Rehabilitation

Walkers, Crutches, Canes

These devices provide support through your arms to limit the amount of weight
on your operated hip. Initially, after a total hip replacement you will use a
walker to get around. When you are ready, the physical therapist will advance
you to crutches. Eventually you can advance to a cane when your surgeon
clears you to put more weight on your leg. The amount of weight bearing on
your leg ordered by your surgeon can be:

• Touch down weight bearing: Almost no body weight should be placed on

Rehabilitation the operated leg, just touch the foot to the floor
• Partial weight bearing: 20% - 50% of your weight can be placed on the
operated leg
• Weight bearing as tolerated: As much weight as you want to put on your
operated leg.

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 1 2 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Rehabilitation Rehabilitation
Getting into Bed Getting out of Bed
• Sit on the edge of the bed with both feet on ground • Slide your legs toward the edge of the bed; keep your operated leg straight
• Scoot your hips backwards as you keep your weight on your hands • Push yourself up to your forearms and onto your hands
• Lower yourself onto your forearms • Slide your legs so that your heels are over the edge of the bed
• Slide your legs onto the bed; keep your operated leg straight • Scoot your hips forward until both feet are on the ground
• Once in bed, keep your toes pointed up

Right Hip
Replacement

Right Hip
Replacement

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 3 4 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Rehabilitation Rehabilitation

Sitting in a Chair: Rising from a Chair:

To sit down in a chair: To rise up from the chair:
• Stand in front of the chair. Turn around and back-up until the back of • Place the foot of your operated leg far in front of you
your legs touch the chair • Bring your hips forward to the edge of the seat
• Place your operated leg far out in front of you • Again, place the operated leg far in front of you
• Place your crutches in the hand opposite of your operated side, and place • Push up with both hands on the arms of the chair and rise on your good leg
your free arm on the arm of the chair • Do not try to use your operated leg in standing up
• Gently ease down into the chair • Place the crutches in the hand on the good side and finish standing
• Once you are seated, you may bring your operated leg back so your foot is • Once standing, place one crutch under each arm
under your knee
Do not try to get up with your hips at the back of the chair. Always first bring
When sitting, always keep your knees lower than your hips. In the early stages, your hips to the front of the seat before getting up.
avoid sitting for long periods of time. Get up every 20-30 minutes to stretch
up and down on your toes or take a walk before sitting again.

Right Hip
Right Hip Replacement
Replacement

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 5 6 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Rehabilitation Rehabilitation
Beginning to Walk after Surgery Beginning to Walk after Surgery (continued)
At first, you will use a walker as you begin to walk. Once you are steady on your As you gain strength and endurance, you will advance to a two-point gait
feet, you will progress to crutches. pattern. This means you will move the crutches and operated leg at the same
time, and then move your good leg beyond the crutches.

In this gait pattern, you should distribute one third of the weight to each hand
Using a walker: and one third on the operated leg. Early on it may be more comfortable to take
• Place the walker one step ahead of you more weight on the hands, particularly the hand opposite the operated side.
• Lean into it and pick up the operated
leg, bend the knee and step forward, It is important to remember that while standing, the crutches should always be
planting the heel down first kept in front of you and slightly out to the side. If the crutches are even with
• Bring your good leg up to the front of your body when you are standing still, they will not keep you from falling.
the operated leg Also, do not carry your weight on the armpits when using crutches. This can
• Repeat the process be painful and can cause permanent nerve damage. The weight should be taken
on your hands and good leg.

Right Hip
Replacement

Using crutches:
• Place the crutches one step ahead of
you
• Place weight on your good leg and
bring the operated leg up between the
crutches
• Bring your good leg up beyond the
crutches

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 7 8 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Rehabilitation Rehabilitation

Stair Climbing Bathing

You will begin to walk stairs with a physical therapist before you are discharged Use a stall shower if you have one. It is okay to use a tub shower, but follow the
from MGH. directions given. Use a stable shower chair in both a stall shower and tub shower.
Never sit in the bottom of the tub. Have someone help you the first time you
In the following photos, the model has a right hip replacement.
shower at home. Place a non-skid mat outside the shower for your safety.

