The surgical procedure takes its toll on the surrounding tissue of the hip joint. Due to the initially reduced quality and extent of movement, the responsible muscles of the hip joint regress. In order to prevent the joint from stiffening, to rebuild the musculature and to make the joint fit for everyday use, the hip is treated after the operation.
The following is an outline of the respective healing phases and their contents. The medical training therapy is the most active healing phase of the patient. In this phase the recovery is so far advanced that the musculature is trained by a constant load increase.
Aftercare
The inflammatory phase (0-5 day) is divided into 2 phases. The vascular phase, which takes place in the first 48h postoperatively and then the cellular phase from day 2-5. In the vascular phase there is an invasion of leukocytes and macrophages into the tissue.
The leukocytes are a component of the immune system. The macrophages are considered to be the waste utilization in the cell. At first, cells in the tissue begin to damage the vascular system.
This allows oxygen-rich blood to enter the tissue, which increases the PH level and triggers the stimulus for further wound healing. Active macrophages are responsible for the division of fibroblasts into myofibroblasts. These are necessary for the new formation of cells.
In the same step, the collagen synthesis for collagen type 3 begins, which is only found in the inflammatory phase. This type is primarily required for wound closure and forms the basis for further collagen synthesis. In these first hours of wound healing, no specific therapy should be applied.
Instead, the patient should be mobilized out of bed and thrombosis prophylaxis and circulation stimulating measures should be carried out with the therapist. In the cellular phase, the tissue is still slightly resilient. Myofibroblasts are still formed and type 3 collagen still closes the wound.
Many sensitive nociceptors are found at the site of the injury, which are particularly sensitive during the course of wound healing. This prevents overloading of the tissue. The warning signal pain should be perceived by the body.
Therefore, in this phase pain should be adapted and moved/treated in a tension-free area in order to avoid overloading the tissue. The patient may move his leg in the pain-free area. In the beginning he gets crutches which he has to use for 2 weeks and during this time there is only a partial load.
Tensioning of the quadriceps muscle by pushing through the hollow of the knee is possible. The proliferation phase lasts from 2-5 days. The actual inflammation should be completed by then, the number of leukocytes, macrophages and lymphocytes gradually decreases.
From the 14th day on, only myofibroblasts are found in the new tissue. In order to further stabilize the wound, collagen synthesis and myofibroblast activity is crucial in this phase. The load should also take place in this phase in the pain-free and tension-free area.
Too early stretching and too intensive mobilisation should still be avoided, as this prolongs the inflammatory phase and can lead to a pain memory. By soft tissue techniques in the BWS area by the therapist or as independent heat therapy by the patient himself, a sympathetic damping for general relaxation can be achieved. Muscular tensions are thus avoided.
Informative conversations about the following therapy process help the patient to get a positive basic attitude. The patient will be able to increase the movement further and further and initial strengthening exercises such as getting up and sitting down from the chair can be included. In addition, the patient can train climbing and descending stairs on a quilting board.
It is also important to develop a proper gait pattern during the wound healing period. Special attention should be paid to rolling over the entire foot to avoid an unphysiological gait pattern. During the gait phase, special attention should be paid to hip extension, since a steady shortening of the groin in the case of a hip flexion contracture can trigger the complaints in the hip again.
The consolidation phase and rebuilding phase extends from the 21st to the 360th day. During this phase, the fibroblasts multiply and begin to synthesize the basic substance, thus improving the elasticity of the tissue. The newly formed collagen is more strongly stabilized and increasingly organized.The collagen fibers become thicker and more resilient, type 3 collagen fibers are further converted into type 1 fibers.
Myofribroblasts are no longer needed in this healing phase and disappear from the tissue. Until the 120th day, collagen synthesis remains increasingly active and has converted approx. 85% of the collagen type 3 into collagen type 1 on the 150th day.
The number of fibroblasts decreases steadily during this healing phase. Movements are finally allowed in the joint and the load can now be increased. The therapy is only successfully completed when the tissue can withstand the stresses of everyday life.
In movement therapy, devices from medical training therapy can be included. Exercise therapy is usually only allowed from the 3rd month onwards. The leg press, abductors and adductor machine are used for muscle building.
Knee bends and lungeing steps can be incorporated during the wound healing phase. Coordination and balance exercises on uneven surfaces are extremely important for stability in the pelvic area. Exercises such as bridging, one-legged kneeling and knee standing provide strength in the pelvic area.
Exercises on the rope pull into abduction can be performed very well, whereby attention should be paid to a low weight in order to avoid leverage. Exercises on the stepper for ascending and descending to work out the standing strength and lateral steps are very effective.
