Total Hip Replacement Exercise Guide

From OrthoInfo &  the American Academy of Orthopaedic Surgeons

Regular exercise to restore strength and mobility to your hip and a gradual return to everyday

activities are important for your full recovery after hip replacement. Your orthopaedic surgeon

and physical therapist may recommend that you exercise for 20 to 30 minutes, 2 or 3 times a day

during your early recovery. They may suggest some of the exercises shown below.

This guide can help you better understand your exercise and activity program, supervised by

your physical therapist and orthopaedic surgeon. To ensure your safe recovery, be sure to check

with your therapist or surgeon before performing any of the exercises shown.

Early Postoperative Exercises

The following exercises will help increase circulation to your legs and feet, which is important

for preventing blood clots. They will also help strengthen your muscles and improve hip

movement.

Start the exercises as soon as you are able. You can begin them in the recovery room shortly

after surgery. You may feel uncomfortable at first, but these exercises will help speed your

recovery and actually diminish your postoperative pain.

Ankle Pumps

Slowly push your foot up and down. Repeat this exercise several times, as often as every 5 or 10

minutes. Begin this exercise immediately after surgery and continue it until you are fully recovered.

Illustration of ankle pumps

Ankle pumps

Ankle Rotations

Move your ankle inward toward your other foot and then outward away from your other foot.

Repeat 5 times in each direction.

Do 3 or 4 sessions a day.

Illustration of ankle rotations

Ankle rotatations

Bed-Supported Knee Bends

Slide your foot toward your buttocks, bending your knee and keeping your heel on the bed. Do not let your knee roll inward. Hold your knee in a maximally bent position for 5 to 10 seconds and then straighten.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of bed-supported knee bend

Bed-supported knee bends

Buttock Contractions

Tighten your buttock muscles and hold to a count of 5.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of buttock contractions

Buttock contractions

Abduction Exercise

Slide your leg out to the side as far as you can and then back.

Repeat 10 times.

Do 3 or 4 sessions a day

Illustration of abduction exercise

Abduction exercise

Quadriceps Set

Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds.

Repeat this exercise 10 times during a 10-minute period, rest one minute and repeat.

Continue until your thigh feels fatigued.

Illustration of quadriceps set

Quadriceps set

Straight Leg Raises

Tighten your thigh muscle with your knee fully straightened on the bed. Lift your leg several inches. Hold for 5 to 10 seconds. Slowly lower.

Repeat until your thigh feels fatigued.

Illustration of straight leg raise

Straight leg raises

Standing Exercises

Soon after your surgery, you will be out of bed and able to stand. You will require help at first but, as you regain your strength, you will be able to stand independently. While doing these standing exercises, make sure you are holding on to a firm surface such as a bar attached to your bed or a wall.

Standing Knee Raises

Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for 2 or 3 counts and put your leg down.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing knee raise

Standing knee raises

Standing Hip Abduction

Be sure your hip, knee and foot are pointing straight forward. Keep your body straight. With your knee straight, lift your leg out to the side. Slowly lower your leg so your foot is back on the floor.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing hip abduction

Standing hip abduction

Standing Hip Extensions

Lift your operated leg backward slowly. Try to keep your back straight. Hold for 2 or 3 counts. Return your foot to the floor.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing hip extension

Standing hip extensions

Early Activity

Soon after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity aids your recovery and helps your hip regain its strength and movement.

Walking

Proper walking is the best way to help your hip recover. At first, you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg.

Illustration of woman using a walker after hip replacement

Early on, walking will help you regain movement in your hip.

Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Advance your walker or crutches a short distance; then reach forward with your operated leg with your knee straightened so the heel of your foot touches the floor first. As you move forward, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step, your toe will lift off the floor and your and knee and hip will bend so that you can reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor.

Walk as rhythmically and smoothly as you can. Don’t hurry. Adjust the length of your step and speed as necessary to walk with an even pattern. As your muscle strength and endurance improve, you may spend more time walking. You will gradually put more weight on your leg. You may use a cane in the hand opposite your surgery and, eventually, walk without an aid.When you can walk and stand for more than 10 minutes and your leg is strong enough so that you are not carrying any weight on your walker or crutches, you can begin using a single crutch or cane. Hold the aid in the hand opposite the side of your surgery.

