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  • THR Rehab Practice Guidelines-Updated 23mar2011

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    arbaz
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    National Guard Health Affairs provides guidelines for rehabilitation after total hip replacement surgery. [1] The guidelines outline a 3-phase rehabilitation program with goals for each phase. [2] Phase 1 focuses on early mobility and regaining range of motion and muscle control while avoiding movements that could dislocate the hip. [3] Phase 2 progresses mobility and adds strengthening exercises while continuing to follow hip precautions. [3] Phase 3 aims to achieve full range of motion, improve strength and endurance, and return to normal activities and advanced functional levels. [3]

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    THR Rehab Practice Guidelines-updated 23mar2011

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    National Guard Health Affairs provides guidelines for rehabilitation after total hip replacement surgery. [1] The guidelines outline a 3-phase rehabilitation program with goals for each phase. [2] Phase 1 focuses on early mobility and regaining range of motion and muscle control while avoiding movements that could dislocate the hip. [3] Phase 2 progresses mobility and adds strengthening exercises while continuing to follow hip precautions. [3] Phase 3 aims to achieve full range of motion, improve strength and endurance, and return to normal activities and advanced functional levels. [3]

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    © All Rights Reserved
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    19 views2 pages

    THR Rehab Practice Guidelines-Updated 23mar2011

    Uploaded by

    arbaz
    National Guard Health Affairs provides guidelines for rehabilitation after total hip replacement surgery. [1] The guidelines outline a 3-phase rehabilitation program with goals for each phase. [2] Phase 1 focuses on early mobility and regaining range of motion and muscle control while avoiding movements that could dislocate the hip. [3] Phase 2 progresses mobility and adds strengthening exercises while continuing to follow hip precautions. [3] Phase 3 aims to achieve full range of motion, improve strength and endurance, and return to normal activities and advanced functional levels. [3]

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    © All Rights Reserved
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    of 2

    National Guard Health Affairs

    King Abdulaziz Medical City


    Rehabilitation Department – Orthopedic PT Team
    _________________________________________________________________________________

    Total Hip Replacement Rehabilitation Practice Guidelines

    Pre-operative
    Patient educated about the expected signs/symptoms, post surgical hip precautions, goals of
    rehabilitation, early postsurgical exercises and ambulation/stairs training with assistive devices.

    Post-operative

    Phase and Goals Interventions


    Time
    Frame
    - Prevent vascular & - Ankle pumping exercises
    Phase 1 pulmonary complications - Deep breathing exercises
    Early - Prevent postoperative - Bed mobility training & gradual mobilization out of the
    Function dislocation or subluxation bed
    Week 1-2 - Increase ROM within - Avoid hip flexion > 90, adduction & internal
    protected ranges rotation beyond neutral*
    - Regain muscle control & - PROM/AAROM & AROM exercises of the hip within
    active mobility of operated protected ranges
    limp - Muscle setting/isometric exercises of hip/knee muscles
    - Independent, safe & early - Sitting balance exercises (at the edge of bed or on the
    ambulation with chair)
    appropriate assistive device - Ambulation training with assistive device **
    - Stairs training (2nd week)

    Criteria to - Decreased pain score (VAS)


    start with - Independent in bed mobility considering hip precautions
    phase 2 - Independent & safe ambulation by assistive device *

    - Prevent dislocation or Continue as in phase 1, in addition to:


    Phase 2 subluxation - AROM within protected ranges
    Progressive - Continue ROM increase - Gentle stretching exercise of hip flexor (gravity
    Function within protected ranges assisted supine stretch to neutral in Thomas test
    Week 3-6 - Prevent hip flexors position
    contractures - Open chain exercise within permissible range
    - Regain strength & muscle against progressive resistance (weights/therapands)
    endurance - Gait/stairs retraining (forward, backward, side to
    - Enhance independent side & marching)
    ambulation
    Criteria to - Minimal symptoms of pain and swelling
    start with - Good muscle control/strength
    phase 3 - Ambulation/stairs without assistive device ***

    - Obtain Full AROM within - Continue as the previous phase; advance as


    Phase 3 protected range appropriate
    Advance - Imporve strength & muscle - Closed chain exercise within permissible range
    Function endurance (mini squats, step ups/downs/sides, bike & sit-stand)
    Week 7-15 - Improve cardiopulmonary ***
    endurance - Nonimpact aerobic exercises (progressive stationary
    - Normal gait pattern cycling, swimming or water aerobics) ***
    - Return to normal ADL - Progressive proprioception exercises (one leg
    - Return to advanced standing) ***
    functional level - Implement exercise specific to functional tasks

    * These precautions will be continued for at least 12 weeks or according to orthopedic surgeon decision.
    ** FWB for cemented procedure & PWB for non cemented procedure or according to orthopedic
    surgeon decision.
    *** After WB allowed.

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