Going Upstairs: Getting in a stall shower with a chair:

• Put one hand on the banister and carry • Walk to the shower with your walker and back up to the shower stall
the crutch under the other arm • Reach back with one hand for the chair while leaving the other hand on
• Put your weight through your arms walker
and step up with your good leg • Sit down on the chair and lift your legs over threshold of the shower
• Then step up with your operated leg • Turn to sit facing the faucet
• Then the crutch

Right Hip
Right Hip
Replacement
Replacement

Coming Downstairs:
• Place the crutch under one arm and
the opposite hand on the banister
• Start down the stairs with the
crutches first
• Then your operated leg
• Then your good leg

If you are strong enough to stand in the stall shower:

A way to remember this is:
Up with the good leg and • Walk up to the shower with your walker or crutches
• Step over the threshold with good leg followed by the operated leg
down with the operated leg.

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 9 10 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Rehabilitation Rehabilitation

Bathing Continued Bathing Continued

Getting into a tub shower with a chair: Getting out of a tub shower with a chair:
• Walk to the tub with your walker and back up to the tub until you can • Place a robe or towel securely around your body after drying off
feel the tub at the back of your legs. • Turn on the seat and lift your legs out of tub keeping your operated leg
• Reach back with one hand for the chair; leave the other hand on the walker out straight
• Sit down on the chair with your operated leg out straight • Push off the back of the chair and keep one hand on the walker
• Lift your legs into the tub, helping your operated leg with your hands • Stand up straight
• Keep your operated leg out straight

Right Hip
Replacement
Right Hip
Replacement

Getting into a tub shower without a chair: Assistive Devices for Bathing:
• Walk to the tub with your walker or crutches A shower chair (pictured above) or a
• Facing sideways, have your good leg against the tub tub bench (pictured to the right) can
• Bend your good leg at the knee and side step over the tub make showering easier following your
• Repeat with your operated leg, bending your knee to clear the tub joint replacement surgery. See page
48 for more information on assistive
devices after joint replacement surgery.

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 11 12 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Rehabilitation Rehabilitation

Getting in and out of Cars Sexual Activity After THR

Front seat: You may start having sex again about four to six weeks after you are discharged
• Open the front door and back up to the seat from the hospital. Your incision and the muscles around your hip need this
• Put one hand on the dashboard and other on back of the front seat time to heal. The exact time will depend on when you feel comfortable.
• Sit down and slide back as far as possible in a semi-reclining position
• Bring legs into the car, helping the operated leg with your hands Follow the hip precautions during sex, which can be found on page 46.
• Swing your operated leg into the car without bending your knee above
your hip At first, usually it is more comfortable for both male or female patients to be
• Reverse the procedure to get out of the car on the bottom when having sex. This position helps to keep stress off your hip
replacement. After three months, as your hip heals, you can have sex in any
comfortable position.

Right Hip
Replacement

Back seat:
• Enter the car from the side that allows your operated leg to be supported
by the seat of the car
• Slide back into the seat as explained above
• Reverse the procedure to get out of the car
If you had a left total hip replacement, you would enter from the driver’s side. If
you had a right total hip replacement, you would enter from the passenger side.

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 13 14 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
 Physical Therapy & Exercises
Following your surgery, you will have many weeks of physical therapy (PT) to
help ease your operated hip back into activity. PT is an integral part of your
recovery and is very important in determining the outcome of your surgery.

We have a list of commonly used exercises, but your surgeon and physical
therapist will prescribe a specific set of exercises that is best for your unique case.

These exercises are important to your overall recovery – preventing blood

clots, improving circulation, improving flexibility and hip movement and

Physical Therapy &

strengthening muscles. While they may feel uncomfortable at first, they will
become easier with time and help you return to normal activity.

Exercises …… Quad Sets

…… Glue Sets
…… Ankle Pumps
…… Hip & Knee Flexion (Heel Slide)
…… Hip Abduction
…… Knee Extension (Long Arc Quad)
…… Short Arc Quad
…… Standing Hip Flexion
…… Squats

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Physical Therapy & Exercises Physical Therapy & Exercises
Quad Sets: Glut Sets:
Quad sets are an important part of your PT regimen because they increase Glut sets will increase circulation and strengthen the muscles of your buttocks,
strength in your quadriceps muscle without straining your joint replacement. which you use when walking and moving. This is an exercise that engages your
Like glut sets, this is an exercise that uses your muscles without moving your muscles without moving your hip or knee.
hip or knee.

