Open Surgical Dislocation
*may include the following concomitant procedures: acetabular rim trimming, labral tear repair, and osteochondroplasty of the head-neck junction
Precautions (must follow for 6 weeks!):
1) When walking with crutches or walker, only place toe of surgical leg on the ground (toe-touch weight
bearing) until indicated. (Change begins at week 4, please see protocol below for specific guidelines)
- do NOT put body weight on surgical leg
2) Do not bend your hips to more than a 70 degree angle
- Do not reach for your feet or try to pick objects up off the floor (use a reacher)
- Do not sit on low surfaces when your knees are higher than your hips
- If a low seat is your only option, place several pillows or a couch cushion on the surface to raise the height
- Use an elevated toilet seat
3) Do not move surgical leg out to the side (called abduction)
- If you have to get out of bed on the same side as the surgical leg, place the surgical leg on top of the non-surgical leg. Then, use arms to move body off the bed.
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the top leg is the surgical leg |
4) Do not drive until your surgeon gives you permission
CPM SCHEDULE:
- Use 4 hours daily until Week 4
- Do not exceed 70⁰
- The below schedule is merely a guideline for increasing flexion (bending of the hip). Progress per pain tolerance
Day of surgery: 0⁰-25⁰/30⁰
Day 1: 0⁰-35⁰/40⁰
Day 2 : 0⁰-45⁰/50⁰
Day 3: 0⁰-50⁰/60⁰
Day 4: 0⁰-60⁰/70⁰
Day 5: 0⁰-70⁰
Exercises to begin on post-operative day 2 and continue daily (3x/day) until week 4:
GLUTEAL SETS
GLUTEAL SETS
Squeeze buttocks within comfort, hold for 5 seconds. Do not hold your breath. Repeat 20 times.
QUAD SETS
Lie with towel roll under knee. Tighten the muscle on the top of the knee while pushing down on the towel with the back of your knee. Hold 5 seconds. Do not hold your breath. Repeat 20 times.
WEEK 4:
Perform exercises 2x/day until week 8:
HEEL SLIDES
Starting position
Ending position
Lie on back with legs straight. Slide heel up towards buttocks (do NOT let hip bend past 70 degrees). Return to starting position. Start with 5 repetitions, when able to perform easily, gradually increase repetitions to 10.
BENT KNEE FALLOUTS
Starting position
Ending position
Lie on your back with the surgical leg bent. Pull in your abdominals and hold your abdominals while you slowly let your bent knee fall out (approximately 6-8 inches). If you begin to experience discomfort, stop lowering at that point. Return knee to starting position. Start with 5 repetitions, when able to perform easily, gradually increase repetitions to 10.
PRONE KNEE FLEXION
Place a pillow under your abdomen. Tighten your abdominal muscles and bend knee of surgical leg, while keeping pelvis and thigh stationary. Return leg to starting position. Start with 5 repetitions, when able to perform easily, gradually increase repetitions to 10.
PRONE HIP ABDUCTION
Place a pillow under your abdomen. Contract your buttock muscle to slide your leg out to the side. Do not let your pelvis move. Start with 5 repetitions, when able to perform easily, gradually increase repetitions to 10.
PRONE FOOT PUSH
Lie face down with your knees apart and bent to 90 degrees. Place a pillow under your abdomen. Allow your hips to rotate so that your feet touch each other. Push your feet together by tightening your buttock muscles. Hold for 5 seconds. Repeat 8-10 times.
PRONE HIP ROTATION (MEDIAL)
Lie face down and place a pillow under your abdomen. Tighten your abdomen and bend your knee to 90 degrees. Rotate your hip by allowing your foot to move away from the opposite leg. Repeat 10 times.
PRONE HIP ROTATION (LATERAL)
Lie face down and place a pillow under your abdomen. Tighten your abdomen and bend your knee to 90 degrees. Rotate your hip by allowing your foot to move in toward other leg. Repeat 10 times.
QUADRUPED ROCKING
Starting position
Ending position
Rock backwards toward your heels by moving in hip joint. Only rock as far back as possible without pain. Repeat 8-10 times.
STRADDLE WEIGHT SHIFTS
Stand with the surgical leg in front and out at an angle. Using the countertop for support of your body weight, place about 10% of your body weight on surgical leg. Then, shift weight back onto non-surgical leg. Repeat 8-10 times.
STANDING HIP ABDUCTION
Shift body weight onto NON surgical leg and move surgical leg out to the side. Keep spine as straight as possible. Repeat 8-10 times.
STANDING HIP EXTENSION
Shift body weight onto NON surgical leg and move surgical leg backwards. Keep spine as straight as possible. Repeat 8-10 times.
WEEK 5:
Continue above exercises. Add the following exercises (perform 2x/day):
SEATED KNEE EXTENSION
Straighten your knee as far as possible. Hold position for 1-2 seconds. Repeat 8-10 times.
