Endoprosthetics of the hip joint sick leave. All about rehabilitation after hip arthroplasty: at home and in the hospital

In order for rehabilitation after hip arthroplasty (HJ) to pass without complications, and for the artificial joint to take root and function normally, it is important to strictly follow the doctor's recommendations. In the early recovery period appointed drug therapy and light exercise. As the recovery expands, the set of exercises becomes more diverse, the load gradually increases.

To in postoperative period the patient was not distracted by extraneous matters, issued sick leave disability.

Stages of rehabilitation: requirements and restrictions

Recovery after hip arthroplasty takes a long time, and at each subsequent stage, a person's life changes. To normalize the condition and fully recover, at least six months must pass. Immediately after prosthetics, the patient stays in the hospital for 2-3 weeks, because during this period there are restrictions that cannot be violated. Further, when the seam heals and the danger of complications passes, the adaptation period continues at home. All this time, the development of an artificial joint and the training of the muscle corset are taking place. If you lead healthy lifestyle life, engage in light sports and follow the recommendations of a doctor, a person will live a full life the same as before implantation.

Early postoperative

General principles

The period begins immediately after the removal of the affected joint and replacement with a hip joint endoprosthesis. Lasts up to 15 days. Once the anesthesia has passed, the patient is allowed to sit down, but not to concentrate the weight on the operated area. Starting from the second day, you can lower the sore leg from the bed to prevent thrombosis, elastic bandages are applied around the limb. Basic rules for recovery after hip replacement surgery in the early period:

• Sleeping in the first week is allowed only on the back.
• Motor mode while should be limited. Sudden movements and long walking are prohibited.
• You can sit for a short time, while it is not recommended to bend your legs more than 90 °.
• It is contraindicated to bring together and cross the limbs. To prevent this from happening, it is recommended to put a roller between the legs.
• In order not to form, and there were no stagnant processes in the veins, exercise therapy is prescribed after replacing the TBS.
• When moving, you need to use a support. It can be a walker, it is also allowed to walk on crutches.

Therapeutic exercises

Physiotherapy at an early stage is aimed at improving the blood supply to the operated area, developing muscles and preventing the development of complications. The course of classes during this period, the patient should be under the supervision of a physiotherapist. He will teach you how to do exercises correctly, and which poses are contraindicated.

• Lying on your back, bend and unbend the toes of both legs, trying to feel the muscles.
• Rotate your feet in different directions, then move back and forth.
• Lying in bed, try to attach the back of the thigh to the bed as much as possible.
• In turn, strain the first healthy, after the operated limb.
• Pull the limbs bent at the knees towards you, helping with your hands.
• Small pillows or rollers are placed under both legs, after which the straight limb alternately rises and lingers for 10-15 seconds.

Recovery exercises should not bring pain and discomfort. If a new activity caused an acute pain symptom and a deterioration in well-being, it is worth informing the doctor about this and reducing the load on the diseased limbs.

Expansion of motor activity

If initial rehabilitation period passes without complications, the stitches are removed, and the patient feels better, the charge expands. The patient is allowed to bend over a little, sit on a chair for a while, walk with a walker or crutches. If the patient has already learned to keep balance, it is recommended to expand the training complex with such exercises:

• Leaning on the back of a chair or bed, lift and hold on weight first a healthy, then a diseased limb.
• Holding on to the support, lift the legs in turn, bent at the knee, to the sides.
• In a standing position, first raise the limbs forward, then take them back.
• During the performance of all classes, the legs must be bandaged or an orthopedic orthosis should be used.

Second stage: what exercises are added?

If the removal of the affected joint was successful, and during the first period in the hospital the patient had no complications, they are then restored at home, but under the supervision of a doctor. This stage lasts 3 months. Still on the operated limb superimposed elastic bandages, if necessary, the patient is still taking medication prescribed by the doctor. The person is still on sick leave, the timing of the extension of which depends on individual features organism.

It is allowed to sleep on your side if two months have passed since the prosthesis, and during this period after the replacement, the x-ray shows positive results, you can move with a cane. The postures taken when performing exercises should not cause discomfort. Exercises after hip arthroplasty at the second stage:

• In the prone position, perform rotational movements with bent limbs, simulating cycling. To increase the load, a pillow is placed under the lower back.
• In the same starting position, in turn, raise even limbs 45 ° from the floor, lingering for 15-20 seconds.
• Roll over on your stomach, bend-unbend both legs at the joint at once.
• Become straight, put a support near you, for example, chairs. Holding on to the back, slowly squat, trying to feel the thigh muscles.
• Sit on a chair, put your legs through a loop made of elastic fabric. Extend both limbs to the sides, straining all muscles.

