From the Guidelines
Hip post-operative patients should be mobilized out of bed as early as the same day of surgery, when medically stable, to reduce the risk of complications and improve overall recovery. Early mobilization is crucial in preventing deep vein thrombosis, pulmonary embolism, pneumonia, and pressure ulcers, as well as maintaining joint mobility, improving circulation, and accelerating overall recovery 1. The goal is to have patients out of bed for at least 2 hours on the day of surgery and 6 hours per day until hospital discharge, as recommended by the Enhanced Recovery After Surgery (ERAS) society 1.
Key Considerations for Mobilization
- Pain management is essential before mobilization attempts, typically using multimodal analgesia including acetaminophen, NSAIDs, and opioids as needed.
- The physical therapist will guide the patient through specific weight-bearing instructions, which depend on the surgical approach and surgeon's protocol.
- Patients should follow hip precautions during mobilization, which may include avoiding hip flexion beyond 90 degrees, internal rotation, and adduction past midline, depending on the surgical approach used.
- Early mobilization has been shown to reduce the risk of complications and improve outcomes, even if the evidence level is low, the recommendation grade is strong 1.
Benefits of Early Mobilization
- Reduces the risk of deep vein thrombosis and pulmonary embolism
- Prevents muscle atrophy and maintains joint mobility
- Improves circulation and accelerates overall recovery
- Reduces the risk of pneumonia and pressure ulcers
- Improves patient comfort and reduces pain
By prioritizing early mobilization, healthcare providers can improve outcomes and reduce the risk of complications for hip post-operative patients, ultimately leading to better morbidity, mortality, and quality of life outcomes.
From the Research
Mobilization Timing for Hip Post-Operative Patients
- The optimal time for mobilizing hip post-operative patients out of bed is a crucial aspect of their recovery, with various studies indicating that early mobilization is associated with improved patient outcomes 2, 3, 4.
- Early mobilization has been shown to reduce 30-day mortality rates and complication rates in patients after hip fracture surgery, although it may not significantly impact the length of stay (LOS) in hospital 2.
- A literature review found that early mobilization can lead to several benefits, including shorter LOS, lower postoperative complications, reduced pain, increased walking ability, and improved quality of life 3.
- A systematic review of randomized controlled trials demonstrated that early mobilization after hip or knee joint replacement surgery can result in a reduced LOS of about 1.8 days, with benefits achievable within 24 hours of operation 4.
Key Considerations for Mobilization
- The decision to mobilize a hip post-operative patient out of bed should be based on individual patient factors, including their overall health, mobility, and surgical procedure 5.
- Early mobilization can help prevent deep-vein thrombosis (DVT) and reduce the risk of postoperative bleeding, although the optimal duration of venous thromboembolism prophylaxis after surgery is still a topic of debate 5, 6.
- Extended prophylaxis with low-molecular-weight heparin (LMWH) or other anticoagulants may be beneficial for patients at high risk of postoperative VTE, particularly after hip replacement surgery 6.
Clinical Implications
- Healthcare professionals should aim to mobilize hip post-operative patients out of bed as early as possible, ideally within 24 hours of surgery, to minimize the risk of complications and promote optimal recovery 2, 3, 4.
- Individualized assessment and planning are essential to ensure that patients receive appropriate mobilization and rehabilitation interventions tailored to their specific needs and goals 3, 4.