When can patients walk after total hip replacement surgery?

Early Mobilization After Total Hip Replacement Surgery

Patients should begin walking within 24-48 hours after total hip replacement surgery to optimize recovery outcomes, with initial mobilization starting as early as sitting out of bed for 30 minutes on the day of surgery (day 0).

Mobilization Timeline After Total Hip Replacement

Day 0 (Surgery Day):

• Patients should sit out of bed for approximately 30 minutes on the day of surgery 1
• Some patients can be safely mobilized as early as 4 hours after surgery, which reduces time to readiness for discharge without increasing adverse events 2
• Early mobilization on day 0 is beneficial even for elderly, obese, and severely diseased patients 2

Day 1 (First Postoperative Day):

• Patients should commence walking on day 1 1
• First walk should be attempted within 24-48 hours after surgery 1, 3
• Aim for 6 hours per day out of bed starting from day 1 1

Benefits of Early Mobilization

Early mobilization after total hip replacement provides several important benefits:

• Reduced hospital length of stay by approximately 1.8 days 4
• Lower 30-day mortality rates (odds ratio 0.35) 5
• Reduced complication rates (odds ratio 0.43) 5
• Improved functional recovery with patients walking further and requiring less assistance with transfers 3
• Higher likelihood of discharge directly home rather than to high-level care facilities 3

Mobilization Protocol

1. Initial Assessment: Before first mobilization, ensure patient is medically stable with adequate pain control
2. First Mobilization:
   • Sit out of bed for 30 minutes on day 0 1
   • Progress to standing and short walking on day 1 1
3. Daily Progression:
   • Increase to 6 hours per day out of bed from day 1 onward 1
   • Gradually increase walking distance as tolerated
   • Use appropriate walking aids as needed (typically walker or crutches initially)

DVT Prophylaxis Considerations

Early mobilization should be implemented alongside appropriate DVT prophylaxis:

• Pharmacological prophylaxis should be administered according to guidelines:
  • Low Molecular Weight Heparin (LMWH): 12-24 hours after surgery for 10-14 days, potentially extended to 35 days 6
  • Aspirin: 81-162 mg daily may be appropriate for standard-risk patients 6
• Mechanical prophylaxis (compression devices or stockings) should be used intraoperatively and continued during periods of immobility 6

Special Considerations

• Failed early mobilization: Patients who cannot mobilize early often have postoperative cardiovascular instability and may require more intensive monitoring 3
• Urinary catheter management: Remove urinary catheter within 24 hours after surgery to facilitate mobilization 1
• Pain management: Ensure adequate multimodal pain control to enable effective mobilization
• Contraindications to early mobilization: Hemodynamic instability, uncontrolled pain, or surgical complications that require bed rest

Pitfalls to Avoid

1. Delaying mobilization unnecessarily: Traditional practices of extended bed rest are not supported by evidence and may lead to complications
2. Inadequate pain control: Poor pain management can prevent successful early mobilization
3. Lack of standardized protocol: Inconsistent approaches to mobilization can lead to suboptimal outcomes
4. Insufficient staff support: Adequate assistance is needed for safe early mobilization, especially for elderly or frail patients

Early mobilization is a key component of enhanced recovery protocols after total hip replacement and should be implemented as a standard of care to improve patient outcomes.