The third stage of rehabilitation after hip arthroplasty

Lasts an average of 6 months. The motor activity of a person is expanding, new, intense exercises are being added, and it is also allowed to move up the stairs. During this period, the gait should even out, the person can already bend over without using the support. In addition to charging, you can connect a course of massage treatments. But do not forget that if the condition has not fully recovered, and in the early rehabilitation period the sutures did not heal for a long time, and there were other complications, massage after hip arthroplasty is contraindicated.

The training complex includes the following exercises:

• Lie on the operated side, straighten the leg, take the healthy one a little to the side. Raise the affected limb, trying to hold it in a hanging position for 5-7 seconds.
• Lying on the mat, raise both straight limbs at a right angle, then slowly lower them to the floor.
• Stand up straight, place an elevation imitating a step in front of you. Rise and descend from it, first with a healthy, then operated limb.
• Put a collar made of elastic fabric on the door handle. Pass the affected leg into the loop and stretch the clamp towards you with maximum effort.

Deforming osteoarthritis (DOA), which develops on the basis of trauma, congenital dysplastic or inflammatory disease, can lead to a serious deterioration in all life activities. This is manifested in constant, oppressive pain, the inability to move normally and do the same work. It often leads to disability. One of the methods of treatment of DOA is arthroplasty. Many believe that after a knee or hip replacement, they automatically give disability.. Is it so?

Disability in DOA and after arthroplasty

There are a lot of indignant letters on the Internet on medical forums, something like this:

My mother, a nurse at City Hospital No. 2, underwent surgery a year ago. Since then, she has been in constant pain, especially her leg aches before a change in the weather. She can't bend her knee like she used to, she can't run. They submitted documents to the ITU, but after the operation they didn’t give her any group ... Why? ..

To understand this, let's consider the principle by which they generally give disability in diseases of the musculoskeletal system.

The basis for assigning a disability group may be:

• Deforming arthrosis of both hip or knee joints not lower than the second stage of arthrosis and a moderate degree of joint dysfunction
• DOA of one or more joints (hip, knee, ankle, shoulder, elbow, wrist) in stage III, with ankylosis or limb shortening
• Bilateral arthroplasty leading to severe disorders

Thus, in itself - is not yet a basis for disability. On the contrary, surgery can be recommended in the late stage of DOA as a method of treating arthrosis and the possibility of removing a number of life restrictions (LIA)

A person agrees to an operation, not wanting to become disabled, but on the contrary, wanting to avoid disability.

Another thing is when the joint replacement was unsuccessful for some reason:

• The quality of the prosthesis is low
• The surgeon did not conduct computer navigation and unsuccessfully selected the geometric dimensions of the prosthesis
• After the operation, the patient did not undergo rehabilitation or did not go through it as it should

A referral to the MSE after arthroplasty is given in the event of moderate and severe musculoskeletal disorders that led to the limitation of the patient's life activity (OIA)

Let's consider how the degree of musculoskeletal functions is determined and by what criteria the OZhD is evaluated at the ITU.

Medical and social expertise in deforming arthrosis

Post-traumatic arthrosis is considered the most unfavorable in its course, since it differs:

• The most pronounced dysfunctions (contractures, restriction of movements, shortening of the leg, muscle atrophy)
• Increased frequency of exacerbations
• The rate of disease progression

For MSE, the following criteria for assessing the patient's condition are required:

1. X-ray diagnostics according to Kosinskaya
2. Functional diagnostics
3. Determination of the degree of statodynamic function (SDF)
4. Determination of the degree of moderation in the development of DOA:
   • How quickly the disease progresses
   • How often do exacerbations occur?
   • What are the complications of the disease

X-ray diagnostics at ITU

Diagnostics in medical and social expertise differs from the usual diagnostics that is used in modern medical practice:

• So, the degrees of arthrosis in medical orthopedics on the basis of x-rays are today determined according to the Leuquesne classification - it distinguishes four degrees of arthrosis
• At ITU, the degrees of arthrosis are determined only according to the classification of Kosinskaya (three degrees)

The third degree according to Leuquesne may correspond to the second according to Kosinskaya, which may cause disputes.

