Penrose Physical Therapy
03
Jan 2016
Jennifer Penrose
Author
Jennifer Penrose

Precautions for first 6 weeks

  • NO hip flexion >70°
  • NO hip abduction >neutral
  • NO hip internal rotation
  • Weight bearing as tolerated with assistive device
  • NO sitting for long periods of time
  • Use toilet with raised seat for 3 months
  • Use abduction wedge while sleeping or resting, up to 12 hrs
  • Transfer to sound side Hip rotation should be limited:
    • AVOID excessive IR and FLEX >70°

1-4 weeks – Immediate Post-op/ Maximum Protection Phase

  • Hip FLEX to 70°
  • Gait training (WBAT)
  • Increase hip ABD
  • Strengthening hip extensors
  • Isometric exercises in pain-free range (low intensity)
  • Gentle massage

Home Exercise Program (post-op)

  • Glute sets
  • Hip abduction, lying on back
  • Ankle dorsiflexion, ankle pumps
  • Heel slides Quad sets
  • Short arc quad sets
  • Hamstring sets, digging heel in
  • Straight leg raise
  • Hip adduction with roll between legs, squeezing

4-5 weeks – Moderate Protection Phase:

  • Weight bearing restrictions as per M.D. Progress
  • AROM gradually and in protected range
    • NO hip FLEX >90°
    • ADD to neutral
  • Open and closed chain exercises can begin
  • Promote hip extension, by lying in prone if possible, to prevent a hip FLEX contracture
  • 90° hip FLEX allowed
  • May begin theraband strengthening

6+ Weeks – Minimum Protection Phase

  • Increase hip EXT and ABD strength for ambulation
  • PRE with light weight and high repititions, no stress ER
  • Bicycling to increase muscular endurance and general conditioning
  • Transition to cane, if necessary
  • Begin stretching and strengthening the glutes
  • AVIOD high-impact exercises

*Be cautious long term for combined motions of hip flexion, internal rotation, and adduction*

References:
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd ed. Philadelphia, PA: The Curtis Center; 2003.

Click here to download: Total Hip Replacement – Posterior Approach

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