Goals – Six Weeks Post-op:

1. Walk without a limp or list.  We prefer patients continue to use an assistive device until they no longer limp.
2. Stairs with a reciprocal pattern without railing assist to ascend.
3. Single leg stance > 10 seconds

Discharge Instructions from the Hospital:

1. Follow Anterior Hip Precautions.
1. No lunges – Excessive hip extension in weightbearing could result in dislocation.
2. No straight leg raises, heel slides or marching for 4-6 weeks.
   Pain-free progression after this period.
2. Gait
1. WBAT
2. Ambulate with assistive device for two weeks and progress to no assistive device when patient is able to ambulate without pain or gait deviation.
3. Expectation is for patient to be discharged from physical therapy after three to four weeks with HEP including
4. IF PATIENT’S ARE HAVING MID-THIGH PAIN WITH WEIGHT BEARING AT THREE WEEKS, PLEASE CALL OUR OFFICE (314-909-1359).
3. Limit walking to 10 mins/hour for the first 1-2 weeks with gradual progression afterwards.
4. NO WEIGHT MACHINES OR RESISTANCE ON CARDIO MACHINES FOR 3 MONTHS.
5. NO TREADMILL FOR 6 WEEKS.
6. NO CUFF WEIGHTS OVER 2 POUNDS FOR 6 WEEKS.  DO NOT PROGESS BEYOND 5 POUNDS OR 3 MONTHS.

Physical Therapy:

1. The surgical positioning often produces significant discomfort in the anterior thigh and lumbar area.  Apply heat when stiff, tight or before therapy; ice after exercise.
2. Massage is a very important part of the patient’s recovery.
1. Hip flexors, IT band, adductors, piriformis, and gluteal muscles often require tissue work.
2. Begin scar massage at three weeks post-op.
3. Focus on the gluteal strengthening (abd/ER/ext) to eliminate limping and to prevent hip flexor overuse.
4. Limit open chain hip flexor strengthening because this tends to irritate the tendon.  Closed chain/functional hip flexor strengthening (Eg:  step ups) is a safer option.
5. Improving hip flexor mobility (to allow 0-10degree AROM hip extension) and restoring gluteal strength will help prevent overuse of the hip flexor muscles.
6. PAIN FREE hip flexor stretching:
1. Prone-lying at one week post-op to restore hip extension to neutral (0 degrees)
2. Modified hip flexor stretch:  Leg hangs off side of table – at 3-4 weeks post-op.
3. Prone hip flexor stretch at one to two weeks post-op.
4. Thomas Stretch at 4 weeks post-op.
7. Patients often complain of feeling “uneven” after surgery.  This is normal and will be addressed by Dr. Collard at their 6 week checkup.  DO NOT GIVE SHOE LIFTS!

PATIENT EDUCATION INSTRUCTIONS

Discharge Teaching and Instructions – Anterior Hip Replacements

Dressing Changes and Incision Care:

1. The surgical dressing should remain in place for 7 days.
2. Change dressing after 7 days and leave second dressing on for another 7 days.
3. A small amount of drainage is normal, but if the dressing becomes saturated with drainage or has significant strike-through then you should notify the office immediately.
4. Drainage may intermittently increase after therapy sessions or long walks.  This is normal and is expected.
5. Leave dressing on while showering, it is a waterproof bandage.
6. After about 14 days you may remove dressing and shower without anything covering the incision.  However DO NOT apply soap, lotion, powder, or anything else to the incision.  Simply shower and pat incision dry.
7. Most patients have steri-strips, these will fall off naturally.

Showering:

1. You may shower as usual at home. Please have necessary equipment such as shower stool, transfer bend, or no-slip bath mat, etc.
2. Do not submerge under water – NO bathtubs, hot tubs, pools, or lakes for 6 weeks.

