The physiotherapist uses the following techniques and modalities for regaining the functionality of the hip joint.
Cryotherapy in combination with PROM exercises, elevation, and massage is used to decrease edema, developed due to inactivity or loss of voluntary movements.
Thermotherapy can be used in combination with ROM exercises (twice daily) with sustained stretching technique (20 – 30minutes).
Neuromuscular stimulations facilitate voluntary motor control and muscle strength.
Cold laser is an effective treatment used for reducing pain thus increase joint range of motion.
Ultrasound decreases pain, increases range of motion, and decreases inflammation.
Cemented total hip: Weight-bearing with walker immediately after surgery.
Touchdown weight-bearing with a walker after surgery.
· Instruct in taking precautions for hip dislocation.
· Transfer instructions for In and out of the bed.
· Depth of the chairs: avoid deep chairs, avoid crossing legs while rising from the chair scoot to the edge of the chair then rise.
· Use elevated commode seat to aid in rising.
· Ambulation: instruct on the use of an assistive device (walker).
0-4 WEEKS – POSTOPERATIVE REGIMEN.
· Out of the bed in a stroke chair twice a day with assistance 1 or 2 days postoperative. DO NOT use a low chair.
· Begin ambulation and assistive device twice a day (walker)) 1 or 2 days with the assistance of the physiotherapist.
· Weight-bearing status for the cemented prosthesis. Weight-bearing as tolerated with a walker for at least 6 wk, then use a cane in the contralateral hand for 4- 6 months.
· Cementless technique: Touchdown weight-bearing with a walker for 6-8 wks, then use the cane in the contralateral hand for 4-6 months.
· A wheelchair may be used for long distances with careful avoidance of excessive hip flexion of more than 80 degrees while in the wheelchair therapist must check to ensure that the footrests are long enough. Place the triangular cushion in the wheelchair seat with the highest cushion point posterior, to avoid excessive hip flexion.
· Quadriceps sets
· Gluteus sets
· Ankle pumps
· Isometric hip abduction with self-assistance while lying.
· Return foot to starting position.
· Hip abduction–adduction
· ROM and stretching exercises
4- 6 WEEKS
· Increase weight-bearing utilization. Maintain general precautions.
· Prone hip abduction.
· Mini squats.
· SLR (flexion & abduction).
· Hip rotation (No IR, ER to 30 degrees).
· Calf raises.
· Standing hip abduction.
· Standing hip extension.
· Hip abduction progress exercises from isometric abduction against self-assistance to therabands wrapped around the knees.
· Hip extension
· Hip flexion to 90 degrees.
· Knee flexion & extension.
· Theraband exercises, sports cords, and step-ups.
· Initiate general strengthening exercises develop endurance, perform cardiovascular exercise, and general strengthening of all extremities.
· Golf when off crutches and steady, approximately 3-4 months.
· Driving approx. 3 months.