Strengthening exercises after total hip replacement

Posted by naturegirl5 @naturegirl5, Mar 3 8:44am

I'm looking for feedback, suggestions, and support for re-building strength after left total hip replacement.

My surgery (anterior incision) was at Mayo in November, 2019. For the first 3 months after surgery, I followed the physical therapist's recommendations for exercises (range of motion, walking, stationary bike) and added no leg bands or weights to my lower body. I even went snowshoeing and that was great! Let me note that I've been lifting weights for almost 30 years and was physically active until the hip pain became worse over the past few years. Thus, the decision to do the recommended total hip replacement. At the 3 month follow-up on February 20, 2020, the surgeon said there are no restrictions on my physical activity but to take it slow. I've still trying to figure out what "taking it slow" means. I'm lifting light weights (10-15 pounds) on machines (hamstring curls, leg extensions, leg press). I've added these just since returning from that February 20 appointment at Mayo and go to the gym twice a week. I have osteoporosis so weight lifting is important. But here's the thing – I have more pain and discomfort in my surgical leg and lower back than before February 20.

What is everyone else doing for their rehab post surgery at the 3 month mark? How are you have pain? How are you managing?

Blessings to you all.

Hi @naturegirl5, I haven't had a hip replacement yet… 🙂 but I'm close to a year out from a total knee replacement and am trying to keep exercising as much as I can because I also think it's important. Sounds like you are doing great with exercising but just trying to figure out how much might be too much. I do all of my exercises at home using an elliptical and a recumbent exercise bike. I also have 10 pound hand weights that I use but not quite as often but then I'm an old guy. I did find a PDF file from Vancouver Health – Exercise Guide for Hip Replacement Surgery that has a section for exercise guidelines 3 months to a year starting on page 33 of the PDF. One thing on the page that I thought might be helpful for you is a chart for hip joint loads during exercise. Page 38 lists a lot of Internet resources that may also be helpful for you.

Exercise Program for Total Hip Replacement – Vancouver Coastal Health
https://vch.eduhealth.ca/PDFs/FB/FB.863.Ex37.pdf

Liked by naturegirl5

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@johnbishop

Hi @naturegirl5, I haven't had a hip replacement yet… 🙂 but I'm close to a year out from a total knee replacement and am trying to keep exercising as much as I can because I also think it's important. Sounds like you are doing great with exercising but just trying to figure out how much might be too much. I do all of my exercises at home using an elliptical and a recumbent exercise bike. I also have 10 pound hand weights that I use but not quite as often but then I'm an old guy. I did find a PDF file from Vancouver Health – Exercise Guide for Hip Replacement Surgery that has a section for exercise guidelines 3 months to a year starting on page 33 of the PDF. One thing on the page that I thought might be helpful for you is a chart for hip joint loads during exercise. Page 38 lists a lot of Internet resources that may also be helpful for you.

Exercise Program for Total Hip Replacement – Vancouver Coastal Health
https://vch.eduhealth.ca/PDFs/FB/FB.863.Ex37.pdf

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This great and thank you for sharing. This is a very long program but one would need to follow in phases. But the pictures and explanations are easy to follow.

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@johnbishop

Hi @naturegirl5, I haven't had a hip replacement yet… 🙂 but I'm close to a year out from a total knee replacement and am trying to keep exercising as much as I can because I also think it's important. Sounds like you are doing great with exercising but just trying to figure out how much might be too much. I do all of my exercises at home using an elliptical and a recumbent exercise bike. I also have 10 pound hand weights that I use but not quite as often but then I'm an old guy. I did find a PDF file from Vancouver Health – Exercise Guide for Hip Replacement Surgery that has a section for exercise guidelines 3 months to a year starting on page 33 of the PDF. One thing on the page that I thought might be helpful for you is a chart for hip joint loads during exercise. Page 38 lists a lot of Internet resources that may also be helpful for you.

Exercise Program for Total Hip Replacement – Vancouver Coastal Health
https://vch.eduhealth.ca/PDFs/FB/FB.863.Ex37.pdf

Jump to this post

Thank you, John. The Vancouver Coastal Health Guide has far more information than anything I've seen. This will be helpful. And for what it's worth, I'm getting into that old girl age (I'm 68) so I don't lift like I used to.

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Wow! The Vancouver Coastal Health Guide blew me away. I had a right THR on Feb.19 and my surgeon said they're not recommending any PT for THR's now and to just continue the (very few!) post-surgery exercises (glute clinch, knee tightening, lateral leg slide and bent-knee slide) because walking is the best exercise for recovery. During surgery, there was pertrochanteric fracture of the femur head during insertion of the prosthesis, which was secured with a coil. In the X-ray at 3 weeks. all looked stable and normal, but at 7 weeks there was a bone displacement along the fracture line. My surgeon said it was nothing to worry about and that it wouldn't require any surgery to correct unless it started causing specific pain. He said I could do whatever activity I wished, as long as I "kept my knees apart".
The problem is that I still cannot put full weight on the right leg without pain from groin out to outer hip and am continuing to have to use a cane, but doing so is causing much pain in my left hand (arthritis), arm and shoulder. I am walking on the treadmill as long as the hand can tolerate providing some support (barely over 1/8 mile so far) and using a pedal exerciser. Walking outdoors would be fine except for the pains in the hand and arm and the excess energy it takes just to use a cane for much distance.
I am nearly 80 years old but in very good health otherwise and am really frustrated with the inability to discard the cane. I have another X-ray next week and then a telephone visit (due to COVID) with the surgeon but am not hopeful that he'll say more than "some people take longer to heal" and shrug it off. I would like to at least get one PT appointment to see if they have any suggestions. Seems a bit late to start all the exercises in the V.C.H Guide 12 wks after surgery!
I have tried to research recovery time after a femur fracture during THR but can't find anything except info about such fractures resulting from falls. Has anyone else had experience with this sort of fracture (and displacement?) I am not even sure if the hip pains are due to the fracture or why they aren't going away!

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Hello, @oregonjan. My surgeon said the same about PT not recommended following total hip replacement. I'm 68-years-old and my surgery was November, 2019. I have osteoarthritis in lower back and prior to the surgery I had a leg length discrepancy of 3/4" in the surgical leg due to congenital hip dysplasia (repaired as an infant). In March, 2020 with ongoing pain in my surgical hip and gait problems I requested a PT referral. I never had the PT assessment because because nation/world closed down in mi dMarch. Since PT wasn't available I have followed up on exercises that the PT gave me to do at home (at my request). I had started some strengthening at the gym because that closed in March so I'm doing some strengthening at home with weights and of course walking. I suppose in many cases one can get by with walking after THR and be okay. You had some complications and I'm also wondering if you've been diagnosed with osteoporosis? Anyway, I'd sure insist on more follow-up with your surgeon with a referral to PT as it seems some guided coaching would be best. In my experience, you just have to keep asking and insisting. I just don't know why some physicians/surgeons resist the referral to PT for THR. I'm wishing you all the best.

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@oregonjan
I am sorry you are still struggling, but really, a cane at 3 months is not so unusual when there are complications of THR. But the continuing pain sounds like it is a concern to you, as it would be for me.

I have had 5 (not a typo!) hip replacement surgeries, the first 2 at age 55 and the next 3 at age 62 – the first round were not followed by PT, and I never did get a proper gait or full strength. When the implants failed and had to be replaced, the new surgeon was appalled that I had not had PT in the past, and sent me to a very good rehab team.

I did land and water therapy (I too had problems with weight-bearing for some time) and gait training. I had limped for so many years before the surgery, and again after the first round, that I needed a lot of help. Altogether, I spent over 3 months in twice a week therapy, and continued on my own for another 6 months. Needless to say, my results in round two were far superior to the first time. Now, some 7 years later, most days I walk at a brisk pace for an hour a day, or dance for 2 hours pain-free and (until Covid-19) was able to keep up with my 2 young grandsons all day.

If you can find a safe way/place to do PT, I strongly recommend you press your surgeon to refer you for therapy once the femur is healed – my friend had a similar complication back in November, and had to wait 12 weeks to begin therapy. She is still having therapy twice weekly and progressing well. She too has arthritis, and found an upright walker (like this: https://www.healthproductsforyou.com/ar-up-walker-walking-aid-upright-walker.html) was the solution to getting about with less pain.

As @naturegirl5 says, you must be assertive on your own behalf, because you are the one who has to live with the results. Good luck

Sue

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@sueinmn

@oregonjan
I am sorry you are still struggling, but really, a cane at 3 months is not so unusual when there are complications of THR. But the continuing pain sounds like it is a concern to you, as it would be for me.

I have had 5 (not a typo!) hip replacement surgeries, the first 2 at age 55 and the next 3 at age 62 – the first round were not followed by PT, and I never did get a proper gait or full strength. When the implants failed and had to be replaced, the new surgeon was appalled that I had not had PT in the past, and sent me to a very good rehab team.

I did land and water therapy (I too had problems with weight-bearing for some time) and gait training. I had limped for so many years before the surgery, and again after the first round, that I needed a lot of help. Altogether, I spent over 3 months in twice a week therapy, and continued on my own for another 6 months. Needless to say, my results in round two were far superior to the first time. Now, some 7 years later, most days I walk at a brisk pace for an hour a day, or dance for 2 hours pain-free and (until Covid-19) was able to keep up with my 2 young grandsons all day.

If you can find a safe way/place to do PT, I strongly recommend you press your surgeon to refer you for therapy once the femur is healed – my friend had a similar complication back in November, and had to wait 12 weeks to begin therapy. She is still having therapy twice weekly and progressing well. She too has arthritis, and found an upright walker (like this: https://www.healthproductsforyou.com/ar-up-walker-walking-aid-upright-walker.html) was the solution to getting about with less pain.

As @naturegirl5 says, you must be assertive on your own behalf, because you are the one who has to live with the results. Good luck

Sue

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Great, positive info! Thanks for more emphasis on PT as I'm going to really insist on some. If I can't get the surgeon to refer me for it, maybe my primary Dr. can have some influence…..
I wondered about an upright walker but walkers are SO inconvenient when you have to carry anything large or bulky. I tried a tray on my regular walker but found it placed me too far to the rear for back comfort. Even carrying things when using a cane is a "pain" and sometimes impossible when 2 hands are needed! Will keep trying things and hoping for PT!
Thanks to everyone for the input!

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@sueinmn

@oregonjan
I am sorry you are still struggling, but really, a cane at 3 months is not so unusual when there are complications of THR. But the continuing pain sounds like it is a concern to you, as it would be for me.

I have had 5 (not a typo!) hip replacement surgeries, the first 2 at age 55 and the next 3 at age 62 – the first round were not followed by PT, and I never did get a proper gait or full strength. When the implants failed and had to be replaced, the new surgeon was appalled that I had not had PT in the past, and sent me to a very good rehab team.

I did land and water therapy (I too had problems with weight-bearing for some time) and gait training. I had limped for so many years before the surgery, and again after the first round, that I needed a lot of help. Altogether, I spent over 3 months in twice a week therapy, and continued on my own for another 6 months. Needless to say, my results in round two were far superior to the first time. Now, some 7 years later, most days I walk at a brisk pace for an hour a day, or dance for 2 hours pain-free and (until Covid-19) was able to keep up with my 2 young grandsons all day.

If you can find a safe way/place to do PT, I strongly recommend you press your surgeon to refer you for therapy once the femur is healed – my friend had a similar complication back in November, and had to wait 12 weeks to begin therapy. She is still having therapy twice weekly and progressing well. She too has arthritis, and found an upright walker (like this: https://www.healthproductsforyou.com/ar-up-walker-walking-aid-upright-walker.html) was the solution to getting about with less pain.

As @naturegirl5 says, you must be assertive on your own behalf, because you are the one who has to live with the results. Good luck

Sue

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After much back and forth with my surgeon while I requested a PT referral, and an unnecessary office visit, HE finally diagnosed that my muscle group lacked strength and HE had a brilliant idea: that I needed PT, as if no one had mentioned it before that! He even asked me if "we had any therapy". However, because of the continuing COVID restrictions on in-person visits, my PT appointment will be a video one. No idea how THAT is going to go but I'll find out on the 16th.
I think I am able to bear a little more weight on that leg and just need to get the muscles back in shape so my hand can start to get better after all the stress it's had.
I'll post again after the virtual PT visit.