Degrees of DOA according to Kosinskaya

First degree DOA:

• Slight restriction of movement
• Mild and uneven narrowing of the interarticular gap
• Initial osteophytes

Second degree DOA

• Restriction of joint movement in certain directions
• The appearance of a rough crunch when moving
• The narrowing of the gap by two to three times, in comparison with the norm
• Moderate muscular atrophy
• The appearance of large osteophytes
• Signs of osteosclerosis and cystic cavities in the epiphysis of the subchondral bone

Third degree DOA

• Large joint deformities and compaction of bone surfaces
• A sharp limitation of mobility with the preservation of rocking movements in the range from 5 to 7 ˚
• Large osteophytes over the entire surface of the joint
• Joint gap closure
• Fragments of cartilage in the synovial cavity of the joint (articular mice)
• Subchondral brushes

With complete fusion, not DOA is diagnosed, but ankylosis, which is informally considered the fourth stage of arthrosis

Functional diagnostics in arthrosis

There are four degrees of limitation of joint movements:

First degree:

• Limitation of movements of the shoulder, hip joint - no more than 20 - 30 ˚
• The amplitude of the knee, ankle, elbow, wrist joints is not less than 50 ˚ from a functionally advantageous position
• Brush amplitude - from 110 to 170 ˚

Second degree:

• Restrictions of hip movements and - no more than 50 ˚
• Knee, elbow, wrist - decrease in amplitude to 20-45 ˚

Third degree:

• Preservation of the amplitude within 15 ˚, or ankylosis and immobility in a functionally uncomfortable position

Fourth degree:

• Fixation of the joints in a tightened functionally uncomfortable position

Degrees of statodynamic function (SDF)

In many respects, the maintenance of these functions, thanks to which we continue to maintain support and move even in the later stages of osteoarthritis, occurs with the help of compensatory processes, the purpose of which is:

• Eliminate the difference in the lengths of the limbs due to the distortion and inclination of the pelvis
• Alleviate contracture leading to limb shortening by increasing mobility of adjacent and contralateral (opposite) joints
• Improve the support of the diseased limb by transferring the load to the healthy leg, etc.

Apart from clinical signs(shortened limb, pelvic tilt and muscle atrophy of the diseased limb), compensation is confirmed by X-ray:

• Bone sclerosis is observed in the most loaded area of ​​the joint
• The support area of ​​the joint increases
• In the diseased joint, signs of osteoporosis and cystic degeneration are observed.
• In adjacent joints, the opposite joint of a healthy limb and the lumbar region, DDD begins

There are four degrees of SDF:

Minor violation of SDF

• Amplitude reduction no more than 10 ˚
• The appearance of aching pain after a deadlift or walking three to five km at a pace of 90 steps per minute
• Pain goes away after rest
• The first stage is determined by x-ray
• Compensation indicators are normal

Moderate SDF violations

Moderate violations (initial stage)

• Pain and lameness when walking 2 km, disappearing after rest
• Stride pace - 70 to 90 steps per minute
• The average number of steps at a distance of 100 m is 150
• moderate contracture
• Support shortening - no more than 4 cm
• The circumference of the affected thigh is reduced by two centimeters
• Muscle strength is reduced by 40%
• X-ray determines the first-second stage of DOA
• Musculoskeletal functions and compensatory mechanism correspond to the degree of relative compensation

Moderate violations (late stage)

• The patient complains of constant pain in the joint, lameness, pain when starting to move.
• He is able to walk no more than one kilometer, and then with the help of a cane
• Walking pace from 45 to 55 steps per minute with the number of up to 180 per 100 m
• Arthrogenic contracture is expressed
• Shortening of the limb - from 4 to 6 cm
• Hypotrophy progresses:
  • The difference in the girth of a healthy and diseased hip reaches from 3 to 5 cm
  • Healthy and diseased lower leg - one - two cm
• Decreased muscle strength - 40 - 70%
• X-ray determined the second - third stage of DOA
• in the joints lumbar and lower extremities changes begin without neurological symptoms
• The mechanism of compensation corresponds to the degree of subcompensation (compensation is insufficient, its tasks are difficult to accomplish)

Severe violations

• Intense pain in the diseased joint, in the lumbar and contralateral joint
• Pronounced lameness, inability to walk more than 0.5 km without rest (using a cane, one or two crutches)
• Walking pace from 25 to 35 steps per minute, with at least 200 steps per 100 meters
• Severe arthrogenic contracture
• Shortening of the limb - more than 7 cm
• Hypotrophy of the thigh in the difference in the lengths of the circumferences of the patient and healthy thigh - more than 6 cm, hypotrophy of the lower leg - more than 3 cm
• Reduced muscle strength - more than 70%
• According to X-ray - the second - third stage
• Degenerative-dystrophic changes in the joints of the extremities and lumbar spine with neuroradicular syndrome
• This stage corresponds to the musculoskeletal functions of decompensation (complete impossibility of compensation)

Significantly pronounced changes in SDF

• This is actually the inability to move independently
• The patient mostly lies and moves with great difficulty only within the apartment, with outside help or with the help of crutches (walkers)

Types of the course of the disease

Slowly progressive:

• It takes at least 9 years from the onset of the pathology to the appearance of pronounced changes.
• By type of compensation - compensated arthrosis
• Synovitis exacerbations are rare (once every one to two years)
• No reactive synovitis

Progressive:

