Post Operative Instructions
Hip Arthroscopy (without microfracture)
Congratulations! You have just completed the surgical phase and entered the recovery/rehabilitation phase of your operative experience. In order to achieve the best possible result, active patient participation is extremely important during this period of time. The following instructions are designed to help you achieve the best possible outcome following your surgery.
Many questions arise during the first week after surgery. There are many new sensations felt in the body, especially in the operative hip and leg. The following will help answer many of your questions to help relieve normal anxiety.
You are restricted to flat foot weight bearing for three weeks. Start weaning off of your crutches post-operative day 22 with 50% weight bearing. Continue this for one week. After surgery, you will beflat foot (heel to toe) weight bearing with 20 pounds of pressure with the aid of crutcheswith a goal of returning to full activity as soon as possible (remember properflat foot (heel to toe) weight bearing assists in decreasing your risk of developing a DVTor blood clot).
You will need to wear the hip brace for three weeks. Place it securely around yourwaist and thigh; this serves as a reminder to control hyperextension and abduction. Youwill need to wear this brace when you are walking with crutches and flat foot weightbearing. You will not need it when you are sitting, lying down, or sleeping.
CPM (Continuous Passive Motion) Machine:
Recommended usage- 4 Weeks for 6-8 hours/day
Range of motion settings:
- Week 1- 10-45 degrees
- Week 2- 0-60 degrees
- Week 3- 0-70 degrees
- Week 4- 0-80 degrees
You will need assistance to get into the CPM for the first couple of days aftersurgery. You may want to set the CPM at a 10 degree angle away from your midline.
(Tip: To help in the prevent lower back pain, try and maintain normal spine alignment whilein the CPM. You may want to place a rolled towel or a small pillow behind your lower back. Place theCPM unit in the middle of the bed to prevent the machine and your leg falling offthe bed. Avoid placing the unit on a couch or narrowed place while reclining.)
COLD THERAPY UNIT/ICE
Ice should be applied to the outside of your dressing frequently during the first 48 hours after surgery (30 minutes ON/30 minutes OFF), and during the first week following surgery. After the first week, you may consider ice after rehabilitation sessions or when swelling occurs. Do not apply ice directly to the skin.
Range of Motion Restrictions:
Abduction 0- 45 degrees for 2 weeks
Flexion: No restrictions. Avoid resting with the hip at 90 degrees for the 1st two weeks.
(Tip: To avoid hip flexion at 90 degrees for the 1st two weeks: use a higher chair, a reclinerchair, or while sitting you can slouch forward or backward. Please have the physical therapist doall circumduction exercises in 70 degrees of flexion.)
Extension greater than 0 allowed after day 21.
Extension goal is to gain full extension to 0 by the end of the 1st week.
No prone therapy
You will have a large waterproof dressing covering your surgical sites when you are discharged from the hospital. You may shower with this dressing in place. A small amount of bloody drainage on the dressing is not unusual. You may remove your dressing on the third day following your surgery. Once you have removed your dressing, please keep your incisions covered with Band-aids. Change as necessary throughout the day if the Band-aids become soiled or wet.
** Do not put any ointments or lotions over the incisions. **
** Do not allow pets to sit on your lap or sleep in your bed for at least 6 weeks followingsurgery. Pets may harbor fleas, mites, or other organisms that may cause a woundinfection. **
If you should have any questions or concerns regarding your incisions, the best thing to do is to contactDr. Mook or a member of his team.
Do not submerge your hip in water (e.g. baths, pools, or hot tubs) while your stitches are in place. Pool therapy is okay with a waterproof dressing (i.e. Op-site) in place. You may resume regular showers after the initial dressing is removed on the third day following your surgery. While the wound isdraining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped youmay allow water to run over the incision sites. When complete, pat the incision dry.
Your sutures will be removed approximately 14 days following your surgery at your first follow-up appointment.
PHYSCIAL THERAPY (PT)
Appropriate PT is critical to the success of your surgery.You are expected to begin PT 3-5 days following your surgery. If you are experiencing pain, takepain medication and/or a muscle relaxant and proceed to PT. Participation in therapy exercises will often help ease the pain. Attending PT will allow your therapist can assess your situation and provide appropriate guidance. Do not hesitate to contact Dr. Mook's office with any questions or concernsat any time. Your attendance of supervised physical therapy and completion of your home exercise program are paramount to your success.You should plan on working with a therapist 1-2 times per week for the first 3 months after surgery. This schedule may be adjusted based on your individual progress.
You may begin the following home exercises the day after surgery. These should be performed several times per day when you are not sleeping.
- Hamstring sets: push heel into bed for count of 10.
- Heel slides: sit on a firm surface with your leg straight in front of you. Slowly slide the heel of your operative leg toward your buttock by pulling your knee to your chest as you slide.
- You may also utilize a stationary bike with no resistance to encourage early motion in your hip joint. Begin with small sessions of approximately 10 minutes at a time twice daily.
- Active Foot/Calf Pumps: Do 10 up and down pumps of your feet every hour while awake. Also remember to do these when riding in a vehicle for any length of time or on an airplane.