Stair Climbing and Descending

The ability to go up and down stairs requires both strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good leg and down the stairs with your operated leg. Remember, “up with the good” and “down with the bad.” You may want to have someone help you until you have regained most of your strength and mobility.

Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than the standard height (7 inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Illustration of woman climbing and descending stairs using a crutch

Stair climbing and descending using a crutch

Advanced Exercises and Activities

The pain from your hip problems before your surgery and the pain and swelling after surgery have weakened your hip muscles. A full recovery will take many months. The following exercises and activities will help your hip muscles recover fully.

These exercises should be done in 10 repetitions, 4 times a day. Place one end of the tubing around the ankle of your operated leg and attach the opposite end of the tubing to a stationary object such as a locked door or heavy furniture. Hold on to a chair or bar for balance.

Elastic Tube Exercises

Resistive Hip Flexion

Stand with your feet slightly apart. Bring your operated leg forward keeping the knee straight. Allow your leg to return to its previous position.

Illustration of resistive hip flexion

 Resistive hip flexion

Resistive Hip Abduction

Stand sideways from the door to which the tubing is attached and extend your operated leg out to the side. Allow your leg to return to its previous position.

Illustration of resistive hip abduction

Resistive hip abduction

Resistive Hip Extensions

Face the door to which the tubing is attached and pull your leg straight back. Allow your leg to return to its previous position.

Illustration of resistive hip extensions

Resistive hip extensions

Exercycling

Exercycling is an excellent activity to help you regain muscle strength and hip mobility.

At first, adjust the seat height so that the bottom of your foot just touches the pedal with your knee almost straight. Pedal backwards at first. Ride forward only after a comfortable cycling motion is possible backwards.

As you become stronger (at about 4 to 6 weeks) slowly increase the tension on the exercycle. Exercycle for 10 to 15 minutes twice a day, gradually building up to 20 to 30 minutes, 3 or 4 times a week.

Walking

Walk with a cane until you have regained your balance skills. In the beginning, walk for 5 or 10 minutes, 3 or 4 times a day. As your strength and endurance improve, you can walk for 20 to 30 minutes, 2 or 3 times a day. Once you have fully recovered, regular walks of 20 to 30 minutes, 3 or 4 times a week, will help maintain your strength.

 


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

3 Trends That Are Disrupting the Total Knee Replacement Market in 2020

By Amanda Pedersen | Jan 16, 2020 MDDI (Source)

Big changes lie ahead for knee replacements in 2020 and beyond. MD+DI recently spoke with an expert at DePuy Synthes for insight into how three key trends are impacting the market.

In recent years MD+DI has reported on a number of ways emerging technologies such as artificial intelligence (AI) and machine learning (ML), surgical robotics, and 3D-printing are impacting a number of different sectors in medtech. In 2020, we expect these technologies to become even more relevant in the industry, particularly in orthopaedics.

MD+DI recently spoke with an expert at DePuy Synthes for insight into how key trends are impacting the total knee replacement (TKR) market, and how emerging technologies can be part of the solution. Rajit Kamal is vice president and global franchise leader of the knee business at Warsaw, IN-based DePuy Synthes.

Outpatient Is No Longer Just a Niche

“We are seeing a very persistent shift toward outpatient or ambulatory surgical care centers and we think that shift makes sense, Kamal said, pointing out several benefits of this trend, including faster recovery and a lower cost of care.

“We think anything that makes sense for the patients clinically and economically is the right thing to do,” he said.

While outpatient will never be right for every patient, Kamal said up to 70% of TKRs could eventually be handled in outpatient settings such as ambulatory surgical centers (ASCs).

“Outpatient is not a niche,” Kamal emphasized. “Outpatient is the site of care of the patient. So when we develop our portfolio, when we drive innovation, it is with outpatient in mind.”

What that means from an R&D perspective is that companies in the TKR space like Depuy Synthes need to keep in mind the fact that ASCs are smaller than in-patient hospital settings.

“We are making sure we are developing the portfolio that is enabling our customers to be able to operate in this site of care and that means developing products that are portable, smaller, and cost effective,” Kamal said.

