Ideally, rehabilitation begins before surgery by assessing the patient's medical and social condition in order to determine what the patient might require postoperatively for a successful outcome. The main goal of the rehabilitation after a total hip replacement is to restore function by controlling pain and normalizing gait.
Preoperative gait instruction might facilitate early post-operative ambulation. The main goal in the inpatient period is early ambulation and decrease of pain and swelling. As many patients experience an antalgic gait or limb weakness preoperatively, postoperative gait training and exercise may be beneficial (Roos).
Individuals who undergo total hip replacement require both physical and occupational therapy. Occupational therapy is needed after surgery for instruction in all transfer training, equipment needs and activities of daily living modifications. Individuals can be assessed and trained by the occupational therapist in the use of equipment such as an elevated commode, tub seat, reacher, long-handled shoe horn and long-handled sponges, as these facilitate independent activities of daily living in the postoperative period (Crowe).
Postoperative physical therapy is necessary for gait training on level and uneven surfaces, such as stairs. Weight bearing status is determined by the physician, and patients may use assistive devices as needed. Knee and ankle range of motion exercises are indicated to prevent the development of postoperative circulatory complications, and to maintain strength and range of motion in these joints during this period of limited patient mobility. Some postoperative protocols dictate the use of hip exercise while others do not. When indicated, isometric exercises of the lower limb and the hip abductors help to regain muscle recruitment and strength. Applying local cold packs, being careful to protect the surgical wound, can decrease pain and swelling. After discharge from the hospital, physical therapy may continue with the goal of normalizing gait, range of motion, and muscle strengthening of the involved lower extremity, according to the limitations of the surgeon. Instruction in hip exercises is based on the surgeon's protocol and should be incorporated only if prescribed.
An important goal of therapy is to teach precautionary measures to the individual and should be reinforced by both the physical and occupational therapists (Grissom). Care must be taken to protect the integrity of the prosthesis and the surrounding soft tissue during all activities and while at rest. All weight bearing and exercise should be continued under the direct guidance of the surgeon and within the movement limitations necessary to protect the integrity of the hip prosthesis. Restrictions of the range of motion and weight bearing depend on the surgical approach.
The final goal of physical therapy is increasing functional abilities. The functional abilities include not only walking, but also abilities required for vocational and recreational activities. |
FREQUENCY OF REHABILITATION VISITS | | Surgical ‡ | |
| Occupational Therapist | | Daily inpatient | | | | | | | | Physical Therapist | | Up to 12-16 visits in 12 weeks | |
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| ‡ Note on Surgical Guidelines: Amount of outpatient rehab is very variable as per the physician's protocol. |
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor