This is how patients with femoral head necrosis recover after surgery

Author: Liu Weilu, attending physician at Nanfang Hospital, Southern Medical University

Reviewer: Wang Jian, Chief Physician, Nanfang Hospital, Southern Medical University

After artificial hip replacement or femoral head replacement, patients need to undergo systematic and gradual rehabilitation exercises. At different stages of treatment, the patient's pathophysiological state, pain perception and expected functional level are different. Professional rehabilitation exercises should provide different rehabilitation training strategies according to the patient's condition. In actual clinical treatment, each patient has different physiques and tolerances. Therefore, a systematic evaluation is required first, and then an individualized rehabilitation plan for the patient is formulated based on the evaluation results. During the rehabilitation training process, attention should also be paid to the patient's pain state and the functional damage caused by pain. At the same time, the addition of instruments and physical therapy can also help patients achieve the goal of painless rehabilitation, and ultimately achieve the best rehabilitation effect for patients. The goals of rehabilitation treatment include pain relief and gradual recovery of limb function. Doctors should give different rehabilitation exercise guidance according to the individual conditions of the patients.

What rehabilitation exercises can I do within 6 weeks after surgery?

The goals of rehabilitation exercises within 6 weeks after surgery are: control pain, reduce edema, protect the trauma site, increase joint mobility, proprioception training, and increase muscle strength without weight bearing.

1. Hip ice pack cold compress: Cold compress is part of postoperative rehabilitation, which can effectively reduce swelling of the surgical area and control pain. Apply for 15 to 20 minutes each time, once every 2 to 4 hours.

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2. Ankle pump exercise: Actively extend the ankle joint to contract the lower limb muscles, squeeze the deep blood vessels, promote blood circulation, and prevent deep vein thrombosis in the lower limbs. Do it 15 times per hour, hold each movement for 5 to 10 seconds, then relax, 10 to 15 times per set, 10 to 12 sets per day.

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3. Joint mobility training

① Hip extension exercise: Flex the contralateral hip and knee joints, and actively straighten the hip joint on the operated side to fully stretch the hip flexor muscles and the anterior part of the joint capsule. 12 exercises make up a group, do 3 groups each time, rest for 30 seconds between each group, and do it twice a day.

② Hip flexion exercise: Lie on your back and flex your knees, slide your heels toward your buttocks, and the angle of hip flexion must be less than 70°. Do 12 exercises as a set, 3 sets each time, rest for 30 seconds between each set, twice a day.

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4. Quadriceps isometric contraction training: Lie on your back, tighten the front thigh muscles, press the knee joint down to the bed, hold for 10 seconds, and slowly relax. 12 as a group, do 3 groups each time, rest for 30 seconds between each group, twice a day.

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5. Sitting quadriceps training: Sit (body leans back, the angle between thigh and abdomen>90°), do full range of flexion and extension of calf, and hold for 5 seconds at the end of extension. 12 for 1 set, do 3 sets each time, rest for 30 seconds between each set, 2 times a day (you can tie a sandbag according to your tolerance).

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What rehabilitation exercises can be done 6 weeks to 3 months after surgery?

The goal of rehabilitation exercises 6 weeks to 3 months after surgery is to normalize gait with assistive devices and to perform daily activities independently. The following are rehabilitation exercises that can be done.

1. Clamshell exercise: Lie on your side, bend your knees, with the affected side on top, and slowly open your knees upwards like a shell. Hold the knees at the end for 5 seconds, then slowly lower them. Do 12 reps as a set, 3 sets each time, rest for 30 seconds between each set, twice a day. Depending on your tolerance, you can increase resistance, such as using an elastic band.

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2. Standing hip abduction training: In a standing position, slowly extend one thigh outward (keep the buttocks still, tighten the abdomen, and do not twist the body), hold it at the end for 5 seconds, and then slowly retract it. 12 as a set, do 2 sets each time, rest for 30 seconds between each set, twice a day.

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3. Single-leg squat: Stand on one leg on the ground, put a box behind your buttocks (the height of the box is about 1/3 above the knee, and the height of the box can be lowered later), then squat, push your buttocks backward, and stand up immediately after your buttocks touch the box. Be careful not to bend your knees too much. 12 reps is a set, do 2 to 3 sets each time, twice a day.

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4. Unilateral hip bridge: The patient lies on his back with both knees bent like hooks. One knee joint is fully extended, while the other lower limb remains bent. Press down with the heel and lift the hip upwards. Try to maintain the position of the body, and then slowly return to the starting point. If the heel is placed on a wedge-shaped pedal with a certain slope, the range of motion of this action can be increased. Remember to practice on both sides. 12 reps make a set, do 3 sets each time, rest for 30 seconds between each set, and do it twice a day.

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5. "Dead Bug" Training: Lie on your back on the mat, bend your knees, make the angle between your thighs and calves 90 degrees, open your arms and straighten them. The key is to tighten your abdomen and lift your shoulders and legs off the ground. Note that the angle between your thighs and body should not be less than 90 degrees. Do 10 times per set, stop for 6 seconds each time, and repeat 2 to 3 sets per day.

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What rehabilitation exercises can be done 3 to 6 months after surgery?

The goal of rehabilitation exercises 3 to 6 months after surgery is to be able to alternately go up and down stairs, be able to independently dress the lower body, including putting on and taking off shoes and socks, and be able to perform special functional activities (cycling, swimming, etc., 1 to 2 times a week). The following are rehabilitation exercises that can be done during this stage.

1. Lateral step training: Stand with the affected leg on the step, flex the hip 20 degrees, slowly lower the healthy foot from the step, and then slowly lift it up (raise your head, chest, and abdomen). 12 reps make a set, do 3 sets each time, rest for 30 seconds between each set, twice a day.

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2. Stability ball pull-up and medicine ball throwing: Lie on your back on a stability ball, bend your knees 90 degrees, place your feet flat on the ground, stretch your arms, hold the medicine ball over your head and quickly curl forward, throw the medicine ball to the wall, and continue to swing your arms to the maximum after the medicine ball is out. 12 reps for 1 set, do 3 sets each time, rest for 30 seconds between each set, twice a day.

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3. Throw the medicine ball obliquely in front of you: Stand with your feet shoulder-width apart, bend your knees slightly, throw the ball toward the wall in the manner of a down throw, and catch the ball by scooping it out. 12 reps make up a set, do 3 sets each time, rest for 30 seconds between each set, and do it twice a day.

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4. Single-leg balance training: Stand on a soft mat or a BOSU ball (Bosu ball or half-round ball) with your supporting leg, stand on one leg, stand for 15 seconds the first time, 20 seconds the second time, 25 seconds the third time... After that, you can close your eyes or throw and catch a ball to increase the difficulty. 12 for a group, do 3 groups each time, rest for 30 seconds between each group, twice a day.

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5. Wall-rolling ball micro squat training: Stand up, lean against the wall (feet shoulder-width apart), clamp a ball between your back and the wall, slowly squat, slowly bend your knees 30 degrees (toes do not exceed knee joints, back straight), hold for 10 seconds, then stand up slowly. 12 times as a set, do 3 sets each time, rest for 30 seconds between each set, twice a day.

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