REPLY
@oregonjan

After much back and forth with my surgeon while I requested a PT referral, and an unnecessary office visit, HE finally diagnosed that my muscle group lacked strength and HE had a brilliant idea: that I needed PT, as if no one had mentioned it before that! He even asked me if "we had any therapy". However, because of the continuing COVID restrictions on in-person visits, my PT appointment will be a video one. No idea how THAT is going to go but I'll find out on the 16th.
I think I am able to bear a little more weight on that leg and just need to get the muscles back in shape so my hand can start to get better after all the stress it's had.
I'll post again after the virtual PT visit.

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@oregonjan Hurray! We really do need to be out own advocates. If your restrictions are like ours, after the initial video consult, you will probably be allowed at least one or two in-person sessions, perhaps with video progress checks in between. In your place, that is what I would campaign for with the PT. Let us know how it goes.
Sue

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@sueinmn

@oregonjan Hurray! We really do need to be out own advocates. If your restrictions are like ours, after the initial video consult, you will probably be allowed at least one or two in-person sessions, perhaps with video progress checks in between. In your place, that is what I would campaign for with the PT. Let us know how it goes.
Sue

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Had my video visit with PT and it went much better than I'd thought it could. She watched my movement, etc. and gave me a new set of exercises. She was amazed I hadn't gotten and standing exercises on discharge from the hospital or at least at first post-op. She didn't look very pleased that the surgeon had said "just walk" because she pointed out that the longer I walked with a cane the more that movement would become part of muscle memory and harder to overcome, even when I COULD put full wt. on that leg.
I can already feel results of just the clamshell and bridging exercises she recommended. The correct muscles show fatigue after exercising. I have follow-up video visits weekly for a month and then will see if I need to be seen in person. (I have had other PT with this therapist in the past and she is very good.)

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@oregonjan Yay! Doesn't it feel great to be actually doing something that will help regain your mobility. I have a new first question for all ortho surgeons now. "What is your view of post-surgical PT?" If they are ho-hum or negative, I find a different doc! After 11 surgeries for ortho issues, almost all due to arthritis, I have concluded that the operation is just ONE STEP in the process, and proper PT and exercise are just as critical to a successful outcome. Keep us posted on your progress. And ice after exercise will help keep you going.
Sue

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Perfect Sue. Keep singing that song. Post-op is not a race.
Chris

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@artscaping

Perfect Sue. Keep singing that song. Post-op is not a race.
Chris

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@artscaping Thanks Chris. Maybe just trying to psych myself up. Thumb recovery is on my horizon in a few weeks. 3 months with an OT twice a week, and 6-9 months of twice daily exercises at home. It worked well for the other hand, so I'll be keeping at it again. Already wriggling fingers and extending elbow to keep everything from locking up before the cast comes off on July 1st. Thinking about the color of splint I want this time – maybe lime green? Have had red, blue and purple for previous ones. Maybe I should have my grandson choose.
Sue

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@oregonjan

Had my video visit with PT and it went much better than I'd thought it could. She watched my movement, etc. and gave me a new set of exercises. She was amazed I hadn't gotten and standing exercises on discharge from the hospital or at least at first post-op. She didn't look very pleased that the surgeon had said "just walk" because she pointed out that the longer I walked with a cane the more that movement would become part of muscle memory and harder to overcome, even when I COULD put full wt. on that leg.
I can already feel results of just the clamshell and bridging exercises she recommended. The correct muscles show fatigue after exercising. I have follow-up video visits weekly for a month and then will see if I need to be seen in person. (I have had other PT with this therapist in the past and she is very good.)

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I am also back to PT for my post hip replacement surgery. It’s going slow, but finding small improvements every week. Also battling lower back problems so strengthening that as well. Keep it up!!

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@sueinmn

@artscaping Thanks Chris. Maybe just trying to psych myself up. Thumb recovery is on my horizon in a few weeks. 3 months with an OT twice a week, and 6-9 months of twice daily exercises at home. It worked well for the other hand, so I'll be keeping at it again. Already wriggling fingers and extending elbow to keep everything from locking up before the cast comes off on July 1st. Thinking about the color of splint I want this time – maybe lime green? Have had red, blue and purple for previous ones. Maybe I should have my grandson choose.
Sue

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@sueinmn, Oh my goodness, I finally figured out your alias. Of course, you are. That sounds about right for thumb surgery. And you are coming off a success.
May you find joy today.
Chris

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