Physical Therapy:

1. Walk five minutes every hour while you are awake to prevent stiffness and to promote strengthening.  Increase to five minutes every half hour and progress as tolerated.  Walking also decreases your risk of blood clots.
2. The physical therapist should be given an order for therapy (given at discharge) and a copy of our protocol.
3. DO NOT use weight machines, weighted pulleys, or greater than 2 pound leg weights to strengthen the legs.
4. You MUST use a walker at all times after discharge.  Your physical therapist will determine when you can progress from a walker to a cane and to walking independently (based on your progress). 

Physical Therapy (continued):

1. Until your 6 week follow-up appointment, your hips should ALWAYS be higher than your knees when sitting.  Depending on the height of your chair, you may need to sit on top of a few pillows.
2. NO straight leg raises for 3 months.
3. Anterior hip precautions must be maintained for 3 months
4. Bring a copy of your physical therapy “progress note” with you to your 6 week follow-up appointment with Dr. Collard.

Activity:

1. You are expected to return to your normal way of life, except the following:
1. NO driving for at least 6 weeks (unless otherwise specified by your surgeon.  You cannot drive until you are no longer taking narcotic pain medication.
2. You may NOT return to work until approved by your surgeon (usually six weeks).
3. No strenuous activity; NO golf!

Raised Toilet Seats:
You MUST use a raised toilet seat for 3 months.  This is to ensure that your hips remain higher than your knees.

Sleeping:

1. You do not need to sleep with a pillow between your knees, but may to be more comfortable.
2. DO NOT sleep on the operative side for 6 weeks.

Recliners:
You may NOT recline in recliners.  You may sit in a recliner with your feet propped on a coffee table or ottoman, but DO NOT recline.

Signs of Infection:
Please notify your doctor’s office if you experience any of the following:

1. Persistent (greater than 24 hours) temp higher than 101.5.  It’s NORMAL for patients to have a low grade fever during the first week or so after surgery.
2. Drainage that becomes yellow/green or has a foul odor.
3. Significantly increased redness around incision.
4. A small amount of redness and/or warmth around the incision is NORMAL.  A moderate amount of swelling and/or bruising is also expected and normal.  These are all part of the inflammatory process and will decrease with time.

Blood Clots:
Although rare, blood clots are a risk after surgery.  If you experience any of the following signs or symptoms you should immediately go to the nearest emergency room and notify the ER physician of your joint replacement:

1. Redness, swelling and/or pain in the calf area
2. Chest pain
3. Sudden onset of shortness of breath or difficulty breathing

Blood Thinners:

1. Most patients will be sent home on aspirin 325 mg. to take twice daily for 6 weeks.  Some patients will be sent home on Xarelto for 14 days.  After 14 days of Xarelto the patient will switch to aspirin 325 mg. daily for another 4 weeks until first appointment.
2. Notify the physician immediately if you experience of the following signs or symptoms:
1. Headaches, dizziness, or weakness.
2. Unusual bruising (significant bruises that develop without known cause or grow in size).
3. Nosebleeds.
4. Bleeding gums.
5. Pink or brown urine.
6. Red or black stools.
7. Coughing up blood.
8. Vomiting blood or material that looks like coffee grounds.
9. Any falls (falling is NOT allowed.)

Anti-inflammatory Medications:
You may take Celebrex or Mobic along with the aspirin or Xarelto.

Pain Medications:
The office will usually refill pain medication for up to 6 weeks after your surgery.  Pain medications will NOT be called in or refilled over the weekend or in the evening when the office is closed.  NO EXCEPTIONS.  Please request refills by Thursday afternoons.  Also, request refills before your current prescription runs out. 

Stool Softeners and Laxatives:
Patients may want to continue taking an over-the-counter stool softener, such as Colace or Senokot, while on narcotic pain medication.  If you need something more aggressive to move your bowels, try taking over-the-counter Milk of Magnesia or Miralax as needed for constipation.

Follow-up Appointments:

All appointments will be given to you in your discharge packet (usually 3-4 weeks after surgery).  Your first physical therapy appointment is normally the first business day after discharge from the hospital.  If discharged on Coumadin you will also have blood draws scheduled on Monday and Thursday as well as a six week follow-up appointment with your surgeon.