Updated: 1/31/2017

THA Rehabilitation

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Evidence
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https://upload.orthobullets.com/topic/5036/images/posterior_hip_precautions.jpg
https://upload.orthobullets.com/topic/5036/images/anterolateral_precautions.jpg
https://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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Questions (2)

(OBQ08.229) A 68-year-old male undergoes the procedure shown in Figure A. After this particular procedure, when are nearly all patients' driving reaction times returned to their preoperative level? Review Topic | Tested Concept

QID: 615
FIGURES:
1

3 months

5%

(138/2586)

2

2 months

21%

(534/2586)

3

4 weeks

61%

(1589/2586)

4

2 weeks

10%

(268/2586)

5

1 week

2%

(46/2586)

L 3 D

Select Answer to see Preferred Response

(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 | Tested Concept

QID: 745
1

Southern

3%

(92/2708)

2

Stoppa approach

1%

(27/2708)

3

Smith-Peterson

90%

(2437/2708)

4

Kocher Langenbach

5%

(144/2708)

5

Pfannenstiel approach

0%

(3/2708)

L 1 D

Select Answer to see Preferred Response

Evidences (7)
VIDEOS (1)
Topic COMMENTS (2)
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