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I was always a swimmer through grade school, high school, and college. I probably should have kept it up because now I need a hip replacement. The exercise would have been good for me. Oh well. What do the experts say about swimming after a hip replacement? How soon can I start?

With the recent effort to reduce the length of hospital stays, physical therapists are exploring the most effective ways to treat orthopedic patients. The standard rehab program after hip or knee joint replacement includes a mix of exercises to improve circulation and to prevent blood clots and other complications. Other goals include improving motion, strength, and function (especially walking). Aquatic therapy after hip replacement may fill the bill nicely. Aquatic (pool) therapy is defined as physical therapy that is performed in the water. There are good reasons to consider using aquatic therapy after joint replacement. Aquatic therapy uses the resistance of water instead of weights. With the reduced load provided by the buoyancy of the water, certain exercises (e.g., squats, step ups, walking without a cane or walker) can be started sooner in water than on land. Circulation is also improved leading to faster tissue healing and reduced swelling. A recent study from Australia looked at the benefit of aquatic therapy in the early days after joint replacement. Physical therapists randomly placed patients getting a hip or knee replacement into one of three different treatment groups. The goal was to find out what kind of treatment is best in the early days after orthopedic surgery. Everyone in the study either had a hip or knee replacement. They each received the standard postoperative hospital care by a physical therapist for the first three days after the operation. After that, the patients were randomly assigned to one of three groups. Group one continued with the standard care. This included circulation and deep breathing exercises, transfer practice, gait (walking) training, and practice going up and down stairs. Stretching and strengthening exercises were also done daily. Group two received a nonspecific water therapy session each day they were in the hospital. Group three had one standard physical therapy treatment each day and attended aquatic therapy everyday while in the hospital. The only reported difference among groups in this study was hip abductor muscle strength. Hip abductor strength is important for trunk and hip stability and normal a gait (walking) pattern. Patients in the specific aquatic therapy program had the greatest improvement in strength. When all other variables were compared among the groups, the aquatic group had the best short-term improvements. At the end of six months, there was no difference in outcomes from one group to the next. There were overall trends that seemed to support the idea that aquatic therapy was slightly more beneficial than either land-based or nonspecific water-based exercises. You may be able to start swimming early on after your surgery. But you'll need to check with your surgeon. Some rehab programs have an aquatic program specifically geared toward postoperative orthopedic patients. Keying into specific muscle groups needing strengthening after each type of surgery may be to the patient's advantage. It might be best to go through a rehab-specific program before just resuming swimming laps. That way you'll get the best of both worlds -- the pleasure of getting back in the pool while performing exercises just for your new situation.

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