Acute Phase (0-2 weeks):
Day 1 until hospital discharge:
- Weight bearing as tolerated with walker / 2 crutches.
- Elevation for edema control.
- Cryo-therapy 20 minutes of every hour for edema and pain control.
- Incision covered with Aquacel bandage. Patients may shower normally with the Aquacel bandage in place.
- Gait training: continue safe ambulation for 50 feet, instruct in transfers and stairs prior to discharge.
- Instruction in hip precautions. Avoid hip flexion beyond 90 degrees, no internal rotation and no adduction.
Home exercises to include:
- Ankle pumps with leg elevation.
- Quad sets.
- Gluteal sets.
- Supine hip abduction.
Outpatient physical therapy should be scheduled prior to surgery. Patients may do home PT or rehabilitation if medically necessary and physician ordered.
Days 3 to 14:
- Begin outpatient physical therapy at approximately 3 days post-op.
- Change Aquacel bandage at 1 week post-op unless excessive drainage is evident within the bandage in which case it should be changed sooner.
- Staple removal at 14 days post-op by PT at which time shower normally without a bandage covering the incision. No submersion until follow up with surgeon at approximately 4 weeks post-op.
- Gait training with appropriate assistive device.
- Continue elevation and cryo-therapy for edema and pain control.
- Tensogrip stocking for edema control if needed.
- Perform home exercise program (HEP) as issued by P.T.
- Instruct in all appropriate transfers for independence in home.
Exercises to include:
- Ankle pumps with leg elevation.
- Quad sets.
- Gluteal sets.
- Flexibility: Groin, hip flexors, and hamstrings <90 degrees with supervision of a therapist.
- PROM: into hip abduction, extension, and external rotation.
- Supine hip abduction.
- Straight leg raises hip flexion, abduction, extension in standing.
- Short arc quads, Long arc quads, hamstring curls.
- Bridging.
- Heel lifts.
- Wall squats to 30 degrees hip flexion.
- Resisted terminal knee extension in standing.
Intermediate Phase (4-6 weeks):
- Progress all previous exercises.
- Step-ups forward and lateral.
- Begin single-leg balance.Balance board bilateral lower extremities.
- Gait training. Wean from assistive device as able with normal gait pattern.
- Stationary bike.
- Knee extension machine (avoid >90 degrees hip flexion).
- Hamstring curl machine.
- Review functional activities (laundry, vacuuming, cooking, sweeping, lifting) for safety.
Final Phase after 6 weeks
- Progress all previous exercises.
- Advance balance and proprioception exercise.
- Begin recreational/sports related simulation activities (ex. practice golf swings).
Goals: Return to prior level of function with normal strength, range of motion within precautions, flexibility, balance, endurance, and gait.
