From the Guidelines
Post-operative management of hip replacement via anterior approach should focus on early mobilization, pain control, and preventing complications, with a recommended pain management regimen including multimodal analgesia with scheduled acetaminophen and NSAIDs, and opioids as needed for breakthrough pain, as supported by the PROSPECT guideline 1, 2, 3, 4, 5, 6, 7, 8. The management plan should include:
- Early mobilization: Patients should begin walking with assistance the same day of surgery or the next morning, using a walker or crutches initially.
- Pain management: Multimodal analgesia with scheduled acetaminophen (1000mg every 6 hours) and NSAIDs like celecoxib (200mg daily) if not contraindicated, and opioids such as oxycodone (5-10mg every 4-6 hours as needed) for breakthrough pain.
- Thromboprophylaxis: Essential, usually with low molecular weight heparin like enoxaparin (40mg daily) or oral anticoagulants like rivaroxaban (10mg daily) for 2-4 weeks.
- Physical therapy: Should begin immediately, focusing on gait training, transfers, and gentle strengthening exercises.
- Hip precautions: Less restrictive with the anterior approach, but patients should avoid extreme external rotation and extension for 6-8 weeks.
- Wound care: Keeping the incision clean and dry, with dressing changes as directed.
- Monitoring: Patients should monitor for signs of infection, blood clots, or dislocation. The anterior approach offers advantages of less muscle damage and faster initial recovery, allowing for earlier discontinuation of assistive devices, typically within 2-4 weeks as strength improves 1, 2, 3, 4, 5, 6, 7, 8.
From the Research
Post-Operative Management of Hip Replacement Anterior Approach
- The direct anterior approach to hip replacement has been shown to have several benefits, including enhanced post-operative recovery and reduced risk of complications such as heterotopic ossification and thromboembolic events 9.
- In terms of pain management, a study found that oxycodone provided superior analgesic efficacy compared to fentanyl in the post-operative period, with significantly lower pain scores and delayed onset to first request for analgesia 10.
- The direct anterior approach has also been shown to have advantages in terms of early post-operative rehabilitation, with better outcomes in terms of hospitalization, blood loss, and functional scores compared to the postero-lateral approach 11.
- A case report described the successful rehabilitation of a 49-year-old female following anterior approach total hip arthroplasty, with a focus on functional-based protocol and hip assessment scale 12.
- In terms of venous thromboprophylaxis, a study found that aspirin and factor Xa inhibitors had the lowest incidence of deep venous thrombosis and bleeding-related complications, and may be preferred over warfarin and enoxaparin 13.
- Key considerations for post-operative management of hip replacement anterior approach include: + Pain management: oxycodone may be preferred over fentanyl due to its superior analgesic efficacy 10. + Rehabilitation: a functional-based protocol and hip assessment scale may be effective in promoting early recovery 12. + Venous thromboprophylaxis: aspirin and factor Xa inhibitors may be preferred over warfarin and enoxaparin due to their lower risk of complications 13.