Post surgery protocol for total hip endoprosthesis

The surgery involves replacing the hip joint with an artificial device which restores normal movements in all planes. Usually it is performed in old patients. Among the prosthesis indications, the most commonly refers to coxarthrosis. Other indications are as follows: hip dysplasia, aseptic necrosis of the femoral head, fracture or dislocation of the acetabulum and the proximal femur, rheumatoid arthritis, ankylosing spondylitis.

    The recovery begins several weeks before surgery, when aiming to increase the muscle strength of certain muscle groups, so that postoperatively, the patient can go easily using the frame or the crutches and thus decreasing the risk of pulmonary complications.

    Total hip prosthesis is of two main types: cemented and uncemented.

   The cemented total prosthesis is indicated in elderly patients after 60-65 years and in those with osteoporosis. In case of cemented prosthesis there are allowed loading and walking immediate postoperatively. However, for the patient’s safety, he should go using the crutches or the frame for few days. The full support is allowed after 14-15 days.

    Arthroplasty with uncemented total knee replacement is preferred in patients under 60 years to increase the duration of ther joint implant. Post surgery, the patient can go out of bed after two days, assisted by physiotherapist and initially using the frame, then crutches. The total support is allowed after 60 days.

     The hospitalization takes about 14 days. The surgery is performed using the spinal anesthesia. The medication of inflammatory and analgesic type controls the subsequent discomfort, especially that generated by changing the position and outreach/mobilization. The results/outcomes are the best. There is no pain, approaching to normal mobility, and over 80% of patients do not need any help by a walking device. The patient is allowed to return to the previous activity level. Contact sports, tennis or ski are not indicated/recommended. The patient will use a crutch or a walking stick until the total healing (3 months).

    Whatever the prosthesis type would be, the objectives of the physiotherapy program relate to:

•    Prevention of the complications induced by the bed immobilisation (thrombophlebitis, decubitus, skin lesions, pneumonia, pulmonary emboli);

•    Restoring the muscle strength of the hip stabilizers, firstly, but also the other joints of the lower limb;

•    Restoring joint mobility for the knee and then for the hip, keeping certain restrictions for some time;

•    Fighting against the factors responsible for the deploying/dislocation of the the prosthesis.

    A period of time, usually six months, there are imposed certain movement restrictions to prevent the dislocation of the prosthesis, as follows:

1.You must avoid crossing the legs or ankles, whether you are standing, sitting or lying;

 

2. When sitting on a chair, your feet should be slightly apart;

3. Do not excessively rotate the feet internally/externally during the daily activities;

 4. When you sit on the chair, your knees should be at your hips level, not higher;

5. When rising from a chair, come slightly forward, then use your frame or crutches for help;

6. Use elevators for your toilet seat;

7. Do not lean forward, use aids for putting shoes, socks, or for picking up objects from the floor;

8. When you lie down in bed, use abduction and adduction pillows to maintain the hip joint in the correct position.