Minimally Invasive Anterolateral Hip Replacement-Physical Therapy Postoperative Protocol

Guidelines

• There are no hip precautions after surgery.
• Walker is used for ambulation for the first week.
• You can start using a cane the second week and you should use it for at least one week. You can come off the cane when you can walk without the cane and without a limp.
• Stairs should be done using the non-operative leg and a cane. When you stand from a seated position, you should favor your operative leg for the first four weeks. At that time, you can walk upstairs normally and also stand up from a chair using both legs.

Week One

• Goal: Ambulate with rolling walker without a limp.
• Complete Phase I exercises 3X/day. Ankle pumps, gluteal and quad sets, heel slides, supine abduction and SAQ sets.

Weeks Two and Three

• Goal: Ambulate with a cane without a limp and after a week go without the cane, if you are not limping.
• Continue Phase I exercises and start Phase II exercises 3X/day. Standing hip abduction, hip extension, standing hamstring curls and standing hip flexion, small step over and if available, stationary bike or elliptical without any resistance.

Week Four

• Goal: Ambulate without limping not using a cane.
• Start Phase III exercises 3X/day. Continue the exercises from phases I and II and start to incorporate more Closed Kinetic Chain exercises. Begin partial squats, sit to stand exercise (using both legs) and stretches as appropriate. Continue cardio exercises on the stationary bike or elliptical.

Phase I Exercises:

1. Elevated Ankle Pumps: Lie back with foot elevated above the heart. Pump the foot/ankle up and down. Complete 1-2 sets of 10 reps, 3X/day.
2. Quad sets: Sit or lie on your back with leg straight. Keep knee straight and tighten the quad muscle just above the knee. Hold for 5 seconds. Perform 1-2 sets of 10 reps, 3X/day.
3. Gluteal sets: Lie on your back with your legs straight and squeeze your buttocks together. Hold for 5 seconds. Perform 1-2 sets of 10 reps, 3X/day
4. Heel slides: Lie on your back and slide your heel towards your buttocks, bending your knee. Return to the start position slowly. Perform 1-2 sets of 10 reps, 3X/day.
5. Leg slides: Lie on your back, tighten your quad and slide your leg out to the side away from the midline. Keep your knee straight and our toes pointed toward the ceiling as you slide your leg. When you get out as far as you can without causing pain, return to the starting position. You can place a pillowcase or plastic bag under your foot to reduce friction. Perform 1-2 sets of 10 reps, 3X/day.
6. Short arc quads (SAQ): Lie on your back with a thick rolled towel or pillow under your knee (bent at about 45 degrees). Straighten your knee by tightening your quad muscles to raise your foot up. Return to start position slowly. Perform 1-2 sets of 10 reps, 3X/day.

Phase II Exercises:

1. Standing hip abduction: Stand at a counter and tighten your quad muscles. Keeping your leg straight and your toes pointing forward lift your leg out to the side. When you get out as far as you can without causing pain, return to the starting position. Perform 1-2 sets of 10 reps, 3X/day.
2. Hip extension: Stand at a counter and tighten your quad muscles. Keeping your leg straight and your toes pointing forward extend your leg backwards. When you get back as far as you can without causing pain, return to the starting position. Stay standing tall and avoid leaning forward as you kick back. Perform 1-2 sets of 10 reps, 3X/day.
3. Standing hamstring curls: Stand at a counter and bend the operative knee back to lift the foot towards your buttocks and then return slowly to the starting position. Stay standing tall and avoid leaning forward. Perform 1-2 sets of 10 reps, 3X/day.
4. Standing knee bends: Stand holding a counter beside you and then lift your operative knee up to the level of your hip. Try to keep the knee in line with the hip in front of you and then return slowly to the starting positions. Perform 1-2 sets of 10 reps, 3X/day.
5. Step overs: Stand in front of a mirror with your cane on the non-operative side. Place a large towel roll (3-4 inches high) on the floor at your toes. Step over the roll bending at the hip and knee. Touch your heel on the other side of the towel and then tighten your quad. Return to the starting position. Watch in the mirror to avoid hiking your hip or leaning to one side. Remember to bend at the knee and hip. Perform 1-2 sets of 10 reps, 3X/day.
6. Reverse step overs: Stand in front of a mirror with your cane on the non-operative side. With the rolled-up towel behind you lift your foot back over the towel and touch your toe on the other side of the roll squeezing your gluteal muscles and letting the hip extend. Return to the starting positions. Try to stay tall. Perform 1-2 sets of 10 reps, 3X/day.
7. Stationary bike: Keep the seat high enough so that you have no sensation of pinching in the hip during the pedal revolution. Start at 5 minutes and work up by 5-minute intervals daily as tolerated.

Phase III Exercises:

1. You can stop the step over exercises when you can walk without a limp.
2. Partial squats: Progress to squats in front of a mirror. Sit back and do not allow knees to come more forward than the tips of your toes. Keep toes forward and chest lifted. Avoid shifting off the surgical leg.
3. Add gentle stretching of the calves, hip flexors, hamstrings, adductors and abductors and quads as needed. Hold each stretch for 30 seconds and repeat each muscle group 3 times.
4. Progress cardio and core strengthening as tolerated.