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For more information, go to www.arthritisresearchuk.org

Getting the most from a hip replacement

Published on 18 April 2013
Source: Arthritis Today
Derek Fisher in a yoga position

Derek Fisher, aged 77, from Newport, South Wales, shares his intensive post-operative routine.


I’m a 77-year-old complementary therapist and former comprehensive school headteacher who had my second total hip replacement a year ago. I wanted to restore my hips to the condition they were in 40 years ago and this article describes my approach to achieving this ambition. Others may have different expectations but I hope that they will be able to use something in each section of the routine to realise these.

I had always been fit and enjoyed physical activities. The need for both operations was largely owing to about 20 years of long-distance running, including 26 London Marathons. I was determined on both occasions to cut the recovery time to a minimum and regain my physically active life. I did this by being in the best possible condition on the day of the operation using a combination of land and water-based exercises, yoga and complementary therapies.

Derek demonstrating a hip flexionI achieved this goal after the first operation in 2010 but the need for a second hip replacement arose two years after the first one. The regime I had employed on the first occasion had been very successful, enabling me to resume normal class yoga after six weeks and to run and undertake long-distance walks after six months in addition to playing table tennis and swimming regularly. Once a decision to have the operation was taken I wanted the same excellent result and it seemed sensible to follow a similar routine of preparation and rehabilitation.

What are the benefits of a hip replacement?

Most surgeons will state their principal objective in performing the operation is the elimination of pain. There is also no doubt that by the elimination of pain, the operation transforms the quality life for thousands of folk each year. There is an improvement in mobility but the extent of this seems to be dependent on the expectations of the patient and the amount of pre and post-operative effort they are prepared to make. At the two ends of the scale there are those who just want to be able to get around the house, drive to the shops and be able to go on holiday and those who want to continue or resume a more active life which might include playing with the grandchildren, walking, cycling, golf or working out at the gym. I wanted to restore the strength, stamina and suppleness necessary to take part in strenuous physical activities so I knew that a more than average amount of hard work was required.

Pre-operative preparation

Patients are urged to be as fit as possible before any operation in order to tolerate the trauma involved and to enable them to make as speedy a recovery as is possible. However, in the case of joint replacements, the more disabled and weak one has become before the operation the more difficult it is to perform the exercises necessary for rehabilitation.

I tried to prepare myself as much as I could before both operations by walking, running and yoga but second time round I did the land and water exercises described later as well. However, the main difference was in the timing of the intervention. For many years I’d been aware that there was arthritis in the left hip and a gradual restriction in its range of movement, but I was getting no pain so I delayed seeking an operation. In the case of the right hip there was some discomfort so I had the operation just five months after the first symptoms occurred. This meant that the hip capsule and the thigh muscles were in a much better condition the second time around.

I feel that GPs might usefully encourage patients on the waiting list for a hip replacement to do the usual post-operative exercises before the operation. This would help in the retention of strength and mobility in the leg concerned. The way patients respond to this advice might be some indication of how likely they are to be committed to the post-operative rehabilitation procedures.

Some standard land-based postoperative exercises

Hip extension Some of the usual standing exercises include: hip flexion (knee raising), hip extension and hip adduction with the leg being moved in the direction of the arrow. Later, an elastic band can be attached from the operated leg to a heavy piece of furniture or similar immovable object to increase the effort required. When it is fully weight-bearing, the operated leg can be strengthened in a different way by acting as the standing leg in these exercises. For more exercises you can either download our Arthritis Research UK booklets on hip pain, and hip replacement surgery or order the booklets by calling 0300 790 0400 or email enquiries@arthritisresearchuk.org

Some water-based exercises

The standing exercises strengthen the thigh and the hip capsule and promote greater flexibility of the latter.

If prior to the operation the leg muscles have become very weak, the patient may experience great difficulty in carrying out these movements both before and after the operation. Progress will be very difficult and the patient may be so discouraged as to give up the exercises. I found it much easier to do the exercises in water with the range of movement being greater than on land. Buoyancy aids attached to the lower leg can be used both to enhance the range of movement and to increase the resistance. As referred to earlier, the operated leg can be strengthened by performing the exercises with the other leg. Yet again, water makes this possible at a much earlier stage in the recovery process.

Squats to strengthen the quadriceps or heel raises for the calves are not advisable on land during the first six weeks after the operation. However, in water these exercises are possible even on one leg. As the operated leg becomes stronger these exercises can be done in progressively shallower water. I found the swimming pool a wonderful place in which to experiment safely.

Derek Fisher demonstrating a hip abductionAfter 10 weeks of working in the pool six days a week the gains became less appreciable and my enthusiasm started to wane. I then cut down the time spent on the exercises and joined the aquarobics classes which continued to strengthen the leg and improve flexibility.

How can yoga help?

The exercises already described will strengthen and improve the flexibility of the hip and upper leg but yoga offers a variety of additional poses which can complement these and fulfil other functions at the same time.

I was on crutches for six weeks after the operation. It seemed to me that during this period of partial weight bearing, there were four principal physical needs which yoga could address:

• The mobilisation of the hip joint capsule.
• Compensating for the stresses that the use of crutches places on various parts of the body .
• Providing a balanced practice for the body as a whole.
• Assisting in the promotion of good circulation in the vulnerable lower limbs.

A staircase is useful for gaining access to the floor from one’s crutches and its stepwise height gradation provides a means of varying the intensity.

During the first six weeks after the operation, it was emphasised that in addition to the operated leg not being fully weight bearing, it must not cross over the other one, allow the hip to rotate, nor must the angle between the thigh and the trunk ever be less than 90 degrees. Nevertheless, a couple of weeks after the operation I was able to start putting together something resembling a safe and balanced programme.

What next?

Six weeks after the operation, the operated leg was strong enough to allow me to gradually dispense with the crutches. The strength was there but in spite of the exercises the hip was tight compared to the other one. I wasn’t satisfied – I wanted back the hip mobility of my youth. I was fortunate that on both occasions the surgeon encouraged me to gradually resume my usual activities. This included attending general yoga classes, provided I listened to my body and did not force it into the postures. Over the next couple of months the many hip stretches performed in a yoga practice coaxed the hip joint into a full range of movement, as they had done with other hip two years earlier. The process was also assisted by regular visits to a physiotherapist who treated the hip and leg with acupuncture followed by manipulation. In addition, massage also helped to normalise the traumatised tissues in the operated leg and to relieve back spasms that occurred from time to time, particularly after the initial abandonment of the crutches.

It’s now a year since the operation and the hip continues to improve in strength and flexibility. I am enjoying all my activities and find a 10-mile walk comfortable. Overall progress was more rapid the second time around, perhaps owing to the earlier surgical intervention.

Summary

All the activities summarised below could be of benefit to patients. What individuals select will depend on their vision of life after surgery.

WEEK ACTIVITY

-8 to 0 Land and water exercises, swimming, walking, jogging, yoga, physio and massage
0 Operation
0 to 1 Land exercises, use of crutches
2 to 6 Land and water exercises, swimming, modified yoga, massage
6 to 12 Land and water exercises, aquarobics, swimming, full yoga, physio and massage
12 onwards Swimming, walking gradually increasing speed and distance, full yoga 

For more details of Derek’s post-operative regime contact him at dgfisher8@sky.com

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