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Guidelines for the patient after total hip arthroplasty

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Last update date 06.23.2019

Not every house has a shower cabin, which you can enter only by crossing a low threshold. As we know, getting into the bath is often not easy even for a healthy person. What to say about people who have just returned home after hip replacement. After all, it’s especially difficult and even dangerous for them to swim.

However, hygiene is necessary, so they still have to climb into a slippery bath. How to do this with minimal risk without damaging the operated leg?

Bathing in the first weeks after surgery

The first 2-3 weeks after surgery, it is forbidden to take a bath. Washing is allowed only in the shower, while standing or sitting in a special seat. During bathing, the bandage must be removed, and the wound itself rinsed with clean running water. You can not rub it with soap and a washcloth.

It is desirable that the scabs separate from the seam by themselves, without the help of external influences.

Having finished washing, the wound should be dried, disinfected and a fresh clean dressing applied to it. It is forbidden to take a shower with a bandage, as this can provoke the development of infectious complications. For example, suppuration of a postoperative wound.

When to wash in the bath

Take a bath only 3-4 weeks after replacing TBSand only subject to complete healing of the wound. Before proceeding with water procedures, a person must obtain the permission of the attending physician. This can be done during the next scheduled inspection.

What is the best way to get into the bath

Go to the bath should be on the special steps. Their installation should be taken care of in advance, during the preparation of the house / apartment for the return of the patient. Such steps are sold in many shopping centers and online stores.

Go to the bath itself very carefully so as not to slip. This is best done with the help of loved ones. Climbing the steps, the first should lower a healthy leg, and only then - operated. This is necessary in order to prevent the sore foot from being reloaded.

In the bath itself, you must sit on a special seat or chair purchased in advance. Sit in it is recommended with the help of loved ones. If this is not possible, then the bathroom must be equipped in such a way that the patient can sit and get up on his own. To do this, install special handrails.

You need to sit in a chair slowly, holding your body firmly with your hands. And you should sit in the device evenly, holding your legs together and avoiding the distortion of the pelvis.

Before using any chair, you must carefully read the instructions for it.

Is it worth sitting down or better standing

The first weeks after replacing the TBS, it is recommended to swim standing, under warm running water. Weak people who are hard to stand are allowed to sit down, but only in a special seat (or chair).

If the attending physician is allowed to take a bath, then you also need to sit in it on a chair, making sure so that the angle of bending of the legs in the hip joints is not less than 90 degrees. In no case can the lower limbs be strongly bent and pulled to the body, because this can provoke a dislocation of the endoprosthesis or other equally dangerous consequences.

How to choose a bathing chair seat

People who have only a bathtub at home (and no shower) should buy a chair or seat designed specifically for it. Sitting in this device can be taken as a shower, as well as a bath.

When making a purchase, it is better to give preference to plastic products, as they are the lightest and most ergonomic. They do not absorb moisture, wash easily, and removing them from the bath and putting them back is extremely easy. In addition to the chair / seat, it is recommended to equip the bathroom with steps and handrails.

What you need to follow

You will wear special stockings that promote blood circulation, from 4 to 6 weeks after surgery, until you reach an average level of activity. During this period, the temperature of the legs may be elevated, swelling, mild soreness may be noted. Ice bags often help reduce them.

If you notice any of the following, call your doctor immediately:
Exacerbation of pain
Increased edema
Wet wounds
Chest pain or shortness of breath
Soreness in the calf or thigh of the operated leg
Persistent or daytime fever

Full, proper physical activity is necessary to maintain strength and flexibility. Once you are at home (even if you are visiting a physical education practitioner), you yourself must follow the schedule of exercises that are so necessary for recovery. It often makes sense to appoint someone close to you as a trainer who will help you mentally and physically in daily exercises. Take the habit of doing exercises during commercial breaks, or when you start reading a new chapter in a book. Remember to use ice and pressure stockings to reduce pain and swelling.

Once at home, you need to learn how to apply the skills acquired in the hospital at home. In no case should you return to old habits. To protect your hip joint and speed recovery, use the techniques and precautions you learned at the hospital. Continue to use support devices and techniques your doctor showed you to protect your hip joint as your home activity increases.

