Hip Replacement Post Op Protocol
DISCHARGE CRITERIA: HIP REPLACEMENT POST-OP PROTOCOL
TO HOME
- Independent bed mobility and transfers
- Able to safely negotiate home obstacles such as stairs and carpet
- Independent ambulation with assistive device for 300 feet
- Coordinate with Social Work Services to obtain home equipment
- Wheeled walker, Three-in-one commode, Reacher
POST-OPERATION (WEEKS 1-6)
- Walker or crutches
- Weight bearing as tolerated (WBAT)
- Progress to cane and discontinue cane when gait is normal
- Ankle pumps
- Heel slides, Active Range of Motion, Active-Assisted Range of Motion
- Quad sets, co-contractions quads/hamstrings
- Short arc quads up to 10 pounds
- Sitting knee extension (chair or mat) 90-0 degrees
- Weight shifts in parallel bars
- Mini squats 0-45 degrees in parallel bars
- Forward, retro and lateral step downs (small step)
- Double leg heel raises
- Stationary bicycle at week 4
GOALS
- Hip ROM 0-90 degrees
POST-OPERATION (WEEKS 6-9)
- Cane as needed, discontinue when gait is normal
- Continue appropriate previous exercises
- Progressive abductor strengthening
- In standing
- Side lying
- Add light weight in side lying when able to perform 25 reps
- In standing with TheraBand bilaterally
- Lateral and retro walking in parallel bars
- Forward, retro and lateral step downs (medium step)
- Wall squats
- Straight leg raises
- Hip extension strengthening – Standing or prone
- Hamstring curl weight machine
- Knee extension weight machine
- Single leg (stork) standing
- Single leg heel raises
- Treadmill- walking progression program
- Pool therapy
GOAL
- Normal gait
POST-OPERATION (WEEKS 9-12)
- Continue appropriate previous exercises
- Hip flexion > 90 degrees
- Hip machine x 4 bilaterally
- Leg press (<90 degrees hip flexion)
- Proprioception exercises as tolerated (age dependent)
- Practice sit-to-stand without using hands
- Stair training
- Elliptical trainer
- Stretches – quads, hamstrings, hip flexors, iliotibial band
GOALS
- Symmetrical hip ROM
- Walk x 20 minutes
- Stand from sitting without use of hands
POST-OPERATION (MONTHS 3-6)
- Discontinue supervised PT
- Resume all recreational activities as tolerated
- Encourage non high impact activities
Knee Replacement Post Op Protocol
DISCHARGE CRITERIA: KNEE REPLACEMENT POST-OP PROTOCOL
TO HOME
- Independent bed mobility and transfers
- Able to safely negotiate home obstacles such as stairs and carpet
- Independent ambulation with assistive device for 300 feet
- Coordinate with Social Work Services to obtain home equipment
- No Precautions necessary
POST-OPERATION (WEEKS 1-6)
- Walker or crutches
- Weight bearing as tolerated (WBAT)
- Progress to cane as balance allows
- Ankle pumps
- Heel slides, Active range of motion, Active-assisted range of motoin
- Quad sets, co-contractions quads/hamstrings
- Straight leg raises (SLR)
- Quad sets
- Knee extension exercises 90 – 30 degrees
- Hamstring stretches (gentle)
PHASE ONE—IMMEDIATE POST-OPERATION PHASE (WEEKS 1-2)
GOALS
- Active quadriceps muscle contraction
- Safe (isometric control), independent ambulation
- Passive knee extension to 0 degrees
- Knee flexion to 90 degrees or greater
- Control of swelling, inflammation, bleeding
DAY 1-3
- WBAT with walker or 2 crutches
- ROM: 0 – 60 degrees
- Cryotherapy: Commercial unit used continuously or ice 20 minutes of each hour
- Exercises:
- Anile pumps with leg elevation
- Passive knee extension
- Electrical stimulation to quads
- Straight leg raises
- Quad sets
- Knee extension exercises 90 – 30 degrees
- Hamstring stretches (gentle)
DAY 4-10
- WBAT
- ROM: 0 – 90 degrees
- Exercises
- Ankle pumps with leg elevation
- Passive knee extension stretch (emphasis on full knee extension)
- Active assistance ROM knee flexion
- Straight leg raises
- Quad sets
- Knee extension exercise 90 – 0 degrees
- Hip abduction/adduction
- Continue use of cryotherapy
- Continue safe ambulation.
- Physical therapist will instruct on transferring from different positions
CRITERIA TO ENTER PHASE 2
- Leg control, able to perform SLR
- Active ROM 0 – 90 degrees
- Minimal pain/swelling
- Independent ambulation /transfers
PHASE TWO – ACTIVE MOTION PHASE (WEEKS 2-6)
GOALS
- Improve ROM
- Enhance muscular strength/endurance
- Dynamic joint stability
- Diminish swelling/inflammation
- Establish return to functional activities
WEEKS 2-4
- WBAT with assisted device
- ROM: Week 2: 100 – 105 degrees/ Week 3: 110 – 115 degrees/ Week 4: 125 degrees
- Exercises:
- Quad sets
- Knee extension exercise 90 – 0 degrees
- Terminal knee extension 45 – 0 degrees
- Straight leg raises (flexion/extension)
- Hip abduction/adduction
- Hamstring curls
- 1/4 squats
- Stretching: hamstrings, gastrocnemius, soleus, quads
- Bicycle ROM stimulus
- Continue passive knee extension stretch
- Discontinue use of TED hose between week 2 and 3
- Begin front lunges and lateral step up week 3
- Begin machine program (gentle) week 4: leg press, hip abduction/adduction
CRITERIA TO ENTER PHASE 3
- ROM at 0 – 115 degrees
- Voluntary quadriceps muscle control
- Independent ambulation
- Minimal pain/inflammation
PHASE 3 – INTERMEDIATE PHASE (WEEKS 5 – 12)
GOALS
- Enhancement of strength/endurance
- Eccentric/concentric control of the limb
- Cardiovascular fitness
- Functional activity performance
WEEK 5 – 10
- Exercises:
- Continue all exercises listed in Phase 2
- Initiate progressive walking program
- Initiate endurance pool program
- Continue closed kinetic chain and management
- Progress to entire lower extremity strengthening
- Return to functional activities
- Emphasize eccentric/concentric knee control
CRITERIA TO ENTER PHASE 4
- Full non-painful ROM at 0 – 120+ degrees
- Strength of 4+/5 or 85% of contralateral limb
- Minimal to no pain and swelling
- Satisfactory clinical examination
PHASE FOUR – ADVANCED ACTIVITY PHASE (WEEKS 10 – 28)
GOALS
- Allow selected patients to return to advanced level of function
- Maintain/improve strength and endurance of lower extremity
- Return to normal life
WEEK 10 – 28
- Exercises:
- Quad sets
- Straight leg raises (flexion/extension)
- Hip abduction/adduction
- 1/2 squats
- Lateral step ups
- Knee extension exercise at 90 – 0 degrees
- Machine weights as tolerated
- Bicycle for ROM stimulus and endurance
- Stretching – knee extension to 0 degrees, knee flexion to 125 degrees
- Initiate gradual golf, tennis, swimming, bicycle, walking program
