THA Rehabilitation - Recon

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