Postoperative dressing change
Thank you for taking time to familiarize yourself with the current protocol for Dr Christoforetti’s hip arthroscopy patients. As your friend or family member recovers from hip arthroscopy, your role is an essential one- thank you for your kindness and dedication! These are general guidelines and are not intended to substitute for the skilled instruction and individual adjustments required in a typical post-surgical recovery process.
HIp arthroscopy procedures are performed at UPMC St Margaret on a same-day surgery basis. Patients return to the office the very day after surgery for check-up and then physical therapy is initiated immediately postoperatively.
Hip arthroscopy involves making small incisions in the skin and slightly larger ones in the ligament capsule surrounding the hip joint. The postoperative leg positioners, hip brace, and CPM (Continuous Passive Motion machine) are designed to initiate healing of the deep incisions properly.
Dr Christoforetti beleives that early and skilled physical therapy and one on one involvement of a caregiver combine to produce an optimal recovery.
Your efforts in assisting the patient with therapy and proper leg positioning WILL greatly impact their outcome in a positive way!
All hip arthroscopy patients are to be on their backs in bed- no prone or side-lying sleeping.
The normal leg should have thigh high TED hose on at all times.
Hip arthroscopy patients should lie on their belly with their legs flat on the bed for 20 minutes in a row 3 times each day.
Abduction Cylinder & Boots
The Philippon hip cylinder and boots must be worn at all times while in bed and NOT in CPM unit. The feet are placed in the black boots. The cylinder should be placed between the feet with the white foam surface against the mattress. The correct foot position is a toes-up position. The Velcro straps should be applied around the midfoot of the boot and attached to the black cylinder.
Hip Brace Use
All hip arthroscopy patients are pre-fit for a hip brace. The brace is set to allow full extension and 90 degrees of flexion. The brace is to be worn whenever the patient is not in the CPM device.
Brace application: apply the padded waist strap around the torso just above the level of the pelvic brim. Attach the thigh straps to the surgical thigh loosely, allowing the strap to maintain contact around the whole thigh, but with enough slack to easily slide one finger between the strap and the thigh.
Continuous Passive Motion Machine (CPM) use is important for prevention of adhesion formation within the joint. Six hours of CPM use daily is required. This can be done in 1 or 2 hour sessions.
The foot should be in a toes-up position while in the CPM. The setting should be from 0-90 degrees.
All patients have a CPM delivered to their home prior to surgery.
Ice will greatly decrease postoperative pain and edema. The EZ wrap is to be laid over the operative hip and kept cold constantly. The only time that the EZ wrap should be off is if it is too difficult to keep in place while in the CPM. Otherwise, it should be applied and COLD at all times.
Hip arthroscopy patients are restricted to 20 lbs foot-flat weight bearing with crutches for the first two weeks after surgery.
Postoperative medications are prescribed and filled prior to surgery for hip arthroscopy patients. The general regimen includes a narcotic pain medication, a sleep aid, a nausea medication, and a NSAID (Indocin, naproxen, or celebrex) for prevention of bone formation in the soft tissues of the hip after surgery. In hospital medications will vary but must include an NSAID.
Patients can take all medications as prescribed on an as needed basis EXCEPT the NSAID pill which is taken as prescribed on a scheduled dose with food.
The bulky postoperative dressing may reveal evidence of drainage the first night postoperatively. Simply reinforce the dressing as needed.
The next morning the bulky dressing will be removed, the skin cleaned and a small adhesive OpSite Dressing applied. Each day thereafter for the first week and anytime the dressing appears wet or dirty; you must remove the dressing, clean the skin with a soft cloth and water, and reapply an OpSite Dressing.
Leaving the Hospital
Typically, for outpatient procedure, the patient will follow with Dr Christoforetti or his staff the DAY after surgery and proceed to physical therapy. This visits must be prescheduled prior to surgery.
If staying overnight, the patient will have a session of physical therapy that must include the participation of the primary caregiver. This will usually occur between 0830 and 0900 the day after surgery. They will all have a follow-up session with a preselected outpatient therapist already scheduled as well as a 2 week postoperative visit with Dr Christoforetti.
Patients can shower 48 hours postoperatively. No bathing, hot tubs or swimming pools. No scrubbing or vigorous drying of the incisions.
Patients are not allowed to drive until they are completely off all sedating medications and crutches. For right hip surgery or standard transmission driving 6 weeks postoperatively is the earliest driving is allowed. For left hip surgery, two weeks postoperatively is the earliest driving is allowed.
School or Work
Return to school or work will vary from patient to patient, but the first two weeks postoperatively are generally devoted entirely to recovery. Arrangements should be made in advance for students to receive school assignments during this period.