Kamal sees opportunities to address these and other unmet TKR needs with emerging technology such as AI, ML, robotics, and 3D printing.

“We think technology has the potential to transform total knee replacement, and we are at the leading edge of that transformation,” Kamal said. “Technology has unlocked a lot of constraints that we had.”

Here are three examples of how technology can play a role in TKR trends:

1. Enhancing Patient Selection and Optimizing Pre-Operative Care

Today, one in five patients who undergo total knee replacement surgery are not fully satisfied but surgeons are perplexed by this problem. Sometimes a patient will come in for a follow-up appointment and everything looks perfect from the surgeon’s perspective, yet the patient is not happy with the outcome of their procedure. Other times, a surgeon may expect a particular patient to be unhappy with their TKR results but the patient will surprise them.

The solution, according to Kamal, is to drive personalization, automation, efficiency, and connectivity. All of these together can really transform total knee replacement, he noted.

“Today, if you go to five different surgeons and ask them which patient is the right patient for surgery you will get five different answers,” Kamal said.

For example, some surgeons will not operate on a patient whose body mass index (BMI) is 35 or higher, while other surgeons are willing to operate on patients whose BMI is 50 and those surgeons say their BMI 50 patients are their most satisfied TKR patients, Kamal explained.

Kamal says this is where AI and machine learning tools could go a long way toward enabling surgeons to not only make the right decision on patient selection, but also help them optimize their pre-operative care pathway.

“So if a patient is not the right patient today, the surgeon can work with them and get them in the best shape before they go through surgery,” he said.

2. Enhancing Efficiency with AI and Robotics

Today, if two different TKR patients go to the same surgeon they are likely to get a similar procedure based on that particular surgeon’s training and clinical experience. Surgeons tend to perform the same procedure on all of their patients because it makes them more efficient, Kamal said.

Once again, AI can help surgeons develop a very personalized surgical plan that analyzes each case based on dynamic motion of the knee and other variables, without costing the surgeon any efficiency.

Surgical robotics also comes into play here.

“We think the right robotic solution should be easy to use, it should be portable, and it should be cost effective,” Kamal said.

Technology also enables surgeons to better monitor their patients remotely.

“Five years ago a patient would be sent home after surgery and come back six weeks later and that’s the first time they saw the surgeon post-op. Or you would end up in the ER if you had a problem,” he said. “Sometimes six weeks might be too late. Technology has unlocked that constraint.”

3. Taking Implant Design to the Next Level with 3D Printing

The emergence of 3D printing in medical device manufacturing has benefited companies like Depuy Synthes not only in terms of cost but in terms of design.

“3D printing enables us to develop designs that we couldn’t do with traditional manufacturing,” he said. “So we are actively investing in all of these technologies because we truly believe that it has the potential to take a very successful procedure to the next level.”

Bringing It All Together

DePuy Synthes recently unveiled its Velys Digital Surgery platform, which will consist of connected technologies that leverage data insights for patients, surgeons, and healthcare systems across the continuum of care. Today, the new platform will focus on joint reconstruction including existing technologies like the Kincise System and the Joint point System, the company noted. Over time, DePuy Synthes plans to add new technologies like its orthopedic robotic solution, patient selection tools, advanced visualization, sensors, and mobile apps. Read more about the Velys Digital Surgery platform here.


At New Mexico Orthopaedics, we like to post articles we think our patients will find interesting. While these posts occasionally contain brand names or product manufactures, etc., we would like to note that we are not necessarily endorsing or recommending these products, brands or techniques.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Common Knee Injuries

What to do if you think your joint replacement is infected

Article Featured on AAOS

Knee and hip replacements are two of the most commonly performed elective operations. For the majority of patients, joint replacement surgery relieves pain and helps them to live fuller, more active lives.No surgical procedure is without risks, however. A small percentage of patients undergoing hip or knee replacement (roughly about 1 in 100) may develop an infection after the operation.Joint replacement infections may occur in the wound or deep around the artificial implants. An infection may develop during your hospital stay or after you go home. Joint replacement infections can even occur years after your surgery.

