient slowly lifts the foot of the operated leg a few inches off the floor, mimicking a marching motion. These initial mobility exercises are often done in short, frequent sessions, increasing the duration of standing and walking as tolerated.
Strengthening and Functional Recovery
Around six weeks after surgery, the focus progresses to strengthening, endurance, and balance, preparing the patient to return to more complex daily activities. These exercises involve overcoming gravity and incorporating light resistance or increased repetitions.
Functional movements like sit-to-stand practice help rebuild the strength and control required for daily transitions. Patients practice rising from a chair and sitting back down slowly, working toward doing so without using their arms for assistance.
Gentle mini-squats, often performed as wall slides, are introduced to strengthen the quadriceps and gluteal muscles in a controlled manner. The patient leans against a wall and slides down a few inches, ensuring the knees do not track past the toes.
Step-ups, using a low step or stair, are another important functional exercise that improves leg strength and coordination. The patient steps up with the non-operated leg first, then brings the operated leg up, followed by a controlled step down. Balance training, such as standing on the operated leg with support, is also integrated to enhance stability and confidence for activities like walking on uneven surfaces.
Essential Safety Guidelines and Precautions
Protecting the new hip joint from dislocation is paramount, particularly in the initial recovery period when the surrounding soft tissues are healing. Patients who have had a posterior approach total hip replacement are instructed to follow a set of strict guidelines known as hip precautions.
The main precautions include avoiding bending the hip past 90 degrees, which means no deep squatting, leaning forward while sitting, or reaching down to pick objects off the floor. Patients must also avoid crossing the operated leg over the midline of the body, whether sitting, standing, or lying down. The third major precaution is to avoid excessive internal rotation, or twisting the leg inward, by keeping the toes pointed forward or slightly outward.
Beyond these positional rules, patients must be aware of “red flags” that require immediate medical attention, as they may indicate a serious complication like infection or a blood clot. Signs of a potential infection include a fever, persistent chills, an unusual increase in warmth or redness around the incision, or cloudy, foul-smelling drainage from the wound. Sudden, severe pain, inability to bear weight, or a new clicking or grinding sound from the hip should also be reported to the surgical team right away.