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

Mostly full load allowed!

With modern cement-free hip prostheses, full weight bearing is usually permitted immediately after the operation. Thanks to improved surgical techniques and the high primary stability of the prostheses, the patient can stand up again shortly after the procedure and put weight on the operated leg. The stability of the prosthesis depends on the precise positioning and good fit in the bone, which forms the basis for the subsequent ingrowth of the prosthesis. In most cases, the bone structure around the prosthesis grows firmly into the implant surface within six to twelve weeks, ensuring long-term stability.

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

Even with a cement-free hip prosthesis that has a stable primary anchoring, full weight-bearing should be carried out in the first few weeks while avoiding shock loads. Walking with walking aids , which is gradually increased, and gentle exercises are the methods of choice here.

Avoid maximum load!

1. Avoiding one-legged exercises

Exercises that should be avoided for the first six weeks after hip replacement surgery include single-legged exercises. These place a significant strain on the operated leg as the entire body weight is transferred to the operated leg.

Risks of one-legged stance:

• High load: The single-leg stand places 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 exercises while standing on one leg increase the risk of unwanted movements that could jeopardize the ingrowth of the hip prosthesis.

Instead, you should focus on movements that put gentle strain on the operated leg.

2. Avoid wobbling plates and unstable surfaces

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

Risks of wobbling plates:

• Micro-movements of the prosthesis: These uncontrolled, small movements can endanger the primary stability of the hip prosthesis.
• Delayed healing: Constant adjustment to the unstable surfaces can slow down or prevent the ingrowth of the prosthesis, which could lead to complications such as loosening of the prosthesis.

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

3. Avoidance of shock loads

Shock loads, such as those that occur when jumping or running, should also be avoided. Such loads place significant pressure on the hip prosthesis and can impair the healing process.

Examples of shock loads:

• Running or jogging: The repeated impact forces of running can interfere with healing and increase the risk of denture loosening.
• Jumping: Similar stress occurs when jumping or during intensive strength exercises.

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

4. Maximum strength and stability exercises in the early phase

Intensive maximum strength exercises and stability exercises are not recommended in the first six weeks after hip surgery. In this phase, the goal is not to put maximum strain on the muscles, but rather to support bone and wound healing.

Reasons against maximum strength exercises:

• Muscle tension: These exercises put a lot of strain on the muscles around the hip, which could jeopardize the fixation of the hip prosthesis.
• Prosthetic load: Excessive exercise could lead to overloading of the prosthesis, which disrupts the healing process.

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

5. Respect bone and wound healing

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

Healing process of the bone:

• Primary phase: The first phase of bone healing takes place in the first few weeks after surgery, in which new bone substance is formed.
• Wound Healing: Soft tissue healing is also critical to the success of the surgery.

Gradual loading that respects healing is the key to successful recovery.

Conclusion

The first six weeks after a cementless hip prosthesis are crucial for long-term ingrowth of the prosthesis. Exercises in a one-legged stance, on wobble plates, as well as shock loads and intensive maximum strength exercises should be avoided in this phase. Instead, gentle movements and exercises should be performed to aid healing and control the load on the hip prosthesis. Respect for the healing process of the bone and soft tissue is crucial for successful recovery and the long-term stability of the hip prosthesis.