For carefully selected patients who have undergone minimally invasive primary THA, an accelerated rehabilitation program may be feasible to achieve optimal outcomes as rapidly as possible. However, few guidelines have been published to date.

Berger and colleagues developed and implemented a program specifically designed for patients undergoing primary cementless THA with a two-incision approach. Patients eligible for the minimally invasive surgery and accelerated rehabilitation program had to be between the ages of 40 to 75 years with a body mass index of  35, no previous hip surgery, and no history of cardiac, vascular, or pulmonary disorders. The following are key elements of the accelerated program described by Berger et al.

Preoperative activities. Prior to surgery, educate the patient about the surgical procedure and postoperative rehabilitation program, wound care, and the home exercise program. Initiate gait training (weight bearing as tolerated) using crutches and a cane.

Immediate postoperative therapy. Approximately 5 to 6 hours after surgery, if the patient is medically stable, begin the following activities.
• Postoperative bed and chair transfers (weight bearing as tolerated)
• Ambulation with crutches, progressing to a cane as tolerated
• Ascending and descending stairs, one step at a time

Criteria for hospital discharge. The patient is discharged from the hospital aid.
• Transfer in and out of bed
• Stand up from and sit down in a standard, firm chair
• Walk 100 feet
• Ascend and descend a flight of stairs

Berger et al. reported that 97 of the 100 participants in the study met the crteria for same-day discharge. The three remaining patients, who delayed therapy because of nausea or orthostatic hypotension, were discharged the day after surgery.

Home-based and outpatient therapy. Patients participate in a home-based therapy program followed by outpatient therapy once able to drive. There are no specific positioning or ROM precautions or weight-bearing restrictions.

• Progress to ambulation with a cane as soon as possible. Continue cane use until able to ambulate with a symmetrical gait pattern and no noticable limp.
• Have patient maintain an activity log to document functional outcomes.

Some of the short-term outcomes of this accelerated rehabilitation program reported by Berger et al. were that patients discontinued use of narcotic pain medication, transitioned to a cane, and started driving after an average of 6 days. Patients who worked returned to work at an average of 8 days. Patients walked without an assistive device at an average of 9 days. At 3 months there were no serious complications identified.

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