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.

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