• Process development time: 3 – 8 years
• Subcompensated type of arthrosis
• Secondary reactive synovitis with exacerbations twice a year
• There are signs of cardiovascular disorders: hypertension, atherosclerosis

Rapidly progressing:

• Arthrosis develops within no more than three years
• Decompensated type
• Reactive synovitis with exacerbations at least three times a year
• Associated pathologies

Basis for assigning a disability group

Minor persistent violations of the SDF in the first and second stages of arthrosis of one joint are not the basis for assigning a disability group

• The basis for the establishment of the 3rd group may be persistent moderate dysfunctions of the SDF:
  • The third stage of DOA of the hip joint or bilateral (gonarthrosis) of the second stage with the first degree of limitation of the range of motion of the joints
• Reasons for the second group of disability - persistent pronounced violations of the SDF, leading to the second degree of mobility restriction
  • Bilateral coxarthrosis with severe contractures 2-3 stages
  • Ankylosis of the knee, ankle and hip joints
  • coxarthosis and

Based on the foregoing, we denote that a certain percentage of patients do not fit into the generally established standards of rehabilitation. At the end of 90-120 days after arthroplasty with unsatisfactory clinical picture issues of granting the status of VUT to the patient will already be dealt with expert commission ITU.

To do this, the medical institution (HCI), where the patient was treated and examined during the entire rehabilitation period, sends a package of documents to the local bureau. The parcel package necessarily includes all extracts and conclusions on the main diagnosis, on diagnostic and therapeutic measures carried out in outpatient and stationary conditions. That is, the health care facility, according to the collected documentation, officially confirms the fact that the patient has depression of functions of one nature or another and the need to undergo specific medical rehabilitation.

Experts of the medical and social commission carefully study the information about the patient received from the health facility and pass a verdict on the degree of limitation of his performance. The ITU, as one of the most common options, can agree that the polyclinic opens a new one from the date of closing the sick leave until the patient's quality of life is restored to the fullest extent possible. The deadlines of the BL are also set for the health facilities by the ITU, however, as well as the admissibility of its extension without their participation, the cyclicity of the update. Another option, less likely, is that the expert commission assigns a disability group (usually 3 gr.) to the patient with its further re-examination at the time indicated by the MS-instance.

We emphasize that MSEC reserves the right to refuse both the extension of the BC and the assignment of the group if the pathological deviations are confirmed as minor.

Article publication date: 08/03/2016

Date of article update: 05.12.2018

Rehabilitation after hip arthroplasty is an integral stage postoperative treatment aimed at restoring muscle tone and leg functionality. Rehabilitation consists in limiting (features) of physical activity in the period after surgery and in performing physiotherapy exercises.

Principles of the recovery period after hip arthroplasty:

• early start,
• individual approach in carrying out rehabilitation activities,
• subsequence,
• continuity,
• complexity.

Rehabilitation after arthroplasty has three periods: early, late and remote. For each of them, a specific gymnastics complex has been developed. The total duration of rehabilitation is up to a year.

Restoration of leg performance begins even in the hospital, where the patient underwent surgery. The approximate length of stay there is 2-3 weeks. You can continue rehabilitation at home or in a rehabilitation center, and finish it in a dispensary or a specialized clinic for rehabilitation treatment. If you work out at home, it is important not to interrupt exercise therapy and therapeutic walks so that the recovery takes place in full - only then the musculoskeletal apparatus will securely fix the artificial joint, and all leg functions will be restored.

Lack of rehabilitation after arthroplasty threatens with the occurrence of dislocation of the endoprosthesis head due to ligament weakness, periprosthetic fracture, development of neuritis and other complications.

Rehabilitation after any type of joint surgery, including hip replacement with an endoprosthesis, is carried out by a rehabilitation doctor and (or) a physiotherapy doctor. He will create an individual program taking into account physical condition the patient, the degree of adaptation to physical activity, his age, the presence of concomitant diseases.

After the installation of the endoprosthesis, it is possible to restore the ability to work. Persistence, desire to recover, strict implementation of the recommendations of doctors are the main criteria positive result rehabilitation after hip replacement surgery.

Three periods of rehabilitation

Early rehabilitation period after arthroplasty

This period begins immediately after recovery from anesthesia and lasts no longer than 4 weeks.

Six Rules of the Early Period

Sleep on your back for the first few nights after hip replacement surgery;

you can turn on your healthy side with the help of a nurse at the end of the first day after surgery, on your stomach - after 5–8 days;

do not make sharp turns or rotations in the hip joint - this is contraindicated;

do not bend the affected leg so that the angle of flexion is more than 90 degrees;

neither bring together nor cross your legs - put a wedge-shaped pillow between your legs;

Do simple exercises regularly to prevent blood stasis.