This article discusses why joint replacements may become infected, the signs and symptoms of infection, treatment for infections, and preventing infections.

Description

Any infection in your body can spread to your joint replacement.

Infections are caused by bacteria. Although bacteria are abundant in our gastrointestinal tract and on our skin, they are usually kept in check by our immune system. For example, if bacteria make it into our bloodstream, our immune system rapidly responds and kills the invading bacteria.

However, because joint replacements are made of metal and plastic, it is difficult for the immune system to attack bacteria that make it to these implants. If bacteria gain access to the implants, they may multiply and cause an infection.

Despite antibiotics and preventive treatments, patients with infected joint replacements often require surgery to cure the infection.

Total knee implants

Examples of total knee implants. Joint replacement implants are typically made of metal alloys and strong, durable plastic called polyethylene.

Cause

A total joint may become infected during the time of surgery, or anywhere from weeks to years after the surgery.

The most common ways bacteria enter the body include:

  • Through breaks or cuts in the skin
  • During major dental procedures (such as a tooth extraction or root canal)
  • Through wounds from other surgical procedures

Some people are at a higher risk for developing infections after a joint replacement procedure. Factors that increase the risk for infection include:

  • Immune deficiencies (such as HIV or lymphoma)
  • Diabetes mellitus
  • Peripheral vascular disease (poor circulation to the hands and feet)
  • Immunosuppressive treatments (such as chemotherapy or corticosteroids)
  • Obesity

Symptoms

Signs and symptoms of an infected joint replacement include:

  • Increased pain or stiffness in a previously well-functioning joint
  • Swelling
  • Warmth and redness around the wound
  • Wound drainage
  • Fevers, chills and night sweats
  • Fatigue

Doctor Examination

When total joint infection is suspected, early diagnosis and proper treatment increase the chances that the implants can be retained. Your doctor will discuss your medical history and conduct a detailed physical examination.

Tests

Imaging tests. X-rays and bone scans can help your doctor determine whether there is an infection in the implants.

Laboratory tests. Specific blood tests can help identify an infection. For example, in addition to routine blood tests like a complete blood count (CBC), your surgeon will likely order two blood tests that measure inflammation in your body. These are the C-reactive Protein (CRP) and the Erythrocyte Sedimentation Rate (ESR). Although neither test will confirm the presence of infection, if either or both of them are elevated, it raises the suspicion that an infection may be present. If the results of these tests are normal, it is unlikely that your joint is infected.

Additionally, your doctor will analyze fluid from your joint to help identify an infection. To do this, he or she uses a needle to draw fluid from your hip or knee. The fluid is examined under a microscope for the presence of bacteria and is sent to a laboratory. There, it is monitored to see if bacteria or fungus grow from the fluid.

The fluid is also analyzed for the presence of white blood cells. In normal hip or knee fluid, there are a low number of white blood cells. The presence of a large number of white blood cells (particularly cells called neutrophils) indicates that the joint may be infected. The fluid may also be tested for specific proteins that are known to be present in the setting of an infection.

Treatment

Nonsurgical Treatment

In some cases, just the skin and soft tissues around the joint are infected, and the infection has not spread deep into the artificial joint itself. This is called a “superficial infection.” If the infection is caught early, your doctor may prescribe intravenous (IV) or oral antibiotics.

This treatment has a good success rate for early superficial infections.

Surgical Treatment

Infections that go beyond the superficial tissues and gain deep access to the artificial joint almost always require surgical treatment.

Debridement. Deep infections that are caught early (within several days of their onset), and those that occur within weeks of the original surgery, may sometimes be cured with a surgical washout of the joint. During this procedure, called debridement, the surgeon removes all contaminated soft tissues. The implant is thoroughly cleaned, and plastic liners or spacers are replaced. After the procedure, intravenous (IV) antibiotics will be prescribed for approximately 6 weeks.

Staged surgery. In general, the longer the infection has been present, the harder it is to cure without removing the implant.

Late infections (those that occur months to years after the joint replacement surgery) and those infections that have been present for longer periods of time almost always require a staged surgery.

