|
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
 

Please rate topic.

Average 3.1 of 26 Ratings

Questions (2)
EVIDENCE & REFERENCES (7)
GROUPS (1)
Topic COMMENTS (2)
Private Note