After the hip surgery: things are running like clockwork again

Pain-free and mobile again after hip surgery: How to enjoy life with a new hip to the fullest, reveals Prof. Dr. med. Karsten E. Dreinhofer, Medical Director and Head Orthopedic Surgeon of the Medical Park Humboldtmuhle in Berlin.

The phone is ringing in the living room, but hurry now! When the gait becomes a little more unsteady in old age, the landing or the doorstep can become a dangerous tripping hazard in a hurry. A foot gets caught or you lose your balance for a moment and then it happens: a fall and crack!. The result is often painful Femoral neck fractures.

In the course of life, however, it is not only bone density that decreases, which increases the probability of fractures. Especially with arthrosis, the age-related wear and tear of the joints, one is increasingly confronted in the second half of life – every third person over the age of 60 is affected. When going for a walk, a slight pain appears at first, getting into the car is no longer as easy as it used to be, or carrying crates of drinks suddenly becomes an extraordinary burden. The pain gets worse over time, and you try to avoid certain movements. Mobility continues to decrease, but the pain increases: if the hip initially only hurt after walking, it soon also hurts when lying down, and in the worst case the pain can even keep you awake at night.

Whether it’s as abrupt as a fractured neck of the femur or a more slowly progressing process like osteoarthritis, a hip joint endoprosthesis, i.e. the replacement of the natural hip joint, can in both cases help patients lead a pain-free life again without movement restrictions.

AFTER HIP-OP:
QUICKLY BACK ON YOUR FEET

THINKING HOLISTICALLY: MEDICAL PARK’S APPROACH TO THERAPY

According to the Federal Statistical Office, a total of 239 femoral neck fractures were performed across Germany in 2018.204 artificial hip joints implanted. After this operation, all these patients are faced with the task: How do I deal with my new hip?? They are helped by intensive training under professional guidance: "Rehab pursues the goal of restoring bodily functions, activities and participation in social life. That means, in particular, gainful employment and the ability to care for oneself," explains Prof. Dreinhofer.

We see the patient as a whole: with all his individual possibilities, expectations, wishes and fears.

Prof. Dr. med. Dreinhofer, Medical Director and Head Physician Orthopedics of Medical Park Humboldtmuhle in Berlin

At Medical Park, we measure the Holistic approach to therapy high importance: What is the patient’s expectation?? What is his personal perception of pain? What fears drive him? These are just a few of the questions that patients face after hip surgery. It is important to talk to each other and, above all, to listen carefully. Depending on the patient’s state of health and the activities desired and needed in normal life, individual rehabilitation goals are then set together with the patient.

NO "OH WEH!"DESPITE HIP SURGERY:
PROF. DREINHoFER IN AN INTERVIEW

The time between hip surgery and rehabilitation is now often only a few days. What does this mean in terms of pain?

Ten years ago, patients stayed in the hospital for the first two weeks after surgery. Nowadays, many patients are transferred after three or five days. That is, still in the very acute, postoperative pain phase. When the pain catheter is pulled, the effects of the surgery are suddenly fully felt. This is difficult for many patients.

How do you react in the rehabilitation clinic to patients coming to you earlier?

We respond to these changed general conditions with a very differentiated, intensive pain therapy. This has to be very individualized, because every patient feels pain differently and has different experiences with painkillers beforehand: some are used to painkillers for years, others have never taken anything before.

Are more painkillers then the means of first choice??

Our goal is to reduce the amount of strong painkillers as soon as possible. In the immediate postoperative period, morphines and opioids are very effective in combating the most severe pain. At the same time, of course, they have side effects. That’s why we try to keep both the amount and the duration as short as possible.

What measures do you rely on instead to relieve pain??

We include alternatives to classic painkillers in the therapy, such as acupuncture, Reiki or the treatment of trigger points. Physical measures in the form of cold or heat can also contribute to well-being. We also use shock wave therapy: it has a mild pain-relieving effect, but at the same time stimulates tissue regeneration. This metabolic activation supports subsequent tissue healing and the reduction of the bruise that forms after surgery. All in all, these are approaches that allow us to keep the amount of pain medication for the patient as low as possible.

REHAB WITH A NEW HIP:
AS DIVERSE AS LIFE ITSELF

Getting into the car, loading groceries into the trunk, sitting in the bathtub, climbing stairs and, above all, walking straight ahead without limping: As natural as these procedures sound for a healthy person, they are challenging for patients with a new hip. "You often think it’s like a car: I change the tire and afterwards I just drive off. But it’s not that simple with a new joint. Muscles that have been shortened for months or years do not suddenly lengthen after surgery – they must be slowly strengthened again and coordination must be trained. As a patient, you need a lot of patience, a lot of perseverance and sometimes also a high tolerance for frustration," explains Prof. Dr. Dr. Wolfgang Schafer. Dreinhofer.

