This THA Home Health PT protocol will be followed by all THA patients referred by Dr. Roe unless specified otherwise at the time of the referral. Additional instructions and/or precautions may be given by Dr. Roe when appropriate.
I. General Information
- Unless specified otherwise, PT SOC assessment is within 24 hours of discharge to home, and OT is to start within 48 hours of discharge to home.
- If indicated SN referral to be made upon SOC assessment for medication management or other Nursing need.
- Frequency of PT visits and duration of intervention will vary according to patient need. Initially, the patient should be seen three times per week for the first two weeks, then twice the third week and discharged the fourth week.
- Frequency of OT visits and duration of intervention will vary according to patient need. Initially, the patient should be seen two times per week the first week, then once per week for two weeks until discharge.
- Treatment is to be initiated during the first visit after the patient assessment is completed. TED hose should be worn on the operative leg for 4 weeks, and non-operative leg for two weeks.
- Should further PT be warranted once the patient is no longer homebound, consultation with Dr. Roe and patient will be performed to recommend referral to outpatient services if needed.
II. PT Procedures
- Therapeutic Exercises
- Active assisted ROM within THA precautions, gradually progressing to Active ROM (to four sets of 20 reps/day).
- Strengthening exercises for the involved lower extremity progressing from isometric to isotonic, and from open chain to closed chain as appropriate.
- Strengthening of gluteal musculature first in supine then in standing. Once the patient is safe and independent in bed mobility and transfers, progress to abduction exercises in standing.
- Cryotherapy
- Ice packs to be applied as warranted to reduce pain and edema.
- Bed Mobility/Transfer Training
- Address bed mobility/repositioning as well as bed, couch, chair, tub and toilet transfers.
- Address Car Transfers prior to first clinic follow-up visit.
- Address bed mobility/repositioning as well as bed, couch, chair, tub and toilet transfers.
- Gait Training
- Weight-bearing status.
- WBAT immediately, unless specified by Dr. Roe.
- THA revisions are patient-specific, confirm with discharge orders.
- Start with walker or crutches as appropriate and progress to cane when control of hip abduction upon weight-bearing is adequate.
- Teach correct gait pattern with emphasis on eliminating Trendelenberg deviation.
- Teach home egress/ingress and stair negotiation and eventual return to community mobility.
- Weight-bearing status.
- Home Program
- Teach patients and caregivers early and frequently on the following: THA precautions, safety measures, joint precautions, exercise program, mobility regimen, pain control, signs of infection, signs of thrombus/embolus.
- Provide a written HEP and update it as appropriate.
- THA Precautions (posterolateral surgical approach).
- No combination of flexion past 90 degrees, adduction past neutral, medial rotation.
- No side-lying on operative hip until incision is healed.
- Teach patients and caregivers early and frequently on the following: THA precautions, safety measures, joint precautions, exercise program, mobility regimen, pain control, signs of infection, signs of thrombus/embolus.
- ADL Assessment
- OT to assess ADL status in the home.
- The patient may shower starting POD #3, leaving Prineo in place.
- Address instrumental ADL/s as appropriate
- Wound Care
- Assess the surgical dressing at each visit.
- At/near post-op day 14 and if incision is healed, remove staples. Any remaining Prineo or Steri-strips are to fall off on their own.
- Notify Dr. Roe immediately of any wound concerns or excessive drainage.
III. Therapy goals
- ROM: Hip ROM within functional limits, while adhering to the THA precautions.
- Strength: Periarticular musculature at 4/5, rest of involved lower extremity 5-/5.
- Transfers: Safe and independent in all household transfers, care transfers, with use of assistive devices as appropriate.
- Ambulation: Safe and Independent household ambulation with device as needed, with no gait deviations, for minimum distance of 200 feet.
- Return to community ambulation if appropriate.
- Home Program: Adequate knowledge and independence in all instructions including THA precautions.
- ADL: Independence in self-care activities, if appropriate modified independence in instrumental ADL’s.
- Incision status: Healed incision.