Initial Assessment

On the first clinical visit in which a patient is established as a candidate for total hip arthroplasty, the physician must explain the real expectations and the limitations a patient will have after surgery. The close family must be included as active participants along with the patient.

Video and Educational Courses

The patients are given a short video or other media resource in which a typical patient is shown in the preoperative, intraoperative, and postoperative environment. This gives the patient his or her first exposure to the surgery and the processes that surround this surgery. Frequently asked questions are resolved throughout the video.

The video should show the patient arriving at the hospital and demonstrate the admissions service. Interactions with the anesthesia team before surgery and the anesthesia procedures also should be shown. The tape should continue showing specifics of the surgical procedure and postoperative care, followed by rehabilitative interventions. The rehabilitation visit can be shown on the same day or the next day depending on the protocol. Early return to physical and functional activity should then be shown. The tape should conclude with discharge to rehabilitation or home, again according to each protocol.

The video should be self-explanatory with questions and complete answers so as to avoid eliciting more questions from the patient. If any questions do arise, a contact person should be provided to resolve them. The patient’s family is encouraged to watch the video as well. A preoperative class or seminar should be available to patients and relatives of the patient. The information presented in this class will increase their knowledge and satisfy any further questions.

Walking

Patients must be able to walk properly with a walker or crutches independently for household distances (50 to 100 feet). If the patient has no prior experience with the required assistive devices, then the proper use of the devices must be taught.

Stairs

Before surgery, the patient must be able to ascend and descend one flight of stairs safely and independently using crutches or cane. The sequence and adequate use of these assistive devices while ascending and descending stairs must be taught if the patient has no previous experience. A general rule is “The good leg goes up first, and the bad goes down first.”

Transfers

The patient should be able to move safely and independently from the bed, chair, shower or tub, and also in and out of a car or vehicle. By learning the movements preoperatively, the patient will understand the movement postoperatively so that he or she can focus exclusively on the physical challenge.

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  A five-step protocol for rising from bed and a three-step protocol for getting into bed must be taught to an inexperienced patient.

  
  
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  Step protocols for standing up and sitting down on a chair should be taught if necessary.

  
  
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  Steps necessary to get in and out of the shower or tub must be learned by the patient.

  
  
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  Steps and rotations must be taught to a patient who lacks the knowledge to get in and out of a vehicle.

Arm Strength

Arm strength should be maximized before surgery so that the patient can properly handle the crutches or walker for the rehabilitative goals outlined previously. Arm strength is increased by exercising regularly with:

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  Sitting push-ups

  
  
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  Wall push-ups

  
  
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  Wall shoulder press-out

  
  
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  Shoulder extension exercises

Leg Exercises

The patient should be taught exercises for the different lower extremity muscular groups. Proper training in these leg exercises will help the patient to increase strength, increase range of motion, and decrease stiffness. The following lower extremity exercises are used:

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  Ankle pumps

  
  
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  Quadriceps sets

  
  
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  Gluteal sets

  
  
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  Heel sets

  
  
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  Short arc quadriceps

  
  
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  Long arc quadriceps