• Lie on your back with your legs extended in bed • Lie on your back with your legs extended
• Tighten the quad muscle on the front of your leg • Squeeze your buttocks together
• Push the back of your knee into the bed • Hold for 5 seconds
• Hold for 5 seconds • Perform one set of 10 repetitions 3 times a day
• Perform one set of 10 repetitions 3 times a day

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 17 18 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Physical Therapy & Exercises Physical Therapy & Exercises
Ankle Pumps: Heel Slides / Hip & Knee Flexion:
This exercise will help you increase your ankle flexibility, strengthen your calf Heel slides are an important component of your recovery because they stimulate
muscles and improve blood circulation in your legs. Strengthening the muscles both your quadriceps and hamstring to improve range of motion in your knee
in your lower leg will help support your hip as you recover. and hip. As you build strength throughout your physical therapy, you will be
able to bend your knee more comfortably and completely.

• Lie on your back with your legs extended • Lie on your back with your legs extended
• Support your operated leg with a folded towel or pillow under your ankle • Slide the heel of your operated leg toward your buttock so that your knee
• Engage your calf muscles, and move your ankle towards your shin and hip bend
• Hold for five seconds • Hold for 10 seconds
• Move your ankle away from your shin • Slide your heel back so that your leg is flat
• Hold for 5 seconds • Keep the opposite leg flat
• Perform one set of 10 repetitions 3 times a day • Perform one set of 10 repetitions 3 times a day

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 19 20 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Physical Therapy & Exercises Physical Therapy & Exercises
Hip Abduction: Long Arc Quad / Knee Extension:
Weak hip abductors can negatively affect your posture and walking gait, so hip Active knee extension increases your knee flexibility range of motion and
abductions target these muscles to strengthen them, and stabilize your legs and improves quadriceps strength.
pelvis.

• Lie on your back and keep your knee straight

• Slide your leg out to the side (away from your body) then back to the
starting position
• Do NOT allow your leg to cross the midline of your body
• Make sure your feet are always pointed up
• Do NOT let your leg roll in or out while sliding it
• Sit upright in a firm chair
• Perform one set of 10 repetitions 3 times a day
• Raise your heel forward until the knee is straight
• Hold for 5 seconds
• Slowly lower and bend your knee as far you can
• Perform one set of 10 repetitions 3 times a day

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 21 22 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Physical Therapy & Exercises Physical Therapy & Exercises
Short Arc Quads / Terminal Knee Extensions: Standing Hip & Knee Flexion:
Short art quads take your quadriceps muscle through a short motion to develop Standing hip and knee flexion is an exercise that helps lubricate your hip joint
and strengthen this important muscle, improving range of motion in your hip and stabilize your hip muscles. Stabilizing and strengthening your hip muscles
and knee. The quadriceps muscles are a group of four muscles that control your is important in preventing further injury to your hip and providing stability in
knee joint while you are standing and prevent your knee from buckling. The your knee and ankle.
quadriceps are important after total hip replacement because the knee and the
muscles that support the knee help support your hip.

• Lie on your back with your legs extended in bed

• Support your operated leg with a pillow to keep your knee bent at 45°
• Straighten operated leg at the knee by lifting only your heel off the bed
• Hold for 5 seconds
• Lower leg back to resting position
• Perform one set of 10 repetitions 3 times a day • Hold onto a table
• March in place
• Do not bring your knees above 90 degrees
• Perform one set of 10 repititions 3 times a day

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 23 24 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols
Physical Therapy & Exercises
Squats:
It is important to have proper technique when performing squats following
total joint replacement. This exercise engages all the major muscle groups in
your legs, especially your quadriceps, gluteus and hip abductors, which helps
strengthen your hips and knees.

• Hold onto a table

• Bend your knees halfway
• Hold for five seconds
• Straighten your knees to your starting position
• Perform one set of 10 repetitions 3 times a day

Total Hip Replacement, Rehabilitation & Physical Therapy Protocols 25 26 Total Hip Replacement, Rehabilitation & Physical Therapy Protocols