Training after hip surgery in the Medical Park

Training after hip surgery at Medical Park

Training after hip surgery at Medical Park

Training therapy after hip surgery at Medical Park

Training and rehabilitation after hip surgery in the Medical Park Therapy Garden

What patients can always rely on is the support of the entire Medical Park team. In order to prepare the patient as optimally as possible for the challenges at home in family, work and leisure, the rehabilitation goals are defined by the patient together with the doctor at the beginning of the inpatient stay, the expectations are realistically adjusted and the therapy plan is put together on this basis.

Particularly in the early phase after the operation, the physiotherapists provide support with the first steps. Targeted muscle building and restoring mobility in the hip joint are the focus of attention. Specialized medical masseurs loosen the muscles and achieve a removal of waste products and a slimming of the leg through lymphatic drainage.

In the ADL (Activities of Daily Living) department, occupational therapists provide tips and instructions on how to successfully cope with everyday life again. This ranges from optimized movement sequences to advice on aids that are very practical for use at home. In addition, there is also a Therapy car The patient has a wheelchair at his or her disposal, which can be used, for example, to practice getting in and out of the car without bending the hip joint too much. In the context of a Driving simulations can also safely test how it feels to be behind the wheel again. Do I sit comfortably? Is the reaction time appropriate? And with the new hip, do I have the strength for a full stop??

At Medical Park Humboltmuhle in Berlin, MTT – medical training therapy – is located right next to the ADL area. Thanks to a wide range of state-of-the-art training equipment, patients can build up their muscles individually under the guidance of sports therapists. This goal is also pursued by the training sessions in the Swimming pool. The buoyancy in the warm water facilitates the movement already enormously, experienced therapists support the patients and demostrieren, how one with careful movements the hip again mobilizes. Exercise in the fresh air is also part of the program: At Therapy garden patients practice walking on different surfaces and climbing stairs on their own. In a highly specialized Gait lab the subtleties of the gait pattern can be analyzed by the doctors and individually corrected.

Although artificial hip replacement is one of the most successful operations on the musculoskeletal system, complications can still arise. In the first year after hip surgery, about 2 percent of patients experience a dislocation, in which the hip joint slips out of the socket. However, the risk of such a dislocation can be significantly reduced with a few tips.

WHAT YOU SHOULD AVOID UP TO 12 WEEKS AFTER HIP SURGERY?

  • Jerky and uncontrolled movements of the operated hip
  • Flexion of the operated hip joint over 90 degrees (d. h. no activities with the hands below the knee joint, so z. B. when tying shoes or putting on stockings)
  • Low sitting position (z. B. with low seating furniture or lowered cars)
  • Cross your legs No heavy lifting or carrying (max. 10 kg)

Number of patients Medical Park helped back on their feet after hip surgery in 2018

A FRESH START WITH NEW HIPS:
BACK HOME AGAIN

WHAT DOES LIFE WITH A HIP JOINT PROSTHESIS LOOK LIKE??

"Once patients have trained intensively for three weeks in rehab, many find that exercise is something very positive again. Of course, we want this enjoyment to last for a long time," explains Prof. Dreinhofer. For this purpose Medical Park has its own Training program booklet developed: The therapist then compiles a circuit training program for the individual patient from the exercises contained therein, which should be performed daily over the following weeks.

However, many people know from their own experience how difficult it can sometimes be to overcome one’s inner obstacle at home. This is where routine helps: if you set aside a specific time each day to work out, you’re more likely to get it done. The best time for this is first thing in the morning! So you give the famous procrastination no chance at all.

While you get a lot of encouragement from therapists and doctors in rehab, you have to rely on yourself for motivation when you get back home. Prof. Dreinhofer relies on the courage to innovate: "In cooperation with various companies, we are currently working on smartphone-based aftercare programs, among other things. In the future, these apps will help patients successfully continue their workouts at home – including corrections, positive feedback, and little reminders if they do want to push off." But even without digital support, a new hip allows you to enjoy many sports again. Sports that are easy on the joints are particularly suitable for this purpose.

THEY BRING IN MOVEMENT:
GENTLE LEISURE ACTIVITIES

  • Swimming
  • Walking
  • Nordic walking
  • cross trainer in the gym
  • Cycling

Sports in which the body is subjected to strong jolts, twists or jerky movements are not recommended. Otherwise, nothing stands in the way of an active lifestyle with an artificial hip joint – so get off the couch and back into the adventure of life!

This article was written with the advisory support of Prof. Dr. med. Karsten E. Dreinhofer, Medical Director and Head Physician Orthopedics at Medical Park Humboldtmuhle in Berlin.

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