Early Goals

• Improve blood circulation in the operated hip area;
• learn how to sit in bed correctly, then get up from it;
• prevent the development of complications (pressure sores, thrombosis, congestive pneumonia, pleurisy);
• accelerate the healing of the postoperative suture;
• reduce swelling.

Basic exercises

In the table - exercises for the calf, gluteal, femoral muscles of both legs:

(if the table is not fully visible, scroll to the right)

Exercise rules:

• make several visits per day, spending 15-20 minutes from each hour during the day;
• keep a slow and smooth pace;
• combine exercises with breathing exercises according to the following scheme: with muscle tension - a deep breath, with relaxation - a long exhalation;
• do breathing exercises to avoid congestion in the lungs.
• at first, do exercises in the early period only while lying on your back (although you need to get up on your feet already for 2-3 days), and then do the same gymnast while sitting on the bed.

A set of exercises for rehabilitation after arthroplasty

I presented the exercises described in the table above in the order of their implementation, they are relevant throughout the entire rehabilitation course. This exercise therapy complex is suitable for the rehabilitation of patients after almost any operation on the joints of the legs.

Additional exercises

In the first 2-10 days after arthroplasty, doctors teach the patient to sit on the bed correctly, roll over, stand up, and walk on crutches.

Having already learned to keep balance and lean on the operated leg, the patient must supplement the complex with other exercises - they must be done every day from a standing position, holding on to the headboard or chair. Here they are:

(if the table is not fully visible, scroll to the right)

The sooner the patient starts to get up and walk after arthroplasty, the less likely it is to develop muscle (limitation of mobility) in the hip area.

Late postoperative rehabilitation

Late rehabilitation after hip arthroplasty begins 3-4 weeks after surgical intervention and lasts up to 3 months. The duration of rehabilitation for each patient varies depending on his age and other factors.

Two goals of the late period:

muscle training to strengthen them, increase tone,

restoration of range of motion in the joints.

After the patient already confidently gets out of bed, sits on a high chair, walks on crutches for 15 or more minutes 3-4 times a day, the motor regime is expanded by training on an exercise bike (no longer than 10 minutes 1-2 times a day). Also, the patient is taught to walk up the stairs.

Climbing a step, start with a healthy leg, substituting the operated one to it. When descending, lower one step lower: first crutches, then a sore leg and then a healthy one.

Remote rehabilitation period

This period begins 3 months after the hip arthroplasty; and last up to six months or more.

• full restoration of the functioning of the artificial joint;
• acceleration of bone regeneration;
• improvement of the functional state of ligaments, muscles, tendons.

Adaptive motor mode involves preparing the patient for more intense physical activity and adaptation in everyday life. Exercise therapy is supplemented with physiotherapy (mud or paraffin applications, balneotherapy, laser therapy and other physiotherapy).

Exercises to do at home

Later, the above gymnastics of the early period after arthroplasty is supplemented with more complex exercises.

Examples of exercises that patients perform at home after discharge. Click on photo to enlarge

(if the table is not fully visible, scroll to the right)

The last two exercises and the rest, where movements must be made with a straightened leg, are necessary after surgery on the hip joint, since they are aimed at developing hip endoprosthesis. For the recovery period when replacing another large leg joint - they are only additional.

Step platform

Gymnastics on simulators

The adaptive motor mode in the long term is expanded due to physiotherapy exercises on simulators. By this time, the ligaments and muscles have already become sufficiently strong after the operation, so the intensity of the loads can be increased. The table below shows the most common exercises to fully restore range of motion in the hip joint.

(if the table is not fully visible, scroll to the right)

Conclusion

At each stage of rehabilitation, the control of a physiotherapy doctor is important. He will tell you when you can complicate the exercises, increase the load.

Independent implementation of exercises for the hip joint after arthroplasty, especially with the use of simulators, can lead to serious consequences. You cannot do gymnastics through pain or, conversely, stop it ahead of time, even if you feel good and the endoprosthesis, as you think, moves well. Only the precise fulfillment of all the tasks set by the doctor will make your new joint work fully.

Owner and responsible for the site and content: Afinogenov Alexey.

