Swelling of the leg after hip replacement
Restoration of the health of the patient who underwent surgery on the joints is necessary after the first hours after awakening from anesthesia. Rehabilitation after hip arthroplasty (TBS) is a complex of exercises, different for each period. It can also depend on the type of fixationprosthesis, the condition and age of the patient, the presence of concomitant diseases. Rehabilitation should be carried out not only in the hospital, but also after discharge, in a specialized medical center or at home.
Rehabilitation of TBS - in the first place it is physical exercise
Rehabilitation after hip arthroplasty
Rehabilitation after the replacement of TBS is divided into early andlate postoperative periods, in which different tasks and the degree of stress on the diseased limb. The recovery of each patient passes individually and is determined by many factors.
Recovery in the early postoperative period
- Prevent postoperative complications
- Master the exercises performed in the main lying
- Learn to sit down and get up
- Learn walking on crutches
Combating possible complications
The main worries, which occur at an early period after the replacement of the joint:
- Caring for the correct position of the sore leg
- Reduction of pain and swelling
- Wound dressing
- Maintaining a gentle diet
- Prevention of thrombosis
Requirements for the position of the legs and movements
- The first days are allowed to sleep only on the back
- In order for the patient's legs not to approach the unacceptable distance or to cross, a wedge-shaped cushion or roller is placed between the legs
After the operation, you must set the correct position of the legs with a wedge-shaped cushion</ li>
Reduction of pain and swelling
It is impossible to avoid pain after surgery. Anesthesia goes by - and inevitable pain attacks begin, accompanied by swellings as well. Endure this already exhausted patient is difficult, and come to the rescue:
- Anesthetic therapy
- Drainage of accumulating fluid in the joint:
- A drainage tube is inserted into the joint cavity, which opens onto the surface
- The tube is removed as soon as the exudate ceases to accumulate in the cavity
- Lining the affected area with ice
- If the pain is accompanied by an infectious process, antibiotics should be used
- The first dressing is usually performed on the second day after surgery
- The frequency of subsequent dressings is determined by the surgeon, with a frequency - at least one in two to three days
- Sutures are removed after 10 to 14 days:
- the removal of the thread can occur earlier with a satisfactory wound condition
- absorbable threads do not need to be removed
Meals and water intake
After the patient comes to, he may have a thirst and an appetite. This is a reaction to anesthesia. But a little drink and eat a little bit of crackers can only 6 hours after surgery.The usual meal is allowed the next day .
The first days you need to keep a diet, which includes:
- Meat broth, slightly salted, with mashed meat
- Oatmeal porridge, mashed potatoes
- Lactic Acid Products
- Fruit jelly, unsweetened tea
Then the usual diet or usual diet, corresponding to chronic diseases of the patient, is prescribed.
After the operation, blood coagulation is alwaysincreases - this is the natural reaction of the body, aimed at accelerating the healing of the wound. Therefore, during this period there is always a threat of thrombosis, and if the patient still has a history of venous insufficiency, the risk is doubled.
For the prevention of thrombosis, the following measures are used:
- Dressing of lower extremities with elastic bandage
- Admission of heparin, warfarin and other anticoagulants
- Special exercises for the limbs
Modes of loading on the operated side
- If the joint is replaced by a cement fixation method.
- initial loads on the operated leg should already be in the early rehabilitation period, in the first postoperative days
- full loads - in a later period
- With a cementless method of fixation.
- 10 - 15% of the full load - after 7-10 days
- Half of the load - after 21 days
- Full load - at the end of a two-month period
- Special clinical cases.
- Stroke, diseases of internal organs, cancer, deep old age, etc. - in all these cases, exercise should be started as soon as possible after surgery, and in full exercise.
- With acute pain:
- The limited-load regime is applied at any stage of rehabilitation
Artificial joint has an idealmobility, but in itself it will not move: you need to "tie" it to the muscles. And this is possible only through active rehabilitation, strengthening the muscles.
Passive exercises on mechanical simulatorsafter the replacement of TBS are usually carried out to prevent muscle contractures, but not to strengthen the muscles. They can not replace the exercise therapy that needs to be performed with the application of their own efforts and without which complete recovery is impossible
Goals of exercise therapy in the early postoperative period
After the replacement of the hip joint at the very beginning of rehabilitation, the following goals are set:
- Prevent blood stasis, accelerate wound healing and reduce puffiness
- To restore the supporting function of the diseased leg and the total amplitude of the movements
LFK is performed during the first two or three weeks, lying in bed. But getting up on your feet should be literally on the second day
The complex of elementary gymnastics is very simple, but there are certain requirements:
- Exercises are often performed throughout the day:
- intensity - up to five to six times per hour for several minutes (obtained on average per hour for therapeutic gymnastics takes 15 - 20 minutes)
- The nature and pace of the exercises is smooth and slow
- All exercises are combined with breathing, approximately according to this pattern:
- at a muscular effort we inhale
- with exhalation we exhale
The complex includes exercises for the gastrocnemius, femoral and gluteal muscles of both extremities.
On the first postoperative day:
- Sequential reciprocating motion of the feet:
The left foot goes to itself, the right one - from itself, then vice versa
Simultaneous movement by foot type foot pump</ li>
On the second day after the operation:
- Static exercises.
