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FVFG: Weight Bearing and Exercise Following Surgery

- Weight bearing: Patients are to remain non-weight bearing for six weeks, followed by six weeks during which they may bear 15 % of their weight on the involved side. The following three months they are allowed to bear 30% of their weight with transition to full unassisted weight bearing at six months. The progression to full unassisted weight bearing depends on the Stage of AVN, if both hips are affected by AVN, follow-up x-rays and symptoms. If both hips will have the FVFG surgery will be performed on the second hip three months following the first hip. The patient remains non-weight bearing on the first hip for 6 weeks following the surgery then they may bear 15% of their weight on the involved side for 3 weeks, then 50% of their weight for 2 weeks with increase to 80% weight bearing the week before the second hip surgery. Sometimes patients prefer to use a walker for greater stability instead of crutches particularly in the home. The progression with weight bearing remains the same. A wheelchair is not required postoperatively but a few patients have used a wheelchair at work or around the home after having surgery on the second hip. Non - weight bearing is accomplished by keeping the involved leg is kept off the ground and the whole body is shared evenly between each walking aid. Throughout the gait cycle, the hip and the knee joint of the affected leg is kept in flexed position. The amount of weight placed on a foot can be determined by placing the uninvolved foot on a telephone book next to a scale and placing the involved foot on the scale bearing weight until the scale reads the desired number of pounds. With partial weight bearing the crutches are moved forward with the involved foot making floor contact in line horizontally with the crutch tip. - Transfers: Getting up from a chair, hold both crutches in one hand and push up from the chair with your other hand. Once up, place one crutch under each arm To sit back down, take the crutches our from underneath both arms. Hold the crutches together in one hand and reach back for the chair with your other one. This makes the transfer a lot smoother and decrease the risk of putting too much weight on your operated leg. - Stairs: Going up stairs, lead with your "un-operated" leg, followed by your operated leg and crutches. Going down, your crutches go first followed by your "operated" leg, then your "un-operated" leg. If a railing is available to you, hold both crutches under one arm and use the railing on the other hand. - Some reminders on the correct use of crutches are: 1. To determine the proper crutch length allow three finger spaces between underarm and the top of the crutch when standing erect with shoulders relaxed. 2. The distal end of the crutch should come to a point 2 inches lateral and 6 inches anterior to the foot. 3. Handle position should not allow elbow flexion to exceed 30 degrees. 4. Do not make a habit of leaning on the axillary bar to avoid injuries to nerves and blood vessels in the shoulder area. 5. Support body weight in the hands not under your arms. 6. Pick up any throw rugs at home as your crutches or toes could easily catch on them. 7. Check your crutch tips after walking outside for gravel or other objects that could cause the crutches to slide on the floor. 8. Be cautious when walking from on floor surface to another such as linoleum to carpet. 9. The pads are susceptible to wear and tear and can be replaced as needed. The tips should be replaced before the pattern disappears or the concave surface flattens. Replacements are available at some drug stores or health equipment stores. - Canes: Canes can be used to unload up to 15% body weight if recommended by your doctor. The cane is used in the hand opposite the involved leg, the cane and involved leg move together . Is very important for the hand piece to be comfortable for use. The reason a cane is not used on the same side as the involved leg is because it requires considerable more pressure on the hand to relieve hip pressure to the same degree as if the cane were held on the opposite side. - Exercise: 1. Continue the exercise program you began in the hospital. 2. No tennis, jogging, basketball or other sports that require a lot of stop-start or jarring. 3. Walking is excellent exercise to help build strength after surgery and once crutches have been discontinued. 4. Swimming or aquatic exercises can be started once the incisions are healed if access to the pool is safe. Be sure to use steps or ramp access rather than ladder. 5. Stationary biking 4 weeks after surgery without resistance on the pedals. You may use resistance when you are permitted to have weight on the operated leg. Any form of exercise that causes new or increased pain should be stopped. If desired the form of exercise can be tried again in two weeks and if pain returns this form of exercise should be avoided. Discuss this with your clinician at your next office visit.

Original Text by Clifford R. Wheeless, III, MD.