Your comments and questions to the doctor:

Victor | 07/06/2019 at 19:43

Hello. I am 67 years old. On March 15 and September 19, 2018, he underwent surgery for arthroplasty of the left and right hip joint (1 year 4 months, 10 months expired, respectively). Couples metal+polyethylene+ceramics. Non-cementing. Rehabilitation is going well, I move around without crutches and canes, I drive a car, I passed the driver's commission without any problems. I don't feel pain or discomfort. Tell me, please, what LIFETIME restrictions exist for such operations? Is it allowed: 1. In a sitting position, placing the foot of the right / left foot on the knee of the opposite leg in order to put on socks without assistance? 2. Full (deep) squat? 3. In a standing position, bend forward, hands on the floor? (washing the floor) 4. Swimming with scrolling fins in the pool, diving? (the difference in the design of the fins and, accordingly, the load on the muscles and hips). 5. In the supine position, do you place the legs behind the leg (left-right)? 6. Avoiding the use of a wedge-shaped pillow between the legs? After what period? 7. After what period of rehabilitation is it allowed (or forever prohibited?!) lifting the knees to an angle of more than 90 °? Eversion of the raised knee to the left-to the right? Thanks in advance for the detailed answer. Sincerely...

michael | 04/25/2019 at 03:25

hello please tell me the operation was done 17 days ago, the hip joint was changed, I am 28 years old. the situation is such that the muscles hurt and in the morning the leg is heavy as a stone, tell me is this normal?

Valentina Viktorovna | 03/04/2019 at 14:05

The PTB operation on 12/06/2017 still hurts the thigh and buttock, the doctor who operated said that the pain was from the back. this is possible osteochondrosis. The thigh along the seam is swollen, when touched, the feeling is as if numb, but the pain is felt. I walk with a cane on the street, and at home without a cane, I do exercises every day lying on the couch, thanks in advance.

Vladimir | 09.11.2018 at 01:20

Hello, during prosthetics, the tbs burst femur during the subsequent operation, they fixed it with 5 ties along the length of the bone, the sutures were discharged, the recommendations were removed not to step on the foot for 3 months, that from the set of exercises recommended by you, I can perform 3 weeks after the operation, thank you in advance for the answer

Olga | 09/17/2018 at 14:13

No fever, no pain, no redness. I will take your advice into consideration, thank you.

Olga | 09/16/2018 at 12:59 pm

Hello! ; September was arthroplasty of the right hip joint. Still very swollen leg, it is difficult to bend at the knee. When I was discharged, they said that everything would pass, but almost two weeks had passed. This was not the case during surgery on the left joint in February of this year. I live in the village, I have not yet reached my clinic. Tell me if there is any danger and what to do, thanks.

Svetlana | 09/06/2018 at 20:25

Hello, my mom (70 years old) is getting ready for a total hip replacement. She has arthritis and severe pain in her elbows and shoulders, I'm afraid she won't be able to use crutches properly. Is it possible to use a walker that has wheels on the front and legs like a chair on the side of the leaning person?

Mina Minsk | 09/05/2018 at 14:51

I had a hip arthroplasty in January.
Since then, the sensitivity of the toes has been impaired. What would you recommend to restore normal sensitivity. Thanks in advance, Mina.

Yana | 08/30/2018 at 11:14

Hello! How soon after arthroplasty can I do a full body massage? I visited a physiotherapist, she prescribed different procedures, prescribed ALIMP, she said about massage that it was early, after 3 months (a month and a half had passed). We all took off our stockings in the ward after a week, and for those who had their heels baked, the sisters cut the stockings at the heels to give freedom to the vessels. I walk for one and a half, sometimes 2 hours in the air with crutches, is that probably a lot? I want to go to the sea, why is there ice on the sea? When will a month pass after endoprosthetics - is it really impossible? Thank you!

svetlana | 08/29/2018 at 16:52

Hello! I am preparing to replace the TB of the right joint, I live on the 5th floor of a house without an elevator, can I go up after the operation home? If you write that there is no more than one flight of stairs. Thank you in advance.

Olga | 08/09/2018 at 15:56

IM 42 years old. They performed an operation to replace the right hip joint on 06/05/2018, i.e. two months have passed. I do gymnastics. Added an exercise bike. I walk with a cane, but my gait is uneven. I can't even lie down on the operated side (drawing pain occurs along the entire leg). I have several questions:
1) When can you break the "90 degree" rule and sit low?
2) When can the compression stockings be removed?
3) Will a straight gait recover and what can be done to achieve this?

Valery | 07/29/2018 at 17:13

I am 61 years old. On July 6, 2018, an operation was performed to replace the left hip joint. A BC metal-ceramic joint (manufacturer Zimmer) was installed. Three weeks have passed. Feeling good. Acute pain missing. Used underarm crutches. Last week one subelbow crutch. Is not it too early? And another question: is it possible to go to the sea at the end of September-beginning of October?

Alexander | 07/06/2018 at 12:37

Hello! I confess, I love to lie in the bathroom, after what time can I take a full bath after replacing the TBS, at the moment it has been almost 2 months?

Natalya | 06/24/2018 at 19:35

Good afternoon. Made 40 days ago to replace the right TBS. I go with a stick. Question: Which side should the stick be held on? On the side of the diseased or healthy leg? It's written differently on different sites. I'm holding the stick on the side of my good leg!??? Food question: How long after the operation (approximately) can I go to the pool or swim in the sea? Thank you.