- Pressing the back of the knee for five to seven seconds to the bed, followed by relaxation - this way, training of the femoral muscles takes place
- A similar snuggling heels - train calf muscle and hamstring
- Slipping sick leg to the side and back, without breaking off the surface of the bed
- Slip with bending of the foot.
- We slip the patient with his foot on the sheet, bending the leg in the joints no more than 90 °
- We return the foot in the same way to its original position (First you can make it easier with an elastic band or a regular towel)
- Straightening with lifting
- This exercise is performed using a roller height of no more than 10 - 12 cm, placed under the knee
- Slowly straining the femoral muscle, straighten the leg and hold it in this position for five six seconds. Then, just as slowly lower it </ ol>
Straightening of a straight leg with a lift with a roller
These exercises need to alternate with each other:
In one hour we do one thing, in the second we do another, and so on.
It is necessary to sit down carefully on the second day. How it's done?
To sit down it is necessary, adhering for a hand-rail, towards a healthy leg
- You need to lean on your elbows or hold on to the frame above the bed
- Sitting should be in the direction of a healthy leg, lowering it to the floor at first, and then pulling to it (it is possible and with the help of elastic bandage) operated limb
- Roller between legs must be sure
- Legs must first be bandaged with elastic bandages
- When planting, observe the straight position of the trunk and do not turn the foot outwards
From the second day mechanotherapy of the hip joint also begins.
The period of circulation after the replacement of TBS
It can also be called "walking on the agony": too little time has passed since the operation, the wound still hurts, and the doctor, despite the pain, already orders to stand on the crutches literally the next day. And this is not a surgeon's whim:
The earlier you start walking, the less likely the development of contractures and more chances to restore the full range of movements
All the difficulties of walking on crutches are described in detail in our article. Rehabilitation after knee arthroplasty. so we will only focus on the load and walking on crutches on the stairs
Load on a sick leg
- During the first postoperative week, you only need to touch the floor with your foot
- Then we go to the 20% load on the aching leg: this is equivalent to transferring to it your own weight without the weight of the whole body, that is, standing on your foot without leaning on it
Increase the load with bringing it to half should be carried out for each patient individually:
If the pain and swelling in the leg is not gone, then the increase in the load is premature.
What they say lasting pain and swelling
Not passing long pains and not dropping puffiness can be signs of postoperative complications, dislocation of a prosthesis, abusing walking or improperly performed medical gymnastics
In any case, the reasons must be understood by the surgeon.
Walking on crutches on the stairs
The method of walking on crutches on the stairs is determined by the direction of movement - up or down
The method of walking is determined by the direction of movement - up or down:
- When climbing up the stairs, the movement starts from the unoperated limb:
- We rely on crutches and transfer to the step a healthy leg
- Pushing crutches and transferring the weight of the body to it
- We tighten the operated leg, while moving the crutches to the top step, or we carry the crutches after the painful leg
- When descending from the stairs, all movements occur in the reverse order:
- First, crutches are transferred to the lower step
- Leaning on crutches, we put down without a stop the sick leg
- We transfer the healthy leg to the same level and rely on it
Walking on crutches on the stairs can begin after you have mastered the exercises for a sick leg in a standing position
Exercise therapy on the tenth day after surgery
Exercises in a standing position
- When performing them, you must hold on to the handrails, the back of the bed or chair
Retracting the operated leg forward, sideways, backward by 20 - 30 cm
- Each exercise should be repeated up to 15 times up to 10 times a day
- Examples of exercises:
- Retracting the operated leg forward, sideways, backward by 20 - 30 cm
- Raising the leg with a bent knee to a small height
Exercises in a horizontal position
- Repetition of all isometric exercises with pressing the muscles of the leg, knee extensors and gluteus muscles alternately to the floor:
- Static tension is achieved by straining the abdominal muscles and stretching the toe socks towards themselves
- Isometric relaxation follows at the moment of relaxation
- Flexion and retraction of the diseased leg to the side by sliding
- Raising of a sick leg to an angle of no more than 90 ° with keeping it on weight and slowly lowering
Raising an operated leg at an angle
- Leaving the sick leg to the side with the position on the side:
between the legs you need to place a pillow
- Flexion-extension of the legs in the supine position
Flexion-extension of the legs in the supine position
The whole complex of exercise therapy should be continued at home.
Late rehabilitation of the hip joint
And now, two months have passed since the operation,However, TBS is still rather constrained, and you step on the operated leg uncertainly. It means - full restoration has not occurred and it is necessary to continue rehabilitation:
- At home, perform previous exercises plus gymnastics with the support of a sick leg
- To work on simulators
Exercise bike for the hip joint
The exercise bike is an effective method of strengthening absolutely all muscles connected to the joint.
On the stationary bike you need to set a light mode and corresponding to a small angle of joint bending the height of the seat
However, you do not need to overdo it:
- Use the simulator in low speed mode
- Adjust the height of the seat so that the hip joint bends no more than 90 °, and when the knee is straightened, the foot hardly touches the pedals of the exercise bike
Video: Rehabilitation of TBS after joint replacement