THR Recovery Redux

Hello,
I posted some questions on a thread that was moved here about recovery after THR. There were no responses by Dr . Miles or Dr. Ray. Was this missed? Or do you not want to weigh in on this situation (if so that’s completely understandable). If it was just missed, I would really appreciate your oppinions and experiences on recovering from this procedure. I attached my original question below.

So what is safe and what is stupid for me to do and when? My initial thoughts are that the first few days will be mostly bed / chair ridden with assisted (cane / crutches / walker if needed) walking, moving towards un assisted walking as soon as possible. Once I can walk without aids, is it then ok to begin squatting to a box unloaded? I’m just brainstorming, but I imagine doing unloaded squats to my current box height 18.5”. If I can manage that in controlled manner, then lowering the box an inch and a half for the next session and repeating this until I can squat to depth at which point I can add the bar? I’m guessing the biggest concerns immediately following surgery are dislocation due to the integrity of the capsule, and movement of the implant because the bone has not integrated itself. Is dislocation less of an issue in a stronger person? It seems like the surrounding muscle helps stabilize the joint, so the stronger the surrounding muscle the less likely it would be? I don’t want to do anything that will interfere with integration of the bone, are there things I should avoid and if so for how long?

Thank you,

Brian

Hey Brian,
I apologize for missing your thread. We attempt to get through the responses systematically but sometimes things slip through. There are many factors that will go into your progression post operatively from the approach taken in surgery and surgeon’s preferences for post operative restrictions (it is not uncommon to have certain movements be limited for 6-12 weeks to protect the integrity of the replacement) to how you respond to nerve blocks/medications. The “norm” (I use quotations marks as this is still highly variable) is to have patients up and walking on day one post operative. The risk of dislocation is not predicated on strength as sometimes being stronger allows you to get into positions that a weak individual cannot obtain which is why there are often restrictions on certain movements. For a posterior approach it is typically avoidance of flexion past 90 degrees, no internal rotation, and minimal adduction. I would have an honest discussion regarding your post operative goals with your surgeon and get his take. This is not to say that he will entirely have the best information as I’m sure it comes as no surprise that not all surgeons have a background in strength training but, being as close to on the same page out of the gate with post operative expectations.