What is the protocol for assessing a patient during a post-hip arthroplasty (hip replacement) follow-up appointment?

From the Guidelines

When assessing a patient for a post-hip replacement appointment, begin with a comprehensive evaluation of pain levels, functional mobility, wound healing, and potential complications, as recommended by the most recent and highest quality study 1. This assessment should include:

• Evaluation of pain management, including effectiveness of prescribed medications such as oxycodone, hydrocodone, or NSAIDs, and adjust as needed
• Examination of the surgical site for signs of infection, proper wound closure, and healing progress
• Assessment of the patient's range of motion, gait pattern, and adherence to hip precautions to prevent dislocation
• Check for signs of deep vein thrombosis and pulmonary embolism
• Review of physical therapy progress, including exercises and mobility aids usage
• Measurement of leg length discrepancy and evaluation for heterotopic ossification These assessments are crucial because early detection of complications can prevent serious outcomes, and proper rehabilitation significantly impacts long-term functional outcomes, as noted in the study 1. The timeline for recovery milestones should be discussed, including expected return to daily activities and driving, typically around 4-6 weeks post-surgery depending on individual progress, as supported by the evidence 1. It is also important to consider the recommendations for postoperative pain management, including the use of paracetamol, cyclo-oxygenase-2-selective inhibitors, and non-steroidal anti-inflammatory drugs, as well as regional analgesic techniques such as fascia iliaca block or local infiltration analgesia, as suggested by the study 1. Overall, a comprehensive assessment and individualized management plan are essential for optimizing outcomes and minimizing complications in patients after hip replacement surgery, as emphasized by the study 1.

From the Research

Assessment of Patient after Hip Replacement

To assess a patient after hip replacement, the following factors should be considered:

• History and physical examination of the hip, which is the key component for evaluation of patients presenting with hip pain 2
• The hip examination should contain 21 steps, considering the hip as comprised of 4 layers: the osseous, capsulolabral, musculotendinous, and neurovascular 2
• The risk of deep vein thrombosis and subsequent pulmonary embolism may persist for some weeks after hip replacement, and antithrombotic prophylaxis should be considered 3, 4, 5
• The choice of antithrombotic prophylaxis, such as low-molecular-weight heparin, warfarin, aspirin, or factor Xa inhibitors, should be based on the patient's individual risk factors and medical history 3, 4, 5

Postoperative Rehabilitation

Postoperative rehabilitation is essential for promoting physical function recovery and minimizing complications after hip replacement:

• A multidisciplinary approach, including physical and occupational therapies, is strongly recommended 6
• Progressive resistance exercises, balance training, early ambulation, weight-bearing exercises, and activities of daily living training should be included in the rehabilitation program 6
• Community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support are also important aspects of postoperative care 6

Venous Thromboembolism Prophylaxis

Venous thromboembolism prophylaxis is crucial after hip replacement:

• Aspirin, warfarin, enoxaparin, and factor Xa inhibitors are commonly used agents for VTE prophylaxis 5
• The choice of agent should be based on the patient's individual risk factors and medical history, as well as the potential risks and benefits of each agent 5
• The incidence of DVT, PE, bleeding-related complications, postoperative anemia, and transfusion should be monitored after hip replacement 5