Introduction Postoperative inpatient management requires a coordinated effort from physician (orthopedic surgeon +/- hospitalist) 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) - this topic inpatient extended care (rehab/SNF) outpatient home care Inpatient Acute Care (Hospital) Pain management preoperative NSAIDS and Acetaminphen are commonly given immediately before procedure to reduce postoperative pain Some use Gabapentin and opiods but the data to support this is not as robust intraoperative regional anesthesia (spinal and/or epidural) login to view 1 more bullet periarticular multimodal drug injection login to view 1 more bullet postoperative multimodal oral drug therapy login to view 1 more bullet Medical management surgical stress response can lead to exacerbation of underlying medical conditions these conditions may require consultation with a hospitalist for workup and treatment hypertension login to view 3 more bullets hypotension login to view 3 more bullets hypoxia login to view 4 more bullets decreased urine output login to view 7 more bullets altered mental status login to view 3 more bullets chest pain login to view 3 more bullets nausea, vomiting, and abdominal pain login to view 4 more bullets postoperative fever login to view 4 more bullets Physical therapy should start the day of surgery decrease LOS reduces pain and improves function exercises bed supported ROM exercises - ankle pumps, knee bends, glut sets, quad contractions, hip abduction, straight-leg raise sit to edge of bed, sit in a chair, standing with a walker, gait training stairs (up with the good, down with the bad) login to view 2 more bullets ambulation login to view 1 more bullet Occupational therapy activities of daily living should be assisted by devices such as raised toilet seats, shower seats, and raised sitting chairs goals of therapy sitting upright --> gait training, ambulation with walker, out of bed to chair --> transfers, gait normalization --> independence Discharge home criteria independent ambulation with assistive device (50-100ft) independent transfers independent ADLs 2 stairs with supervision follows dislocation precautions if present 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 Levels of rehab include inpatient rehab and skilled nursing facility(SNF) or subacute rehab (SAR) SNF/SAR those patients who do not meet the above discharge criteria and do not qualify for inpatient rehab considered a complement to acute care hospital and more cost-effective than inpatient rehab inpatient rehab for total joint arthroplasty patients must be able to participate in 3 hours of therapy/day and be >85 yo, BMI >50, or have undergone bilateral total joint arthroplasty intensive rehabilitation services rarely utilized following total joint arthroplasty