Many patients are reluctant to attempt standing post-operatively. Pain makes initial weight bearing a true test of courage. Generally, the physical therapist will be present to encourage and assist in the initial weight bearing exercise. From two to three hours later a second round of weight bearing typically follows, this time a few steps away from the bed then back are encouraged. The presence of a walker for these first excursions is invaluable, because the procedure can affect balance and coordination. As strength and confidence is regained excursions become progressively longer. Hesitancy to ambulate may be overcome by the discontinuation of the foley catheter and the need to go to the toilet.
Initial physical training concentrates on balance and coordination of the affected leg. Constant positive encouragement is key to this process, with the goal always being a few more steps away. It is essential to respond to any negative self-talk that the patient reveals. Comments like "I cannot do this" or "I will never be able to walk right" reveal an attitude of self-depreciation that must not be tolerated for success to be achieved. Negative self-talk is best handled by flipping any comments around and immediately responding back. "I cannot do this" should be dealt with using responses such as "Look how far you have walked this time".
When teaching the patient to climb stairs, tell him to hold onto the handrail with one hand and take his walking aid in the other hand. The non-operative, good leg goes up first. Then the operative leg and walking aid are brought up together to that same step. Going down the stairs the operative leg, the bad leg, and walking aid go down the step first, followed by the non-operative leg to the same step.
After three to five days in a hospital the patient is discharged with instructions about how to continue physical therapy at home and with appointments scheduled for further physical therapy and physician visits. The level of physical therapy varies based on patient age, fitness, and level of motivation. Therapy usually lasts around a month with two to three sessions per week, either at home or in an outpatient location (Leopold, 2003).
During outpatient sessions, balance and safe walking are emphasized. Hip precautions are constantly reinforced and muscle-strengthening work begins. All patients are given a set of home exercises to do between supervised physical therapy sessions, and the home exercises make up an important part of the recovery process.
Once it is safe to put full weight on the surgical leg, fine tuning of the gait begins. Retraining is especially needed if the person had developed an antalic gait (limp) before the procedure, otherwise the habit of limping will continue. The first thing to relearn is how to shift weight when walking. Hesitation to shift the weight leads to a limp. Have the patient stand on the foot of the operative side and prepare to step through with the opposite foot, swaying as he does so. Each step should be consistent and equal in width and length.
A typical course of recovery is ambulation with a walker (or two crutches) for 4 to 6 weeks; then using a cane for another month or so. The assistive devices should remain available to the patient for the entire rehabilitation period, including after independent ambulation, because even with younger patients balance and coordination suffer with fatigue (Leopold, 2003).
Rehabilitation Timeline Post Hip Arthroscopy |
Day of The procedure:
Immediate post-operative activities to help prevent problems with breathing and blood clots begin. These are encouraged by nursing staff every hour. - Breathing deeply
- Coughing
- Ankle pumping
- Tightening the muscles in legs and buttocks
Day 1:
Exercises and activities to help strengthen leg muscles and increase the movement in the hip joint begin. - Bending each leg while sliding the heel toward the hip while in bed
- Sitting on the side of the bed
- Walking a few steps with a walker or crutches
- Sitting in a chair
Day 2:
Stretching and strengthening exercises are added. These may include; - Stair climbing
- Standing leg and knee raises
- Bathing
- Walking to the bathroom
Day 3 to Hospital Discharge:
Continue to increase activities and exercises. Before discharge the patient should: - Demonstrate safe walking with a walker or crutches
- Move to the chair or toilet without help
- Independently bathe and dress
Hospital Discharge to six weeks post-operative:
The number and duration of the exercises increase as tolerated. Activities of daily living are added. - Walking increasing distances with a walker, crutches, or cane
- Placing increasing amount of weight on the leg
- Exercises such as leg and knee raises and hip extensions
- Activities of daily living such as washing dishes, cooking, and laundry
Six to 12 weeks post-operative:
Continue the leg and hip exercises while gradually returning to normal activities of daily living. Such as; - Walking without a walker or crutches
- Exercising with an elastic band or tubing
- Driving an automatic shift car
- Resuming sexual relations
12 weeks post-operative:
Resume most of the activities performed before the procedure while using good judgment to avoid undue stress on surgical hip; - Walk 20 or more minutes daily
- Return to work
- Drive a stick shift car
- Recreational activity like golfing or sedate dancing
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By watching the patient walk during the post-operative rehabilitation, health professionals can encourage corrections for stride and balance. At times, orthotic devices may aid a person on a temporary or even permanent basis. Orthotic devices are externally applied devices that act as a support to the musculoskeletal system. Common examples are shoe inserts or specially adapted shoes and braces to support an unstable or weak joint. Orthotic devices are available to assist in balance and security while walking (Hoenig H, Siebens H. October 2003).
The large majority of patients are able to return to a good level of function without hip pain. Most patients are able to walk without a limp, and may resume reasonable personal and recreational activities gradually in the weeks and months following the procedure.