What should be avoided to extend the life of the implant.

Total hip arthroplasty is a frequent operation with a predictable and highly successful result. Many patients are so glad to relieve pain and improve joint function that sometimes they begin to overestimate the acceptable level of activity and function of the joint. Increased activity leading to excessive load on the joint can reduce its service life. The unsuitability of the endoprosthesis is directly related to movements that wear out the plastic surfaces and disrupt the fixation of the implant. Loosening of the implant and wear of its plastic parts may require revision surgery, which, as a rule, is not as successful as primary endoprosthetics. The life of the implant is individual in each case. It depends on factors such as the patient’s physical condition, activity level, weight and accuracy of implant placement during surgery.

In order to maximize the life of the implant, you must adhere to the following rules:

  • Avoid lifting heavy things several times
  • Avoid long walks on stairs.
  • Do not gain weight
  • Take care of your health and stay active
  • Avoid sports that stress the joint, such as running, downhill skiing, sports aerobics
  • Consult a surgeon before embarking on a new sport or activity
  • Think first, then move

How to avoid dislocation:

  • Avoid flexion in the hip joint of more than 90 °
  • Avoid internal rotation (inward rotation) of the thigh when it is bent or when sitting
  • Do not sit on low chairs or beds, or on chairs without armrests
  • Avoid crossing the legs with the midline of the torso
    • DO NOT cross the operated leg with the midline of the torso.
    • DO NOT bend the operated hip joint more than 90 °
    • DO NOT allow the foot or knee of the operated leg to turn inward.

    Infection prevention

    Your implant is at a high risk of infection. For any infections, dental diseases or surgical procedures, be sure to consult your doctor. Any bacterial infection must be treated without delay, to prevent infection of the joint. Prophylactic antibiotics should be preceded by any invasive procedure, including any kind of dental care.

    Sex life

    As a rule, sexual life can be resumed after the healing of a postoperative wound, and at least partial restoration of movements in the hip joint. In order to avoid excessive stress on the hip joint, small changes in sexual activity may be required. The attending physician can tell you which sex poses are safe.

    EXERCISE №1: Tens of the quadriceps femoris

    Lie on your back, stretch your legs along the bed or mat. Keep your foot bent so that your toes point upwards and straighten your leg at the knee as much as possible, tensing the muscles of the front surface of the thigh. Maintain voltage for 5 seconds.
    Repeat exercise 10 times. Do not hold your breath while doing this.

    EXERCISE # 3: Ankle Training

    Bend the foot so that the fingers are pointing up, keep the knee straight. Keep this position for 5 seconds. Bend your foot so that your fingers are pointing down. Keep this position for 5 seconds. In addition, make several rotational movements of the foot.
    Repeat 30 times per hour.
    Begin this exercise as soon as you return to your room after waking up.

    Using a walker

    When getting up from a chair before using the walker, push your hands away from the armrests. Never lean on the walker while standing up. As soon as you get up, put your hands on the walker one by one. Get balanced before taking a step. Feet should always be within the walker. Move the walker forward at a convenient distance (arms are pulled back but not extended forward) and place it on all four legs at the same time. First, take a step with your operated leg, right in the center of the walker. Take a step with the second foot, placing it slightly behind the operated leg. Use a walker for at least 10-15 minutes, three times a day.

    Lie either on your back or on that side where there was no operation. If you prefer to lie on your back, put a small pillow between your knees so you don't accidentally cross your legs. When you lie on your side, place a pillow between your legs for 4-6 weeks after surgery to reduce discomfort. Lie down on the bed (or get up from it) that side where the operation was. Make sure that the operated leg does not cross the midline of the body.

    Standing with your back to the chair, step back until the edge of the chair touches your legs. Leaning your hands on the armrests, lower yourself into the seat, keeping your torso straight. The operated leg should be stretched forward all the time. When you are sitting, your knees should always be below the hip joints (you can sit on a small pillow for this). The legs should be 8-15 cm apart. To rise from the chair, move to the edge of the seat. Keep your operated leg extended forward. Pushing your arms away from the armrests, raise your torso. Do not lean forward.

