Post-Total Hip Replacement Rehabilitation: Key Questions Answered

Rehabilitation after Total Hip Arthroplasty

I underwent surgery on May 7, 2016, for a right thigh "right pelvic fracture with associated right hip dislocation." However, after nearly two years, I developed post-traumatic arthritis, leading to a total hip arthroplasty on March 27, 2018.
I have some questions as follows:
1.
My attending physician did not specifically mention arranging rehabilitation.
Does this mean I do not need rehabilitation, or should I continue to follow the treatment plan set by a physical therapist? I understand that certain movements are prohibited within the first three months; will the therapist be aware of this? What specific movements are allowed after the replacement? Is it sufficient to just walk every day, and is it okay to walk for extended periods?
2.
My attending physician mentioned that I can drive and ride a motorcycle, but he advised against riding a motorcycle due to the risk of falling.
Regarding driving, car seats are typically higher in the front and lower in the back.
Will this position cause my knee to be slightly higher than my hip joint, and is that acceptable?
3.
Will I be able to sit cross-legged in the future?
4.
I have a ceramic hip prosthesis; can I continue to ride a bicycle for exercise? What other activities can I safely engage in after having a hip replacement? Thank you.

Justin, 30~39 year old female. Ask Date: 2018/04/23

Dr. Li Weiqiang reply Rehabilitation

Hello, on May 7, 2016, I underwent surgery for a "right pelvic fracture with associated right hip dislocation." However, after nearly two years, I developed post-traumatic arthritis and faced a total hip arthroplasty on March 27, 2018.
I have some questions as follows:
Q1: My attending physician did not specifically mention arranging rehabilitation for me.
Does this mean I do not need rehabilitation, or should I continue to follow the treatment plan arranged by the rehabilitation therapist? I understand that certain movements are prohibited within the first three months; will the therapist be aware of this? What movements can I perform after the surgery? Is it sufficient to just walk every day, and is it okay to walk for longer periods?
A1: After surgery, you should avoid vigorous exercise, but under the guidance of a professional, you can engage in appropriate rehabilitation (joint mobility and strength training), which will positively impact your recovery.
You may refer to the educational video from China Medical University: https://www.youtube.com/watch?v=mct5ODxRSrQ.
You can gradually increase your walking time until you return to your pre-surgery condition.
Q2: My attending physician said I can drive and ride a motorcycle, but he advised against riding a motorcycle due to the risk of falling.
Regarding driving, since car seats are typically higher in the front and lower in the back, will my knee be slightly higher than my hip joint while driving? Is this slight difference acceptable?
A2: You can place a cushion on your seat to elevate your hips, ensuring that your hip joint does not flex beyond 90 degrees.
Q3: Will I be able to sit cross-legged in the future?
A3: No.
Q4: My artificial hip joint is ceramic.
Can I continue to ride a bicycle for exercise? What other activities can I do with an artificial hip joint?
A4: You should avoid any activities that involve hip flexion greater than 90 degrees.
Wishing you safety and health,
Dr.
Li Wei-Chiang,
Attending Physician, Department of Rehabilitation, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/04/23

More Info

Post-total hip replacement (THR) rehabilitation is a crucial aspect of recovery, and it is understandable that you have several questions regarding your rehabilitation process. Here’s a comprehensive response to your queries based on the information provided and general medical knowledge.

1. Rehabilitation Necessity: It is highly recommended to continue with physical therapy after a total hip replacement, even if your surgeon did not explicitly mention it. Rehabilitation is essential for regaining strength, flexibility, and mobility in the hip joint. A physical therapist can provide a tailored exercise program that considers your specific condition and recovery progress. While it is true that certain movements may be restricted during the first few months post-surgery, a qualified therapist will be aware of these limitations and will guide you accordingly. Walking is beneficial, but it should be complemented with specific exercises to strengthen the muscles around the hip and improve overall function.

2. Driving Concerns: Regarding driving, it is generally safe to resume driving about six weeks post-surgery, provided you feel comfortable and can operate the vehicle without pain or difficulty. The concern about the height of the car seat is valid; however, a slight elevation of the knee above the hip joint is usually acceptable. You should ensure that you can comfortably reach the pedals and have full control of the vehicle. If you experience any discomfort while driving, it may be wise to consult your physician or physical therapist for further advice.

3. Sitting Cross-Legged: After a total hip replacement, sitting cross-legged is often discouraged, especially in the early stages of recovery. This position can place undue stress on the hip joint and increase the risk of dislocation. It is advisable to follow your surgeon's or therapist's recommendations regarding sitting positions. Typically, you may be able to sit cross-legged after a few months, but this varies based on individual recovery.

4. Cycling and Other Activities: Cycling is generally considered a low-impact exercise that can be beneficial after hip replacement surgery. It helps improve cardiovascular fitness and strengthens the muscles around the hip without putting excessive strain on the joint. However, you should start with a stationary bike before transitioning to a regular bicycle to ensure you can maintain balance and control. Other low-impact activities such as swimming, walking, and specific strength training exercises are also encouraged. High-impact activities, such as running or jumping, should be avoided, as they can lead to complications or joint wear.

In summary, it is crucial to engage in a structured rehabilitation program post-total hip replacement to ensure optimal recovery. Regular communication with your healthcare providers, including your surgeon and physical therapist, is essential to address any concerns and adjust your rehabilitation plan as needed. Always listen to your body and avoid any activities that cause pain or discomfort. With proper care and rehabilitation, many patients can return to a fulfilling and active lifestyle after hip replacement surgery.

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