The first stage of this treatment includes:

  • Removal of the implant
  • Washout of the joint and soft tissues
  • Placement of an antibiotic spacer
  • Intravenous (IV) antibiotics

An antibiotic spacer is a device placed into the joint to maintain normal joint space and alignment. It also provides patient comfort and mobility while the infection is being treated.

Knee Implant Compressors

(Top) These x-rays show an original knee replacement from the front and from the side. (Bottom) An antibiotic spacer has been placed in the joint during the first stage of treatment for joint replacement infection.

Spacers are made with bone cement that is loaded with antibiotics. The antibiotics flow into the joint and surrounding tissues and, over time, help to eliminate the infection.

Patients who undergo staged surgery typically need at least 6 weeks of IV antibiotics, or possibly more, before a new joint replacement can be implanted. Orthopaedic surgeons work closely with other doctors who specialize in infectious disease. These infectious disease doctors help determine which antibiotic(s) you will be on, whether they will be intravenous (IV) or oral, and the duration of therapy. They will also obtain periodic blood work to evaluate the effectiveness of the antibiotic treatment.

Once your orthopaedic surgeon and the infectious disease doctor determine that the infection has been cured (this usually takes at least 6 weeks), you will be a candidate for a new total hip or knee implant (called a revision surgery). This second procedure is stage 2 of treatment for joint replacement infection.

During revision surgery, your surgeon will remove the antibiotic spacer, repeat the washout of the joint, and implant new total knee or hip components.

An antibiotic spacer in a hip joint.

This x-ray shows knee components used in a revision surgery (stage 2). Note that the stems of the implants are longer to help support bone that has been compromised due to infection and removal of the previous implants.

Single-stage surgery. In this procedure, the implants are removed, the joint is washed out (debrided), and new implants are placed all in one stage.  Single-stage surgery is not as popular as two-stage surgery, but is gaining wider acceptance as a method for treating infected total joints. Doctors continue to study the outcomes of single-stage surgery.

Prevention

At the time of original joint replacement surgery, there are several measures taken to minimize the risk of infection. Some of the steps have been proven to lower the risk of infection, and some are thought to help but have not been scientifically proven. The most important known measures to lower the risk of infection after total joint replacement include:

  • Antibiotics before and after surgery. Antibiotics are given within one hour of the start of surgery (usually once in the operating room) and continued at intervals for 24 hours following the procedure.
  • Short operating time and minimal operating room traffic. Efficiency in the operation by your surgeon helps to lower the risk of infection by limiting the time the joint is exposed. Limiting the number of operating room personnel entering and leaving the room is thought to the decrease risk of infection.
  • Use of strict sterile technique and sterilization instruments. Care is taken to ensure the operating site is sterile, the instruments have been autoclaved (sterilized) and not exposed to any contamination, and the implants are packaged to ensure their sterility.
  • Preoperative nasal screening for bacterial colonization. There is some evidence that testing for the presence of bacteria (particularly the Staphylococcus species) in the nasal passages several weeks prior to surgery may help prevent joint infection. In institutions where this is performed, those patients that are found to have Staphylococcus in their nasal passages are given an intranasal antibacterial ointment prior to surgery. The type of bacteria that is found in the nasal passages may help your doctors determine which antibiotic you are given at the time of your surgery.
  • Preoperative chlorhexidine wash. There is also evidence that home washing with a chlorhexidine solution (often in the form of soaked cloths) in the days leading up to surgery may help prevent infection. This may be particularly important if patients are known to have certain types of antibiotic-resistant bacteria on their skin or in their nasal passages (see above). Your surgeon will talk with you about this option.
  • Long-term prophylaxis. Surgeons sometimes prescribe antibiotics for patients who have had joint replacements before they undergo dental work. This is done to protect the implants from bacteria that might enter the bloodstream during the dental procedure and cause infection. The American Academy of Orthopaedic Surgeons has developed recommendations for when antibiotics should be given before dental work and for which patients would benefit.  In general, most people do not require antibiotics before dental procedures. There is little evidence that taking antibiotics before dental procedures is effective at preventing infection.

    Antibiotics may also be considered before major surgical procedures; however, most patients do not require this. Your orthopaedic surgeon will talk with you about the risks and benefits of prophylactic antibiotics in your specific situation.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.