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Updated: Jun 10 2021

THA Rehabilitation

  • 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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