Rehabilitation is started as soon as possible after hip fracture repair or replacement surgery. The first goals may be to increase strength and to prevent atrophy on the unaffected side. Initially, only isometric exercise of the affected limb while it is fully extended is permitted. Placement of a pillow under the knee is contraindicated because it may lead to flexion contracture of the hip and knee.
Gradual mobilization of the affected limb usually results in full ambulation. Speed of rehabilitation depends partly on the type of surgery done. For example, after prosthetic hip replacement, rehabilitation usually progresses more rapidly, less rehabilitation is needed, and the functional outcome is better than that after nail-and-plate or pin-and-plate fixation. Postprocedure weight-bearing status is determined by the surgeon, type of surgical procedure, pain, age, and health status. Many patients require inpatient rehabilitation. Precautions, recovery rate, and complications may vary depending on whether the replacement is done via the more traditional posterior approach or the newer direct anterior hip replacement approach. After hip replacement surgery, typically rehabilitation proceeds as follows:
Days 1 to 2: Bed rest or encouraged mobility with partial weight bearing as tolerated
Days 3 to 5: Partial weight bearing
Days 6 to 8: Progression to full weight bearing with assistive devices
After 4 to 8 days: Ambulation exercises (assuming that patients can bear their full weight and can balance)
After about day 11: Stair-climbing exercises
Patients are taught to do daily exercises to strengthen the trunk muscles and quadriceps of the affected leg. Prolonged lifting or pushing of heavy items, stooping, reaching, or jumping can be harmful. During ambulation, the amount of mechanical stress is about the same whether patients use 1 or 2 canes, but using 2 may interfere with certain activities of daily living (ADLs). Patients should not sit on a chair, particularly a low one, for a long period and should use the chair arm for support when standing up. While sitting, they should keep their legs uncrossed.
Occupational therapists teach patients how to modify ways of doing basic ADLs (BADLs) and instrumental ADLs (IADLs) safely after hip replacement, thus promoting healing and improving mobility. For example, patients may learn the following:
To keep their hip correctly aligned
To wash dishes and iron while sitting on a high stool
To use a pillow to raise the seat of the car while transferring in and out
To use long-handled devices (eg, reachers, shoe horns) to minimize bending over
This instruction may occur in the hospital, in longer-term rehabilitation settings, in the patient’s home immediately after discharge, or in outpatient settings.
(See also Overview of Rehabilitation.)
