Walking After Hip Surgery: Tips for Recovery and Strength Training

Walking issues after hip joint surgery?

Hello Dr.
Shi: I have asked you two questions before, and I appreciate your responses.

1.
It has been three months since my hip joint (femoral neck closed fracture) surgery.
During my follow-up appointment at the end of March, the doctor said my recovery is going well and that I can practice walking with crutches.
How should I arrange my walking schedule and intensity? I feel soreness if I walk for a bit longer.
2.
How long does it typically take to progress from using double crutches to a single crutch and then to no crutches? I have tried using a single crutch directly, but it feels a bit challenging, and I tend to limp.
3.
Is there a significant risk of avascular necrosis in the future? I am quite worried about this.

P.S.
I do not smoke or drink! Thank you for your response.

A-Rong, 30~39 year old female. Ask Date: 2019/04/05

Dr. Shi Guozheng reply Orthopedics

1.
The healing time after a femoral neck fracture surgery is approximately 3 to 6 months.
If the X-ray shows signs of healing, you can begin practicing walking.
Initially, you can use two crutches and gradually transition to one.
If the condition improves further, you can keep the crutch on the side without surgery and eventually discontinue the use of crutches altogether.
2.
The risk of avascular necrosis depends on whether the fracture was displaced.
If there was displacement, the risk is higher; if not, the risk is lower.
Physicians typically estimate the risk to be around 50%, meaning both outcomes are possible, and continuous monitoring is necessary.

Reply Date: 2019/04/05

More Info

Recovering from hip surgery, particularly after a femoral neck fracture, involves a structured approach to rehabilitation and strength training. Here are some tips and insights to help you navigate this recovery process effectively.

1. Walking and Strength Training Schedule
After three months post-surgery, it's encouraging to hear that your recovery is progressing well. When it comes to walking, it’s essential to gradually increase both the duration and intensity of your walks. Start with short distances, perhaps 5-10 minutes, using two crutches for support. As you gain confidence and strength, you can transition to one crutch, and eventually to walking unaided.

Tips for Walking:
- Frequency: Aim for multiple short sessions throughout the day rather than one long session. This helps prevent fatigue and soreness.

- Duration: Begin with 5-10 minutes and increase by 1-2 minutes each week as tolerated.

- Intensity: Focus on maintaining a steady pace. If you feel pain or excessive fatigue, it’s a sign to slow down or take a break.

2. Transitioning from Crutches to Walking Independently
The transition from using two crutches to one and then to walking without assistance can vary significantly among individuals. Generally, this process can take anywhere from a few weeks to several months, depending on your strength and confidence levels.
Guidelines for Transitioning:
- Two Crutches to One: Once you can walk comfortably with two crutches for about 10-15 minutes, try switching to one crutch. Use the crutch on the opposite side of your surgery to provide balance.

- Walking Independently: When you can walk with one crutch without pain and feel stable, practice walking without any support. It’s normal to feel a bit unsteady at first, so take your time.

3. Concerns About Avascular Necrosis (Bone Death)
Your concern about the risk of avascular necrosis (AVN) is valid, especially after a femoral neck fracture. The risk of AVN can depend on several factors, including the nature of the fracture and the quality of blood supply to the femoral head.
Monitoring for AVN:
- Follow-Up Care: Regular follow-ups with your orthopedic surgeon are crucial. They may recommend periodic X-rays or MRIs to monitor the health of your hip joint.

- Signs to Watch For: Be alert for symptoms such as increased pain, swelling, or a decrease in range of motion, which could indicate complications.

4. Strengthening Exercises
Incorporating strength training into your rehabilitation is essential for regaining function and stability. Here are some exercises you can consider, but always consult with your physical therapist before starting any new exercise regimen:
- Quadriceps Sets: Sit with your leg straight and tighten the thigh muscle, holding for 5 seconds, then relax. Repeat 10-15 times.

- Straight Leg Raises: Lying on your back, keep one leg bent and raise the other leg straight up to the height of the bent knee. Hold for a few seconds and lower it back down. Repeat 10-15 times.

- Heel Slides: While lying on your back, slide your heel towards your buttocks and then back out. This helps improve range of motion.

- Standing Hip Abduction: Stand and lift your leg to the side, keeping your knee straight. This strengthens the hip muscles.

5. Additional Considerations
- Pain Management: It’s normal to experience some discomfort as you increase activity. Use ice and elevation to manage swelling and pain.

- Nutrition: A balanced diet rich in calcium and vitamin D can support bone health and recovery.

- Patience and Consistency: Recovery takes time, and it’s essential to be patient with yourself. Consistency in your rehabilitation exercises will yield the best results.

In summary, focus on gradual progression in your walking and strength training, maintain regular communication with your healthcare providers, and stay vigilant for any signs of complications. With dedication and the right support, you can achieve a successful recovery and regain your mobility.

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