The different phases of wound healing | Physiotherapy after hip surgery

The different phases of wound healing

In the acute phase after a hip operation (1-5 days after surgery) the tissue is still inflamed and not resilient. Pain relief and support of wound healing are the focus of physiotherapy here. Soft tissue treatment and cold and heat therapy are part of the physiotherapeutic approaches, as is manual lymph drainage, which can support wound healing.

Movements are performed gently and to an appropriate extent, always well below the pain threshold. After an endoprosthesis it is possible that the early functional load is important for wound healing. In this case, the transfer to a standing position and light, appropriate gait exercises are performed in the first few days after surgery.

If a joint cannot be loaded, usually only the safe, joint-gentle transfer into the seat is practiced in order to strengthen the patient’s circulation again. In the following phase, the proliferation phase (day 5-21), the body begins to break down old tissue and build up new tissue and heal it. It is important in this phase to set the right stimuli.

However, since the new tissue is not yet very resilient, it is very important to avoid overstraining and trivializing the wound. Physiotherapy after a hip operation in this phase still takes place in the pain-free area. The pain-free improvement of mobility is becoming more and more important, and even light strengthening exercises can be included in the treatment.

The patient is more and more actively involved in the therapy. In gait school, the walking distance is now longer, more emphasis is placed on a physiological gait pattern and the correct use of aids such as forearm crutches. Soft-tissue techniques and other therapeutic techniques are also used.

In the consolidation phase (day 21 – 60) the focus is now clearly on active therapy. The patient becomes more resilient day by day and the stabilizing tissue can now be challenged more. Active exercises to improve mobility as well as functional exercises for strengthening are part of the therapy.

Auxiliary means can now also be used. Thera bands or training on equipment such as the leg press are particularly suitable for this purpose. It can be trained up to the pain threshold.

Passive therapist techniques are hardly part of the therapy – only in the case of persistent adhesions or pain points are soft tissue techniques possibly still used.In the organization phase (from 60th day), the tissue continues to rebuild as the body will need it later. This can be supported by setting specific stimuli. Active exercises become more difficult, coordination training and exercises suitable for everyday life and tailored to the patient become part of the therapy. In this way, the tissue is specifically prepared for the coming stresses and strains. The hip joint with its surrounding musculature can now again be strongly and supra-threshold loaded with training stimuli.