(Foot pump and calf pump rationale: Compression of calf muscles causing return of the blood in your lower legs to your heart.)
**Note: Spare the Hip Flexors for 2 weeks**
In order to NOT irritate your hip flexors (and have them bother you for weeks/months) do not actively lift your operative leg against gravity initially. This means whenlying on your back, getting off the bed/table, or getting into the CPM, someonemust lift your leg for you the first 2 weeks. When getting in/out of a vehicle,or turning sideways in a chair, the leg needs help - for this you can use the bracenear the knee as a handle to lift/move your thigh. After you are feeling andmoving more comfortably, you may be able to use your other foot/leg to move the operativeleg about if comfortable.
A prescription for pain medication will be given to you upon discharge from the hospital/surgery center. Pain medication should be taken as prescribed until your pain is undercontrol. It will help to take your pain medication thirty minutes beforetherapy if you are experiencing any pain. Most patients are able to discontinue their use of pain medication prior to their first follow-up appointment.
(Tip: Applying ice and elevating the leg as much as possible will help alleviate pain. Try to relaxand allow others to assist you as much as possible the first week.)
Your post-operative regimen consists of several of the following medications.
Please take the following as needed for pain:
_____ Roxicodone (Oxycoodone) 5mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
— OR —
_____ Dilaudid (Hydromorphone) 2mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
— OR —
_____ Norco 5mg (Hydrocodone/APAP): 1-2 every 4-6hrs as needed for pain. (Narcotic)
Please take the following as needed for muscle spasm (will cause drowsiness):
_____ Diazepam (Valium)2mg tabs: 1 every 6hrs as needed fro muscle spasms. (Muscle relaxer)
— OR —
_____ Robaxin 750mg (Methocarbamol): 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
Please take the following as needed for nausea/vomiting:
_____ Zofran 4mg (Ondansetron) oral dissolving tablets: 1 every 6-8hrs sublingually as needed for nausea.
— OR —
_____ Phenergan 25mg tablets (Promethazine): 1 every 6 hours as needed for nausea.
Please take the following SCHEDULED medications as directed:
Heterotopic Ossification Prophylaxis:
_____ Voltaren DR 75mg (Diclofenac) - 1 capsule every 12 hrs for 6 weeks
Potentiation of Cartilage Repair (matrix-metalloproteinase inhibitor):
_____ Doxy 20mg (Doxycycline) - 1 tablet daily for 4 weeks
DVT Prophylaxis (i.e. blood clot prevention):
_____ Enteric Coated Aspirin 325mg (ECASA) - 1 daily for 4 weeks
— OR —
_____ Xarelto (Rivaroxaban) 10mg tablets- 1 daily for 4 weeks
_____ Omeprazole (Prilosec) 20 mg tablets: 1 daily for 6 weeks (while taking NSAIDs)
Pain Medication Tips:
- Do not drive while taking pain medications.
- Do not drink alcoholic beverages while taking pain medications.
- Pain medication should be taken with food as this will help prevent any stomach upset.
- Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible. To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
You should resume taking your normally prescribed medications unless otherwise directed. In some circumstances, additional/alternative medications are prescribed:
SPECIFIC QUESTIONS / PROBLEMS
There are several risks to hip arthroscopy surgery that should be acknowledged:
Infection:The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, andappropriate wound care.
DVT: The risk of DVT (deep vein thrombosis, blood clot) is decreased by instituting early motion(CPM), mechanical means (foot pumps, ambulation), and medication. Following the pre-operative andpost-operative instructions will reduce the risk of deep vein clots.
Pain:There is a potential for painwith any surgical procedure. Motion, medication, ice, rest,compression, elevation, and therapy can reduce the chances of excessive post-operative pain.
Numbness:There is a small chance of numbness in the perineal (groin) region postoperatively. This can be caused by the pressure placed in the groin by a post necessary to distract (pull) the femoral head (ball) from the hip socket to allow for the procedure to be performed safely. The arthroscopic incisions are in close proximity to the course of the lateral femoral cutaneous nerve. As such, you may also experience numbness of the upper outerportion of the thigh on the operative leg after surgery. This is normal and the numbness will likely resolve over time.\
Scarring: Superficial and deep scarring can occur following surgery. Following the rehabilitation restrictions and recommendations can reduce this risk. To minimize the appearance of superficial scars of the skin, it is important to avoid exposure to UV light (e.g. sunlight, tanning lights) as the scars mature.
Please contact my office for further instruction if you develop fevers greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable pain, or persistent numbness/tingling in your leg.
Your follow-up appointment has been schedule on _____________________ at the Reston Office.
If you need to verify or change your post-op appointment, please call 703-277-BONE (2663).
You may schedule physical therapy to begin approximately 3-5 days following your surgery.
*Please feel free to contact my office at anytime if you have any questions or concerns regarding your post-operative course.
*Dr. Mook would like to thank Dr. Marc Philippon and his support team in Vail, Colorado for the creation of these rehabilitation recommendations. They have been updated and modified to suit the needs of Dr. Mook's patients.