PART TWO (REHAB CONSIDERATIONS):
Rehab following hip surgery should include maintaining the positional “hip precautions” during all activities, as well as several other considerations. Most patients are placed on a weight-bearing as tolerated (WBAT) status following surgery. Although the status is WBAT, you should try to decrease weight-bearing during transfers and avoid bridging on involved extremity to provide protective load bearing during the first 6 weeks to allow for tissue healing. A straight leg raise, while a good hip flexion strengthening exercise, should be avoided initially (6 – 8 weeks) due to it causing increased friction between the bone and the implant and compromises the healing process.
Another issue that might arise following a hip arthroplasty is a leg length discrepancy. This is sometimes unavoidable or intentional by the surgeon. Their first priority is for joint stability which might cause a limb length difference. The patient might end up with the leg length discrepancy and require a heel lift following surgery. However, make sure you have addressed soft tissue flexibility with stretching prior to the use of a lift.
Once patients are more mobile and are up and about in their wheelchairs, they have a tendency to be in the wheelchair for prolonged periods of time and performing a lot of exercises seated. Therapists need to remember to emphasize hip abductor and extensor strengthening to insure hip/pelvic stability in standing and walking. Hip abductor and extensor strengthening should be performed throughout the rehabilitation, beginning with supine and progressing to standing activities.
These are suggested considerations for the post-operative care of the patient status-post hip fracture surgery; however, you should always adhere to the specific physicians’ orders as they have seen the integrity of the joint and know the extent of the tissue damage and its subsequent repair.
*Information gathered from conference presented by Dr. Corrie Mancinelli, PT, PhD – “Update on Hip, Knee and Shoulder Arthroplasty: Current State of Evidence”. May 2009