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http://upload.orthobullets.com/topic/5036/images/posterior_hip_precautions.jpg
http://upload.orthobullets.com/topic/5036/images/anterolateral_precautions.jpg
http://upload.orthobullets.com/topic/5036/images/bridging.jpg
Introduction
  • Rehabilitation requires coordinated effort from
    • orthopaedic surgeon
    • physical therapist
    • occupational therapist
    • case manager
    • nursing staff
    • patient and patient's family
  • Care can be broken down into different phases including
    • preoperative teaching
    • inpatient acute care (hospital)
    • inpatient extended care (rehab/SNF)
    • outpatient home care
Preoperative Teaching
  • Physical therapy
    • preoperative physical therapy has not been shown to improve postoperative outcomes
  • Hip precautions
    • useful if discussed before surgery
    • types of hip precautions
      • posterolateral approach  
        • avoid
          • flexion past 90 degrees
          • extreme internal rotation
          • adduction past body's midline
      • anterolateral approach  
        • avoid
          • extension
          • extreme external rotation
          • adduction past the body's midline
      • direct anterior approach        
        • avoid  
          • bridging
          • extension
          • extreme external rotation
          • adduction past body's midline
Inpatient Acute Care (Hospital)
  • Pain management
    • preoperative
      • NSAIDS and opioids given immediately before procedure reduce postoperative pain
    • intraoperative
      • regional anesthesia (spinal and/or epidural) 
        • preferred over general anesthesia
      • periarticular multimodal drug injection
        • decrease postoperative pain with minimal risks
    • postoperative
      • multimodal oral drug therapy
        • gold standard
  • Physical therapy goals
    • sitting upright -->
    • gait training, ambulation with walker, out of bed to chair -->
    • transfers, gait normalization -->
    • independence
  • Discharge home criteria
    • independent ambulation with assistive device
    • independent transfers
    • independent ADLs
    • stairs with supervision
    • appropriate home assistance (spouse, family, visiting nurses)
Inpatient Extended Care (Rehab)
  • Earlier discharge to rehab from hospital associated with improved outcomes
  • Discharge criteria to home similar to those in hospital
Outpatient Care
  • Return to sport
    • low-impact exercises are preferred
      • golf
        • handicap shows minimal change after THA
        • handicap shows increase after TKA
    • high-impact exercises increase revision rates in patients less than 55 years-old
  • Driving recommendations
    • 3-4 weeks after right THA
    • less than 3-4 weeks after a left THA
    • reaction time returns to preoperative levels at 4-6 weeks
  • Return to work
    • within a month if no manual labor
 

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Technique Guides (3)
Questions (1)

(OBQ07.84) A 60-year-old female underwent hybrid total hip arthroplasty with good position of implants and post-operatively is instructed not to extend, adduct, and externally rotate the hip to prevent dislocation. What approach was likely performed? Review Topic

QID:745
1

Southern

3%

(55/1635)

2

Stoppa approach

1%

(17/1635)

3

Smith-Peterson

90%

(1476/1635)

4

Kocher Langenbach

5%

(81/1635)

5

Pfannenstiel approach

0%

(3/1635)

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

The position to dislocate a hip anteriorly is extension, adduction, and external rotation which is the position at risk after an anterior approach. Hips are most likely to dislocate the direction of the approach assuming the implants are correctly positioned. Other important variables to THA stability include: component design, component alignment, soft-tissue tensioning, and soft tissue function.


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