    Bath wash

    Bathing in the shower is more convenient than taking a bath, as getting into the bath is not easy. Standing in the shower, spread your legs 20-30 cm, under your feet there should be a non-slip litter. If you are unsure, sit in the shower in a chair. Use a soap bag or liquid soap so that you do not have to pick up the fallen remnant.

    How to get into the bath

    On the first day after returning home, it is recommended to put a chair for a sitting shower in the bath. Leaning on a walker, sit on the edge of the tub. Grasp the back of the chair with one hand and hold the center of the walker bar with the other hand. Sit on a chair slowly, moving your foot over the edge of the tub. Then turn on the water. To get out of the bath, turn on the chair, moving your legs over the edge of the bath. For safety in the bath and shower, a safety rail is highly recommended.

    Toilet use

    Leaning on a walker, back to the toilet until you feel its edge with your feet. Grasp the arms of the armrests behind you, transfer your weight to them and slowly lower yourself into the seat. The operated leg should remain extended forward all the time. Stand up in the reverse order. Always keep your balance.

    Other types of motor activity

    You should use outside help or special equipment to get objects from the floor lying on a chair that is far from the patient. It is not advisable to get objects located behind or on the side of the patient due to the rotation of the body with fixed legs. In order to take these items, you must first turn in the right direction, standing up to the subject face. Lifting heavy objects is not allowed.

    It is possible to take a shower, subject to safety measures, so as not to slip on the wet floor or in the bath. Additional help should be used when washing the feet below the knee joints, as the new joint should not bend more than 90 ". It is undesirable to sit on the low seat in the toilet room to fix this situation, you can put an inflatable ring or install a special console.

    The patient is allowed to cook, wipe the dust, wash the dishes. But you can not use a vacuum cleaner, clean the bed, use a mop when washing floors, perform work that requires considerable physical effort.

    Special therapeutic exercises To improve the function of the new joint, you should continue to exercise, gradually complicating them and increasing the number of repetitions of each movement. Exercise will help restore mobility in the joint and prepare the muscles for movement without additional support.

    List of basic special exercises

    I.p. lying on your back:
    1. Alternating bending of the legs in the knee joints, without taking your feet off the floor (bed).
    2. Alternate abduction of the legs to the side, sliding on the floor.
    3. Imitation of cycling.
    4. Putting a pillow (roller) under the knees, alternating extension of the legs in the knee joints.
    5. Bend the legs at the knees, alternately straighten the legs, keeping them on weight.

    If the joint bends to 90 ", then you can add the following:
    Alternately pulling bent legs to the stomach with your hands.

    I.p. lying on its side (on the non-operated side) with a pillow (roller) between the hips.
    1. Raising the straight leg up (hip abduction).
    2. The movement of the straightened leg back (hip extension).

    I.p. lying on your stomach.
    1. Bending the legs in the knee joints.
    2. Extension of the legs in the knee joints when resting on the toes with the simultaneous tension of the gluteal muscles.
    3. Raising the straight leg back.

    I.p. standing on a healthy leg with arms resting on the back of a chair.
    1. Raising the straight leg forward,
    2. The same aside.
    3. The same back.

    When performing exercises should not be pain. Movements are performed at a slow pace, from 5 to 8 times. These exercises alternate with hand movements and breathing exercises. The duration of the procedure is 20 minutes.

    Late postoperative period

    After 3 months after the operation, a control x-ray examination is performed, after which the orthopedic surgeon decides on the possibility of expanding the motor regime. However, in order to avoid a number of complications in the long-term period after surgery, one should know and adhere to a number of recommendations.

    In the absence of complaints and radiological signs of instability of the endoprosthesis, walking with the support of a cane is allowed, and subsequently after 6-8 months. after surgery - without additional support.

    If you experience unpleasant sensations in the joint area, consult a doctor. However, it must be remembered that these sensations cannot be removed by the usual methods of physiotherapeutic influence, since they are most often associated with phenomena of joint instability. In this regard, we consider it unreasonable to use physiotherapeutic treatment. In addition, there is no data on how the passage of electric current through the metal structure of the prosthesis affects.

    The objectives of the late postoperative period were:
    • strengthening paraarticular muscle groups,
    • adaptation to everyday and working physical activity.

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