HIP ARTHROPROSTHESIS
(Rehabilitation Protocol)

Bed position: the patient's leg is placed in a foam rubber valve for about 48 hours (until the draining tubes are removed). From this moment, the patient is allowed to lay on the heterolateral flank while keeping a pillow between his/her legs in order not to abduct or intrarotate the operated leg.
Re-education is carried out by a rehabilitation therapist, following a protocol designed by both the orthopaedics and phisiatrics teams.
The treatment includes a sequence of phases the duration of which can vary according to the patient's general conditions as well as the conditions of his/her adjacent and heterolateral joints.

The first 2 days: isometric contraction of the gluteus and quadricepts muscles; strengthening of the heterolateral limb. Breathing exercises.

From the 3rd day: passive kinesitherapy of the operated hip. The muscular strengthening program continues. The patient can gradually sit up on the bed with his/her legs out.

From the 4th day: static exercises and later assisted deambulation exercises begin (walker, parallel bars, anti-brachial supports) with a gradual increase of the load. When the patient achieves a certain degree of stability using crutches, he/she will start practising climbing and going down the stairs: while climbing, he/she will put the healthy leg forward, while coming down, he/she will put the operated leg forward.
The patient is generally discharged from the hospital after 10-12 days.
When at home, the patient will have to repeat the muscular strengthening exercises he/she learned in the hospital, various times a day.
When it is possible, the use of a stationary bike is highly recommended: at the beginning, we suggest raising the seat so that the leg can easily make a whole rotation of the pedal, even though the operated leg still suffers some functional impediments. The following days, the seat can be gradually lowered, in order to improve the bending ability of the hip.
We suggest the patient leave the first crutch, the one for the operated leg, when he/she is capable of maintaining the monopodalic support on the operated leg without suffering any unbalance of the hip. The second crutch can be left later on, when the patient is able to walk correctly.
In the case of a NON-CEMENTED ARTHROPROSTHESIS, the patient begins to walk by only partially loading his/her body weight on the operated leg. This partial loading phase is usually extended to the 45th day; usually, after such period of time, the full loading is allowed.

In the first two months after the operation, it is very dangerous to adopt postures that could potentially cause a luxation of the prosthesis. Therefore, when leaving the Hospital, the patient receives advice and explanations on the postures and movements he/she should avoid:
Crossing the operated leg over the other one should be avoided.
The operated leg should not be intrarotated.
The operated leg should not be bent too much: in particular, sitting on seats that are too low should be avoided (toilet seats and bidet as well).
Being especially careful to avoid potential fall situations (bath tubs, showers).


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