CRAIG MCALLISTER, MD | ORTHOPEDIC SURGEON

    CRAIG MCALLISTER, MD | ORTHOPEDIC SURGEON

    SwiftPath Physical Therapy Protocol
    for the Hip

    The Preoperative PT Visit

    The preoperative PT visit is an opportunity for patients, family and physical therapists to become engaged in the SwiftPath approach to recovery after surgery.
    Be sure to take your Patient Guide to this visit. Your therapist will need it to complete the visit.

    4 goals of the Preoperative PT visit:

    1. Gain confidence in and demonstrate skills that enable discharge to home after surgery
    2. Provide instruction on basic exercises for patients for days and weeks after surgery
    3. Identify critical milestones that measure progress allowing patients to report after surgery
    4. Complete the Physical Therapy Evaluation section in the Patient Guide

    SwiftPath Post-op Protocol

    Dr. McAllister’s approach to rehabilitation includes opiate sparing pain management and patient engagement. This approach is proven to reduce pain, stiffness, and the need for prolonged, painful physical therapy. 1,2

    SwiftPath sets a new standard for communication between you and Dr. McAllister’s team. Engaged patients take control of their care, better understand their exercises, and advance to self-directed programs quickly. The result is a more pleasant and faster recovery. This timeline works for most patients. But if your experience is different, please share your goals with your physical therapist to make adjustments.

    1.McAllister, CM, et al. Rapid Rehabiliation after Joint Replacement. AAOS Annual Meeting, San Diego, March, 2016
    2. Austin MS, et al. Formal Physical Therapy After Joint Replacement is Not Required: A Randomized Controlled Trial. JBJS Am. 2017 Apr 19;99(8):648-655

    Postoperative Exercises and Milestones

    Do exercises for 5 minutes every hour for 8-10 hours per day until you get to PT.

    Days 2-7: Do your best to get up and walk or do your exercises

    Goals and Milestones: Icing/elevation, out of bed, chair rise, bathroom skills, stairs, household ambulation, community ambulation, in/out of a car.

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    Assisted leg raises
    When getting up from laying position, use your non-surgical foot or a leg-grabber to raise leg to lift it in and out of bed.

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    Gravity Stretch
    Sit on high stool or table so leg is hanging, and use gravity to work toward 90° of flexion.

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    Calf pumps
    (Foot flexed and pointed): Do these when awake and laying down.


    Weeks 1 - 2: Same exercises as above, and adding the ones below.

    Goals and Milestones:
    Independent walking, ascending/descending stairs (with walker, crutches, and stair rails for support, at least 90° of flexion, increase efforts at active range of motion, Continue with icing and (if appropriate) NSAIDs/acetaminophen before and after exercises.

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    Extension without support
    Sit in a stable chair, lift leg out straight. Hold for 10 seconds then relax. Repeat 10 times.

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    Independent walking
    Walk without assistive devices. Use walker or rails for support on stairs.

    One of the main goals of physical therapy is to help regain your independence. The sooner that happens, the better patients do overall. This is a good time to consider fewer visits with a physical therapist with more emphasis on an independent, self-directed physical therapy program. Your therapist will help you develop a program that works best for you.

    Weeks 2-6:

    1. Walking with or without crutches.walker depending on doctor's orders
    2. Elliptical
    3. Treadmill
    4. Stairmaster
    5. Stationary bike
    6. Pool therapy (once physician has cleared wound healing)
    Continue with icing, NSAIDs before and after exercises. Avoid overexertion and limit duration of exercise based on pain and swelling and stiffness.

    Weeks 6 - 12:
    Transition to low-grade recreation (gentle hikes, golfing, extended walks, treadmill, elliptical, etc). Progress to more strenuous activities slowly and judiciously. If you struggle with pain, stiffness, range of motion or in any other way, return to the clinic and consider a PT consult.


    Post-op Hip Surgery DOs and DO NOTs

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    DO keep feet part and even put a pillow between legs at night to prevent crossing.

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    DO sit in a high chair with feet apart.

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    DO walk up steps with the non-operated leg first.

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    DO walk down steps with the operated leg first.

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    DO NOT cross your legs for six months.

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    DO NOT sit with legs crossed for six months.

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    DO NOT bend deeply at waist. To bend over, move the operated leg back or use a reacher.

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    DO NOT twist your body around with the operated leg fixed on the ground.


    Post-op Hip Precautions

    • Riding in a car is permitted as long as you make frequent stops, at least once per hour, to get out and walk around.
    • Always sit in a chair with arms. Avoid sitting on low chairs or sofas. Instead sit in a high chair or place a firm cushion on your furniture. Use the armrests on the chair to assist you getting up.
    • Do not cross your legs. Always sit with your legs 3 - 6 inches apart.
    • Have a pillow between your legs when turning in bed.
    • Avoid low or conventional toilet seats. Use a toilet seat riser for the next 12 weeks to avoid excessive bending of the hips. When using a public restroom, you should use the handicapped facilities to ensure adequate toilet height.
    • No tub baths, only showers, until hip precautions are discontinued by your physician.
    • Sitting in the bottom of your bathtub is forbidden. Do not sit in a bathtub until your physician approves that activity. You may want to get a shower seat for your tub.
    • Do not reach down to put on shoes and socks. You may want to get a long handled shoehorn. Eventually, you put your shoes on by placing your foot of the operated hip on the opposite knee.
    • Avoid stooping, squatting or bending forward excessively for the first 6 weeks. Use a reacher if you need something very low.
    • Do not turn your knee, hip, or foot inward when sitting, standing, or lying down.
    • Avoid sitting more than 60 minutes at a time.
    • All furniture that you sit or lie on must be at least 18 inches off the floor.
    • It is recommended that you do not drive until three to four weeks following surgery. When getting into a car, back up to the seat of the car, sit and slide across the seat toward the middle of the car with your knees about 12 inches apart. A plastic bag on the seat will help you safely slide in/out of the car.
    • Sexual activity can be resumed per your physician's instructions and positioning of the hip must be careful as outlined above.
    • You can usually return to work within three to six weeks or as instructed by your doctor.