Alexander | 06/17/2018 at 06:09

Hello! A month ago there was an operation to replace the TBS. I am 70 years old, can I use an elliptical trainer instead of an exercise bike for rehabilitation? I feel good, there is no pain in the joint and never was. When can I start exercising on the simulator? Thank you!

Catherine | 06/13/2018 at 06:12

Good afternoon! I am 70 years old, after the operation to replace the hip joint, 4.5 months have passed (01/25/2018), in general, nothing bothers me while I walk at home without a cane (I walked on crutches for about 3 months). But when I go out into the street I use a cane, it is worth walking 200 meters. The operated leg immediately gets tired and is looking for a place to sit down. Tell me what is the reason? I had a consultation with a doctor with pictures in May, they said everything was fine. Thank you for your reply

Olga | 05/14/2018 at 04:25

Hello! I read all the comments, many thanks to everyone, I learned a lot of useful things for myself. Question: they write that you need to exercise on an exercise bike, but I have a cardio simulator - walking, is it possible to walk and how much - I have a replacement of the left hip joint on 2.02.18. Right - severe pain, September 3, 2018. there will be an operation.

Viktor Nikolaevich | 05/08/2018 at 23:39

Hello. I am 66 years old. The operation for total arthroplasty of the right hip joint was performed on March 15, 2018. May 15 2 months after the operation. Pair cementless, polyethylene - ceramics. The seam was tightened, the seams resolved, the condition is normal. With the permission of the attending, I now walk on one elbow crutch. After the release of control pictures and examination, there was no doctor for an internship abroad. There is his absentee permission to lie on the operated side, the sensations are normal. Please tell me when it will be possible during sleep, when getting out of bed, etc. refuse to use a wedge-shaped pillow between the thighs?! And secondly: when is it better to perform an operation on the second TBS in terms of time and season (we have very hot weather and the summer is promised to be the same)? Thanks for the answer.

Tatyana | 04/30/2018 at 09:24

Good afternoon! In February, there was an operation to replace the vehicle, now you can get another vaccination against tick-borne incephalitis in May. Thanks for the answer.

Maryam | 04/07/2018 at 04:59

Hello! 27.02.2018 I had surgery to change vehicles. While doing gymnastics. When can I go to rehabilitation center? And when will you be able to drive? Right leg. Left hand drive car. Thanks in advance for your reply!

Sergei | 03/01/2018 at 20:28

Thanks for the answer. In the pictures with exercises Exercises to perform at home Long-term rehabilitation period No. 3, 6, 12 movements that doctors usually forbid to do. In these pictures, the movements and loads are both healthy joint. Does this mean that over time, all movements will be restored. It scares me that in life you won’t be able to tie your shoelaces and just squat down. I am 44 years old but before the injury I led an active sports lifestyle. Therefore, the question. Traumatologists do not have a unanimous opinion on the current state, either to wait another six months or prosthetics. nicrotic processes are not observed, but there is no accretion. Here you are trying to assess what can expect you after prosthetics.

Svetlana | 03/01/2018 at 08:52

Good afternoon! I have such a question. I had a hip arthroplasty in November 2016. I would like to know what I am strictly forbidden to do for life. I want to go to the gym on which simulators I can do.

Sergei | 28.02.2018 at 21:01

Good afternoon. I have a fracture of the femoral neck with displacement, intra-articular. For six months, the fracture did not heal. There is a high probability of prosthetics. Tell. After completing the rehabilitation course - a year, two, three, will it be possible to bend the leg more than 90 degrees. To what extent is it possible to restore the degree of movement of the leg without fear of joint breakage or dislocation. Knee to chest, squats, etc. Or does it depend on the brand of the prosthesis?

karina | 26.02.2018 at 15:20

Good afternoon. I want to ask, a week has passed since the operation. I have read a lot, but it is not clear how much you can walk, I am hyperactive, it is difficult for me to sit and lie down. Thank you.

Christina | 02/25/2018 at 06:23

Alex admin, thank you very much for your answer. A new one has arisen, how long should I sleep on my back after surgery? It’s just that the husband is already tired, I want to roll over on the unoperated side. It's been 2 weeks since the surgery.

Hip replacement surgery is one of the most difficult, after which a long recovery is required. If a person works, and most often it happens, you have to worry not only about your health. Sick leave required at work. The problem is that immediately after the operation it is impossible to say exactly how long the rehabilitation will last and how the artificial prosthesis will behave: will a person be able to lead a full-fledged lifestyle or will he have to apply for disability and leave work.

Recovery period after endoprosthetics

According to the law, after such an operation, rehabilitation lasts 3 months: 2 weeks a person is in the hospital under the supervision of doctors and then continues to be treated at home. Immediately after discharge, an open sick leave is issued for a period of 3 months.

