Total Joint Replacement — Total Hip Arthroplasty (Anterior Approach)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

WBAT with assistive device unless otherwise specified; transition to 1 crutch/cane possible wks 3-6, D/C device once gait normal/pain-free

Key Restrictions

Limit passive extension and ER (direct anterior); avoid SLRs x4 wks; avoid overuse of hip flexor activation with transfers; ROM regained via active/active-assistive movement, avoid passive forced stretching/joint mobs (dislocation/subluxation risk); no yoga x6 wks; no impact activities (running/jumping discouraged) through Phase III

Timeline & Phases

Phase I (surgery-6 wks): protect hip via WBAT gait and ROM precautions (limit passive extension/ER), normalize gait with AD progressing to no device by wks 3-6, restore leg control (standing hip abduction), transition off narcotics to NSAIDs, DVT prevention (TED hose, anticoagulation), isometric hip extension/abduction/adduction/IR/ER, weight shifting to balance exercises, hip AROM without resistance, bridging, supine hip dangle, grade 1-2 hip mobilizations, UBE/treadmill/elliptical; Phase II (6-8 wks): regain muscular strength (focus abduction), progress off assistive device, single leg stance control, functional movements (step up/down, sit-to-stand, squat) pain-free, don socks/garments independently, stationary bike 10-20 min, transfer training to/from ground, hip AROM with progressive resistance, standing/side-lying abduction, functional closed chain abduction strengthening, low-impact endurance training; Phase III (9-12 wks): improve strength/endurance, pain-free with ADLs and work-specific movements, walk 1 mile without limp, strength/balance progressing double-to-single leg and single-to-multi-plane, dynamic control low-to-high velocity, hip/core strengthening progression, ROM/stretching toward and above 90 deg flexion with ER for shoe/sock donning, advance aerobic training (walking, swimming, golf, hiking, Stairmaster, weight training, elliptical, cross-country skiing, doubles tennis, cycling, downhill skiing), lifelong exercise commitment encouraged

Notes

OSMS Rehabilitation Guidelines; antibiotic prophylaxis for dental procedures recommended; references Lahey Hospital THA protocol (Argillo, Barerera, Dynan 2015) and UW Health STAR Team outpatient THA guidelines (2014)