Exercises and advice after hip reconstruction surgery

This resource has been designed to help you remember the exercises and advice the therapist went through with you whilst in hospital.

The exercises should be done slowly and smoothly. Some discomfort may be noted whilst doing these exercises after surgery. If pain is limiting doing the exercises, then timing them around pain relief or muscle relaxant medication may be helpful. However, if pain becomes worse please seek advice from a healthcare professional and stop the exercises.

After hip reconstruction surgery it is important for the bones and muscles to heal in their new position. In order for the surgery to be successful it is important to follow the daily program as instructed by your child’s therapist.

Exercises

Hip and knee bends

Start by lying your child on their back or in reclined sitting.

Support your child’s leg under their heel and at their knee. Bend their knee by moving the heel towards the bottom and knee towards the chest.

Do not go past 90 degrees at the hip.

Return to the starting position. Repeat 10 times.

Hip abduction

Start by lying your child on their back.

Make sure your child’s hips are level. Support their leg under the heel and knee.

Gently and slowly take one leg out to the side with the knee and toes pointing up and the knee straight. Continue to take the leg out to the side until resistance is felt then hold this position for 10 seconds. Keep their other leg anchored to stop any movement in it.

Return back to the starting position. Repeat 10 times on each leg.

Ankle exercises

Start by lying your child on their back or propped up.

Make sure your child’s knee is straight. With one hand grasp underneath the heel, place your forearm along the bottom of your child’s foot.

Slowly apply pressure on the foot with your forearm so that the toes point up and back towards the child’s body until resistance is felt. Hold this position for 10 seconds.

Return back to the starting position. Repeat 10 times on each leg if both operated on.

How many times should I do these exercises?

These exercises should be done a minimum of 3 to 4 times a day and they should be staggered throughout the day. Any positive positions your child’s therapist has advised should be adopted whenever your child is resting

What else can improve the outcome of my surgery?

Positioning

Positioning is an effective way of maintaining muscle length by holding a positive position for a prolonged period of time.

If your Consultant has decided to use a broomstick or spica cast to maintain a positive position then the therapists will have provided additional information on how to care for your child and the cast. Your child’s doctor and therapist will have discussed this at the pre assessment appointment if they planned to use a cast.

If your child does not have a cast then they will be given an abduction wedge and gaiters. The abduction wedges is a shaped pillow that supports the legs apart. Gaiters keep the legs straight to help with positioning. These should be used day and night for the first 6 weeks then dropping to overnight and when able during the day after this time. The wedge and gaiters can be removed for completing exercises, personal care needs and sitting in their wheelchair.

Sleeping and sitting

If your child has a sleep system their local therapist should adapt it to accommodate the abduction wedge and support the legs in an open position.

If they do not have a sleep system the therapists will show you how to support your child with pillows, towels and other items you might have at home. Your child would benefit from having something between their legs when sitting in their wheelchair however it is advised to limit the amount of time they spend sitting initially.

They should build up their sitting time gradually to a maximum of 3 to 4 hours at a time. If your child is able to rest with their knees straight do not put pillows under your child’s knees or use the bed function to allow them to bend their knees as this does not promote a good position for healing.

Walking, standing and hydrotherapy

Children must not put any weight through their legs for around 6 to 8 weeks, until they have been back to clinic and had an X-ray. After this time they may begin to stand and bear weight but are encouraged to gradually build up their activity.

For children who access a standing frame they should be able to return to this after 6 to 8 weeks. Once their wounds have healed your child can return to, or start hydrotherapy as long as they do not weight bear if in the first 6-8 weeks.

Managing pain and pressure

Increased pain or discomfort is expected after this operation. Having appropriate pain and muscle relaxant medication can help manage this.

It is important to make sure there is no pressure damage by regularly checking the skin for redness or evidence of rubbing. Any red marks should disappear after 30 minutes of the gaiters or splints being removed. If marks do not disappear and pain continues discuss this with your child’s therapist.

Increased tolerance and time wearing gaiters and wedge will increase the effectiveness of the surgery but issues around pain and skin integrity must be addressed.

What happens next?

We will contact your child’s local therapist to pass on any important information and ask them to see you at home or in school. Your therapist will review your child’s muscles length, exercises and positioning.

It is important that you see your therapist once you leave the hospital so they can continue to help with your child’s exercises and rehabilitation. Your therapist can guide your child’s rehabilitation however it is your responsibility to make sure your child completes the necessary exercises. You should speak with your child’s therapist and school to make a plan for returning to school, when this is appropriate varies based on each child’s individual needs.