After a cementless hip replacement, careful aftercare is essential to ensure successful ingrowth of the prosthesis and to avoid long-term complications. In the first six weeks after surgery, the focus is on promoting healing and avoiding unnecessary loads that could jeopardize the ingrowth of the prosthesis.

Mostly full weight-bearing allowed!

With modern cementless hip prostheses, full weight-bearing is usually allowed immediately after surgery. Thanks to improved surgical techniques and the high primary stability of the prostheses, the patient can get up and put weight on the operated leg shortly after the procedure. The stability of the prosthesis depends on its precise positioning and good fit in the bone, which forms the basis for the later ingrowth of the prosthesis. The bone structure around the prosthesis grows firmly onto the implant surface in most cases within six to twelve weeks, ensuring long-term stability.

Despite this early possibility of full weight-bearing, it is important to adjust the postoperative load individually to the patient. Factors such as the general bone quality, the extent of the intervention, and the individual rehabilitation potential play a role here. In the first days after the operation, the load is gradually built up, often supported by physiotherapy, to optimally promote the healing process and strengthen the muscles around the hip joint.

Even with a cementless hip prosthesis that has a stable primary anchorage, full weight-bearing should be done in the first weeks with caution against shock loads.Walking with walking aids, which is gradually increased, and gentle exercises are the means of choice here.

Avoid maximum load!

1. Avoidance of single-leg stance exercises

Exercises to be avoided in the first six weeks after hip replacement surgery include single-leg standing exercises. These pose a significant strain on the operated leg as the entire body weight is transferred onto it.

Risks of single-leg standing:

• High stress: Single-leg standing puts excessive stress on the operated leg, which could interfere with the ingrowth of the prosthesis.
• Instability: In the first few weeks after surgery, the muscles around the hip joint are weakened, so single-leg standing exercises increase the risk of unwanted movements that could compromise the ingrowth of the hip prosthesis.

Instead, movements that gently stress the operated leg should be used.

2. Avoidance of unstable surfaces and wobbly plates

Unstable training devices such as wobble boards should also be avoided in the first six weeks. These normally promote balance and coordination, but after hip replacement surgery, they can cause uncontrolled movements that interfere with the integration of the prosthesis.

Risks of wobble boards:

• Micro-movements of the prosthesis: These uncontrolled, small movements can compromise the primary stability of the hip replacement.
• Delayed healing: Constant adaptation to unstable surfaces can slow down or prevent the ingrowth of the prosthesis, potentially leading to complications such as prosthesis loosening.

Gentle, controlled movements on firm surfaces are preferable during this phase of healing.

3. Avoidance of impact loads

Impact loads, such as those occurring during jumping or running, should also be avoided. Such loads exert significant pressure on the hip replacement and can impair the healing process.

Examples of shock loads:

• Running or jogging: The repeated impact forces during running can interfere with healing and increase the risk of prosthesis loosening.
• Jumping: Similar stresses occur when jumping or during intense strength exercises.

Patients should focus on gentle movements, such as walking, in the first weeks after surgery to support healing.

4. Maximum strength and stability exercises in the early phase

Intense maximum strength exercises and stability exercises are not recommended in the first six weeks after hip surgery. The goal during this phase is not to maximally stress the muscles, but to support bone and wound healing.

Reasons against maximum strength exercises:

• Muscle tension: These exercises heavily stress the muscles around the hip, which could jeopardize the fixation of the hip prosthesis.
• Prosthesis stress: Too intense exercises could lead to overloading of the prosthesis, disrupting the healing process.

In the early phase of post-treatment, the stability of the hip should be promoted through controlled movements and gentle exercises.

5. Respecting bone and wound healing

The main focus of the first six weeks after a hip replacement should be on supporting bone healing and wound healing. Unnecessary stress or excessive movements can disrupt the healing process.

Bone healing process:

• Primary phase: In the first weeks after the operation, the first phase of bone healing takes place, in which new bone substance is formed.
• Wound healing: The healing of soft tissue is also crucial for the success of the operation.

A gradual build-up of stress that respects healing is the key to a successful recovery.

Conclusion

The first six weeks after a cementless hip replacement are crucial for the long-term ingrowth of the prosthesis. Exercises in single-leg stance, on wobble boards, as well as shock loads and intensive maximum strength exercises should be avoided during this phase. Instead, gentle movements and exercises should be performed that support healing and control the load on the hip replacement. Respectful behavior towards the healing process of the bone and soft tissues is crucial for successful recovery and long-term stability of the hip replacement.