Why is this happening:

• a person must adhere to an individual schedule of classes under the supervision of exercise therapy specialists, therefore, be at home;
• at first, heavy loads should not be given, because the prosthesis has not yet taken root in the body and there is a danger of dislocation, a person should always be able to lie down and rest - this is impossible at work;
• 90% of people after endoprosthetics experience severe pain in a sitting position, therefore, frequent changes in position and the use of painkillers are required - if the work is sedentary, a person needs to go through the recovery stage in a calm environment;
• if you do not adhere to the regimen within a year after the operation, complications are possible in the form of dislocation, fractures. The risk increases in people old age who have concomitant diseases or endocrine disorders, working pensioners after arthroplasty should be more attentive to their health after surgery.

Even a year after hip replacement, up to 22% of patients complain of pain. These are official statistics, so you need to be prepared to extend the sick leave in case of continuous pain that will prevent you from working normally.

The primary development of the joint should take place under the strict supervision of the medical staff

Discharge from the hospital after hip surgery occurs after 3 weeks. Must pass:

• acute stage and end the inflammatory reaction;
• wound healing, which is controlled by doctors;
• recovery initial period, also controlled by the clinic staff.

At home, a late recovery period lasts, in which bone tissue is renewed and the body adapts to the prosthesis.

3-4 months is the minimum period that is given to a patient who is in good health. It is difficult to imagine that when bone tissue is destroyed, the body works like a clock. In most cases, returning to work after a hip replacement is delayed.

How to extend sick leave after arthroplasty

If, after 3 months, a person is unable to go to work for health reasons, the issuance of sick leave is transferred to the attending physician. He can issue sick leave for up to 15 days, based on the patient's well-being. That is, a person must come to the hospital 2 times a month or more often - as the doctor says.

After 4 months from the date of the onset of temporary disability, sick leave is closed. Further, the following is possible:

1. The man goes to work.
2. The doctor applies for recognition of the patient as disabled. Appointed medical and social expertise and the person is recognized as disabled. The group is determined by the members of the commission on the basis of the available documents on the state of health.

If health does not improve or a person wants to spend more time at home and devote it to recovery, a temporary disability option is possible. Immediately after the joint replacement surgery, disability documents are submitted, the amount of payments is determined, and the patient sits at home. A year later, the documents are submitted again, after which the disability can be removed and the person starts working. In case of health problems, the disability is extended and he further receives disability benefits.

A sheet of temporary disability with a slow recovery and adaptation, but with positive dynamics, can be extended up to 7-8 months.

Difficult situations with disability recognition

If a conservative treatment does not help a person, one has to resort to surgical intervention. But it often happens that after the operation a person is not able to fulfill his labor obligations. How does the medical and social examination proceed in this case:

1. Logically, an operation is done to a person in order to improve his well-being. After the operation, the patient should feel better, but he applies to the authorized bodies to recognize him as a disabled person.
2. Disability may not be assigned and the patient is at a loss - how to continue to live.

Solution: sue medical organization, substantiating this by the fact that before the operation the person had no disability, but after the surgical intervention he needed it, because the condition worsened. Thus, it is possible to challenge the decision of the ITU.

Controversial situations with sick leave, temporary disability and disability arise when a person undergoes surgery on both hip joints at the same time. The period of sick leave after hip arthroplasty on both sides depends on the patient's condition, the dynamics of the recovery process, but does not exceed 2-3 months. Further, it is possible to extend the sick leave or temporarily issue a disability. Much depends on the position that a person occupies: if this is an office sedentary job, then he is theoretically able to perform it. If it is severe physical, associated with lifting weights or constantly being on your feet, then it is better to immediately apply for disability and adapt to prostheses. A year later, the group may not continue.

A controversial situation in which you need the help of a lawyer and the advice of a doctor is associated with the successive replacement of TBS. If the duration of sick leave after hip arthroplasty on one side is 3-4 months, and the next operation is scheduled in 5-6 months, is it worth going to work or spending time at home taking care of your own health. Practicing lawyers who specialize in social issues are advised to apply for disability after the first operation, calmly wait for the next one and recover after two surgical interventions.

There are cases when the decision of the ITU allows a person to be sent for retraining if the previous place of work is not available for health reasons, and temporarily receive disability benefits. In any case, the terms for extending the sick leave are within the competence of the attending physician, who also sends the person to the commission and writes his opinion on the condition of the operated joints. Therefore, it is necessary to seek help from him.

To apply for the ITU, documents are collected - x-rays, the duration of the sick leave after hip replacement surgery or both, a copy of a diploma, a work book. Great importance has the presence of concomitant diseases and the length of stay in hospital.