SIDE-LYING HIP LATERAL ROTATION
Starting position
Ending position
Lie with surgical leg on top with a pillow between your legs. Bend your top hip and knee about 45 degrees. Slightly rotate knee so knee cap is pointing upward. Move in hip joint only and do not let your pelvis rotate. Repeat 8-10 times.
Can begin aquatic therapy in the DEEP water (please contact me for specific instructions). Due to hip precautions, only use a therapy pool that has a chair lift to assist in getting in and out of the pool.
During week 5, still using two crutches, attempt to place 20-30% of body weight on surgical leg.
WEEK 6:
Still using two crutches, attempt placing 50% of body weight on surgical leg. If your PT clinic has an underwater treadmill, you may begin walking on in (10 minutes). Or, you may begin walking in the shallow end of the pool if you are able to hold onto the edge.
WEEK 7:
Continue above exercises.
With the guidance of your PT, attempt to walk with one crutch (held on the side opposite to the surgical leg). Use one crutch until advised by your therapist (or until you can walk without a limp).
Also, if participating in aquatic therapy, you may place cuffs (for resistance) on your ankles for deep water exercises.
WEEK 8:
May begin riding an upright bike for 10 minutes (make sure that the seat is elevated enough so that your hips are not bending past 90 degrees).
Add the following exercises to your program (perform 2x/day):
SEATED ACTIVE-ASSISTIVE HIP FLEXION
Using your hand, lift your thigh without causing pain. Repeat 10-15 times.
SEATED LATERAL ROTATION
Rotate your hip by allowing your foot to move in toward your alternate leg. Repeat 10-15 times.
SUPINE ACTIVE-ASSISTIVE HIP FLEXION WITH TOWEL
Lying on your back, wrap towel around thigh and gently pull towel to lift leg. Do not cause pain. Repeat 10 -15 times.
Additional exercises:
- Face a countertop and hold on. With legs together, move one leg out to the side. Then, move the other leg to it (a side step). Continue side stepping in that direction for 1-2 minutes. Then, perform same exercise in opposite direction.
- Lying on back with both legs straight, move surgical leg out to the side. Begin with 5 repetitions. Gradually increase repetitions to 10-15.
WEEK 9:
SEATED ACTIVE HIP FLEXION
Sit with hips at right angle with the trunk and shoulders in line with the hips. Actively lift surgical leg (without pain). Hold for 1-2 seconds. Repeat 5-10 times.
STANDING LATERAL ROTATION WITH THERA-BAND®
Starting position
Ending position
Wrap Thera-Band® around foot and attach to something stable (i.e. table leg). Pivot foot outward as shown in the ending position photograph. Return to starting position. Repeat 20-30 times.
Thera-Band® can be obtained from your therapist. The strength depends on the color.
Order of resistance from easiest to hardest: yellow, red, green, blue, black, gray
Additional exercise:
- In exercise from week 4 (prone hip abduction), tie ends of a piece of Thera-Band® together and slide around thighs. Now, perform exercise (Contract your buttock muscle and slide surgical leg out to side. Do not let pelvis move). Repeat 10-20 times.
WEEK 10:
Add resistance to the standing hip extension and hip abduction exercises from week 4 (perform these exercises 1x/day):
STANDING HIP ABDUCTION
Wrap Thera-Band® around ankle of surgical leg and attach to something stable (i.e. table leg). Shift body weight onto NON surgical leg and move surgical leg out to the side. Keep spine as straight as possible. Repeat 20-30 times.
STANDING HIP EXTENSION
Wrap Thera-Band® around ankle of surgical leg and attach to something stable (i.e. table leg). Shift body weight onto NON surgical leg and move surgical leg backwards. Keep spine as straight as possible. Repeat 20-30 times.
WEEK 11:
SUPINE ACTIVE HIP FLEXION
Starting position
Ending position
Lying on back, slide heel toward buttock. Then, lift leg as high as possible without causing pain. Repeat 8-10 times.
SINGLE LEG STANCE
Stand on surgical leg as long as possible (5-30 seconds). Make sure that you are positioned close to a stable surface in case you lose your balance. Repeat 3-5 times.
WEEKS 12-16:
Exercises:
Increase resistance for the following exercises: prone hip abduction, standing lateral rotation, standing hip abduction, and standing hip extension. When you are able to perform 30 repetitions of each exercise without difficulty or pain, you may increase resistance.
Order of resistance from easiest to hardest: yellow, red, green, blue, black, gray
Upright bike:
Increase time and resistance gradually
Walking:
By week 16, you should be strong enough to walk without a crutch or cane
* A special thank you to Nancy Bloom, PT, DPT, MSOT for her guidance*
* A special thank you to Nancy Bloom, PT, DPT, MSOT for her guidance*