Post Op Rehab Protocol?
Dr. Scott Ball: “Recovery is gradual and somewhat variable from patient to patient. Most patients are pretty comfortable getting around without assistive devices (crutches or cane) within 2 to 3 weeks. I encourage patients to use an exercise bike right away as a ‘motion machine’ pedaling with the non-operative leg and letting the operative leg go along for the ride. My patients typically get home physical therapy (where the therapist comes to the house) for a few weeks. However, frequently patients progress faster than the home-based therapist can push them. About half of my patients will continue with outpatient therapy for longer than a month. I use blood thinners; typically injectable (Lovenox), and TED stockings for 2 weeks after discharge from the hospital.”
Dr. Vijay Bose: “At home they walk with a pair of crutches usually for about 10-15 days and when completely comfortable discard the crutch on the side of the operation first. Then when the other crutch is also felt unnecessary, this is also discarded. Walking, climbing stairs or cycling can be done for long periods of time. There is no post –op restrictions after a Hip Resurfacing operation and the patient can use it as a ‘normal hip’. However the soft tissues around the Hip Joint, which were contracted at the time of the hip disease, will take time to relax following the excellent movement that has been restored in the hip. Hence if there is pain while attempting a certain activity like sitting on the floor, it implies the patient is not yet ready for that particular activity. One can give a gap of about a week and then try it again. Like wise the activity level improves in a stepwise manner till the soft tissues also become normal. Patient is ready for sports (inclusive of contact sport) at about 3 months post-op.”
Dr. Michael Clarke: “Weight bearing as tolerated day 1. Crutches/walker until OK with a cane or no aids. Non impact exercises from Day 1. Hip precautions for one month. Non-impact sports at 6 weeks (e.g. golf). Impact sports and running at 6 months. “
Dr. Koen De Smet: “There are no restrictions anymore, 10 days 2 crutches, 10 days 1 crutch. 3 weeks subcutaneuous heparines. 3 weeks below knee TED stockings. Ice, PT.”
Dr. Thomas Gross: “Phase I: Walking and minor exercises for 6 weeks. Typically crutches for 1-2 weeks, followed by a cane for 1-2 weeks. Phase II: Progressive walking and exercises between 6 weeks and 6 months full return to all activities including running after 6 months. Almost no one needs formal PT. Recovery from a posterior approach is not difficult. A lot more work may be required if the abductor muscles are impaired by a lateral or anterolateral approach. For blood thinners I use Arixtra daily self-administered injections for 10 days and baby aspirin for 1 month thereafter. With a minimally invasive technique, a rapid recovery program and the above anticoagulation regimen, I have had less than 0.5% blood clots and no pulmonary emboli in 1500 cases. In the last 300 cases, I have not even had any blood clots. I don’t use Ted stockings. They offer little benefit and make patients miserable. I wouldn’t wear thick nylons if they paid me. Ice is an excellent adjunct for pain control in the first few days after surgery. Patients love it. I use an ice machine on everyone who likes it.”
Dr. Cynthia Kelly: “The typical recovery is 3 days in the hospital (2-4 days range) with patients up and out of bed with physical therapy as soon as possible. Patients begin to weight bear as tolerated immediately and use crutches for as long as they are needed for comfort and safe ambulation. Most patients feel using crutches for about 3 weeks is advantageous for ease of walking and speeding recovery. I advise patients to follow the 90 degree restriction for 6 weeks.”
Dr. William Macaulay: “Typical patients are 90% improved in 4 to 6 weeks. Last week I saw a gent back who got bilateral MOMHR’s (5 and a half weeks post surgery) who has squatting over 700 pounds (against medical advice)." 90 degree restriction? I use 120 degree flexion restriction for MOMHR’s after the spinal wears off (2 hours post surgery). Never seen a dislocation; Walker? Usually one day; Crutches Cane? Usually off cane in 2 to 4 weeks amount of time?; Blood thinners? Multimodal approach use aspirin for low risk patients; TED stockings? None; Ice? As desired; PT typically 6 wks
Mr. Derek McMinn: “The evidence from a DEXA study on BHR patients published from Japan is that the bone density in the proximal femur returns to normal 1 year after operation. The at-risk period for femoral neck fracture following the BHR is in the 6 months after surgery. I advise patients not to return to impact sport for 1 year after surgery. For those patients who want to road run, I get them running on a treadmill at 10 months post-op and they resume road running at 12 months post-op. My unit published on activity level after resurfacing some years ago in a group of patients who followed those rules. In young men with a single osteoarthritic hip resurfaced, 92% played sport and 62% played impact sport. The ladies were not quite as active, but you can see from the publication that they still had an impressive activity level. In the total group their 10-year implant survival is 99.8% showing that high activity introduced at a sensible time does not deteriorate the results."
Dr. Michael Mont: “Patients are restricted only in the first five weeks to 50% weight bearing and a 90º rule and no crossing their legs. After five weeks, they advance to full weight bearing with absolutely no restrictions on position and they start strengthening. In summary, they use a cane or crutch for the first five weeks with some restrictions of motion and these are lifted at five weeks. We are presently working on some advanced rehabilitation protocols that should be used for young patients. I believe that many of the rehabilitation protocols that have been used in the past were developed for typical patients that are getting standard total hip replacements who might have an average age of approximately 72 years. In my patient population, the average for resurfacing is 48 years and patients want to return to higher-level activities and may need different protocols. We are presently prospectively analyzing these protocols. Blood thinners, if patients have any history of any problems, are used for 42 days, but typically I will use aspirin for five to six weeks with mechanical compression stockings. We often use ice for post-operative pain."
Dr. Thomas Schmalzried: “The patient is the biggest variable in the process. “Fully recovered” is also patient dependent. Is the patient a homemaker or a professional athlete? I place no restrictions on my patients after surgery.”
Dr. Edwin Su: “The typical rehab protocol is weight bearing as tolerated on the operated leg, using a walker the first few times the patient gets up. Then, we will advance you to using two crutches, either the axillary (armpit) or lofstrand (forearm) crutches, depending on your preference. They are used like walking sticks, so you are still putting full weight on the leg and walking with alternating steps. I like you to use the crutches for walking for about 2 to 3 weeks. They are to provide additional stability so that you don't fall and for my peace of mind. Many patients are able to walk 1 mile at a time, at 2 weeks after surgery. At this point, the best thing for your recovery is simply walking, and you will be able to do exercises on your own. We will send a therapist to the house 2-3 times per week to help guide you, but before long, you will be independent. You can also ride a stationary bicycle, swim, and exercise your upper body in the gym during this time. I don't impose any 90-degree restrictions postoperatively. In fact, I find it important to begin mobilizing your hip. After 2-3 weeks of using 2 crutches, you'll advance to 1 crutch or a cane. Shortly thereafter, within another week or so, you'll be walking without anything to help you. At this point, you will be ready to go to outpatient therapy. The main purpose of outpatient therapy is to mobilize the hip and strengthen the muscles around the hip. In addition, after the first postoperative visit, I will show you some stretches to help you regain the motion. This phase of therapy will last about 1-2 months. You may begin to play tennis, golf, and cycle outdoors at about 6-8 weeks postoperative. I like you to remember that the hip is still healing at this point, and heavy lifting over 50 lbs and impact activities should be avoided until you are 6 months postop. After 6 months postoperative, I remove all activity restrictions — it's your hip! In general, I use a full strength, coated aspirin (325 mg) twice a day for 1 month following surgery as your blood thinner. Certain patients will require stronger blood thinners. TEDS stockings can be very helpful if you experience swelling, and would be used while a patient is up and around during the day (since fluid tends to accumulate by gravity)."