Rehabilitation for a Hip Fracture and Hip Replacement

Occupational and physical therapy play important roles in rehabilitating someone who has had a hip repair, whether an ORIF or a hip replacement. Therapy is often provided in a rehabilitation unit of a hospital or extended care facility and, when appropriate, within the home. It may then progress to an outpatient status when the patient is no longer homebound.

Occupational therapy

Occupational therapy’s (OT) role in a THR is to get the person back to self-care and household activity following THR precautions.

Dressing. Putting on socks is completed by placing your sock on a chute-like device, inserting your foot, and pulling the sock up with attached ropes. A dressing stick with an upward-facing hook and downward-facing hook is used to remove socks and assist with removing and putting on pants. When used with a long-handled shoe horn, elastic laces convert shoes into slip ons.

Bed mobility and transfers. Bed mobility requires a leg lifter to lift and move the operated leg into and out of the bed. Sit with the operated leg towards the head of the bed (may have to change the side of the bed). Recline back while bringing the non-operated leg into the bed, followed by slowly bringing the operated leg into the bed using the leg lifter. Get out on the same side of the bed using the same procedure. Be sure to remain reclined. Put a pillow between your legs before rolling to the side with the operated leg on top. Stand up by extending the surgical leg first, reclining, and pushing up to a standing position.

Bathing, toileting, and other activities. You should use a raised toilet seat or commode. Transfer into the shower with the non-operated leg and out with the operated leg first. Use a shower bench to get into and out of the tub with assistance at first. Use a long-handled sponge to wash your lower legs and feet. A grabber or reacher is used to obtain items out of reach. This could be clothing, a tv remote, or a container. Sitting on a stool allows you to do simple kitchen activities and other everyday chores.

Physical therapy

Preoperative exercises. Physical therapy can guide exercises before surgery and during the rehabilitation phase after the hip repair or replacement. Some pre-rehabilitation exercises for a total hip replacement include bridges, squats, thigh squeezes, heel slides, and ankle pumps.

Postoperative exercises. Early after surgery, the PT will then provide post-operative exercises following THR protocol. These exercises increase hip motion and strength and improve the circulation necessary to avoid blood clots. Most exercises are performed on the bed. They include ankle pumps, rotations, bed-supported knee bends, buttock contractions, abduction (sliding leg out to the side), quadricep set (tighten your thigh muscle and try to straighten your knee), and straight leg raises. Knee raises, hip abduction, and standing hip extension are performed in standing.

Walking. The PT will guide you on the proper walking device (two canes, 2 crutches, or a walker). Walking early on is important as it begins to strengthen your operated leg.

When walking, ensure your weight is evenly balanced on your crutches or walker and you are standing upright. Advance your walking device a short distance, then reach forward with your surgical leg. Your knee should be straight, so your heel touches the floor. As you advance, your knee and ankle will bend, and your entire foot will rest fully on the floor. As you finish the step, your toe will lift off the floor, and your hip and knee will bend so you can reach forward with your next step.

Don’t hurry; walk rhythmically and smoothly as possible. When you can walk for more than 10 minutes, and your leg is now strong enough to not put so much weight on your crutches or walker, you can advance to a cane or single crutch.

Stair climbing. When using a single cane, it should be held in hand opposite the operated leg. For stair climbing, use a cane and a handrail or two canes.

To go up the steps, place the non-surgical leg up on the first step and use the handrail to help step up. Bring the surgical leg up to the same step.

To go down the step, bring the cane and your surgical leg to the next step, and then step down to the same step with the non-surgical leg. A good reminder is the saying, “Good go to heaven, bad go to hell.”

Getting in and out of a car. The PT will also teach proper car transfers. The car should be parked a couple of feet from the curb with the car seat as far back as it will go and the passenger door fully open. You should proceed toward the car and turn your back, facing away from the car and back up until you feel the seat against your legs. Place one hand on the car seat and the other on the passenger overhead handle or the dashboard. Avoid using the car door for support. Lower yourself onto the passenger car seat with your surgical leg slightly advanced.