Total Hip Arthroplasty, Posterior Approach

Discharge criteria

To rehabilitation hospital

• Independent / minimum assist with bed mobility
• Ambulation with assistive device for 30 feet

To home

• Independent bed mobility and transfers
• Able to safely negotiate home obstacles such as stairs and carpet
• Independent ambulation with assistive device for 300 feet
• Coordinate with Social Work Services to obtain home equipment:
  • Wheeled walker, Three-in-one, Reacher

Precautions for the first 6 weeks

• Wear TED Hose
• Sleep on back
• Pillow under ankle, NOT under knee, keep foot of bed flat
• Wedge pillow (abduction bolster) between legs while sleeping
• No Flexion > 90 degrees
• No Adduction past midline
• No Internal Rotation

Weeks 1–6

Exercises

• Walker or crutches – weight bearing as tolerated (WBAT)
  • Progress to cane and D/C when gait is normal
• Ankle pumping
• Heel slides, AROM, AAROM with above restrictions
• Quad sets, Co-contractions quads/hams
• Straight leg raise (SLR)
• Short arc quads with up to 10#
• Sitting knee extension (chair or mat) 90–0 degrees
• Weight shifts in parallel bars
• Mini squats 0–45 degrees in parallel bars
• Forward, retro and lateral step downs (small step)
• Double leg heel raises
• Progressive abductor strengthening
  • In standing
  • Sidelying
  • Add light weight when able to perform 25 repetitions
  • In standing with Theraband, bilaterally

Goals

• Protection
• Hip ROM 0–90 degrees

Weeks 6–9

Exercises

• Cane as needed, D/C when gait is normal
• Continue to caution against hip flexion > 90 degrees
• Continue to sleep on back
• D/C pillow between legs while sleeping
• Continue appropriate previous exercises
• Lateral and retro walking in parallel bars
• Wall squats
• Hip machine x 4 bilaterally
• Single leg (stork) standing
• Single leg heel raises
• Stationary bicycle
• Treadmill – Walking progression program
• Pool therapy

Goals

• Normal gait

Weeks 9–12

Exercises

• Continue appropriate previous exercises
• Hip flexion > 90 degrees
• Leg press (< 90 degrees hip flexion)
• Hamstring curl weight machine
• Knee extension weight machine
• Proprioception exercises as tolerated (age dependent)
• Practice sit-to-stand without using hands
• Stair training
• Elliptical trainer
• Stretches – Hamstring, quads, hip flexors, ITB

Goals

• Symmetrical hip ROM
• Walk x 20 minutes
• Stand from sitting without use of hands

Months 3–6

Exercises

• Discontinue supervised PT
• Resume all recreational activities as tolerated
• Encourage non-impact activities
• See attached Precautions and Activities

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from William Beaumont Army Medical Center, Physical Therapy Section, "THA Post WB08", Revised August 2008, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: THA Post WB08.pdf.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.

Current version and every other protocol: aaronweymd.com/post-op-protocols