Activity Level

The activity level prescribed after hip arthroscopy is variable, depending on the pathology found at the time of surgery and the surgeon's preference. Generally, an assistive device such as crutches or a walker is recommended during the first week, with the patient bearing weight as tolerated. A normal gait pattern usually returns within this time frame, but patients should be encouraged to use their assistive devices until they see the physical therapist or return to the surgeon's office. Weight-bearing status may be more restricted in certain cases such as abrasion arthroplasty of the weight-bearing surface of the hip joint.

The patient will be most comfortable immediately after surgery in a reclining or sitting position. The most comfortable sleeping positions are usually supine or on the nonoperative side with a pillow between the legs. Sleeping on the operative side does not cause harm, but usually this is not comfortable until 4 or 5 days postoperatively.

Patients need to be reminded that it is easy for them to overdo activities in the first few days after surgery, and patients should be encouraged to limit their activities. Once they feel like being up and around, daily activities can be performed to tolerance, but they should be respectful of any discomfort felt in the hip. Often patients experience a honeymoon phase during the first 3 to 4 weeks following surgery. They are enthused by the way their hip feels, but they have not yet resumed most of their normal daily activities. As patients resume more normal activities, there will always be some transiently increased soreness. If the patient is not prepared for this, it can be an abrupt and disheartening experience, shaking the patient's confidence in the eventual recovery process. The nurse can explain that it really takes a month to get over the actual surgical procedure. After that initial month, it can take 3 to 4 months before patients may actually appreciate the benefits of the surgery.

Fatigue is one of the biggest considerations after surgery.4 This can be related to several factors including the anesthetic, analgesics, pain, or sleep disruption. The nurse should inform the patient that this effect generally dissipates after postoperative day 3 but can last as long as several weeks.

Physical therapy is usually initiated 2 days after surgery. The rehabilitation program for the postoperative patient is individualized to the pathology addressed and the procedure performed. The primary focus of the rehabilitation process is to reduce discomfort and improve function. A successful result after surgery is often dependent on a properly constructed rehabilitation program. This is an important concept to be relayed to the patient because there may often be a reluctance to go to physical therapy. When the hip hurts, the idea of exercise may not be appealing.

The most frequently asked question regarding activity is "When can I drive?" General guidelines include the following two parameters: the patient must have discontinued the use of narcotic analgesics and have regained adequate leg control to operate the accelerator and brake pedals or clutch.

It is important for the clinical nurse to remember several things pertinent to the postoperative recuperation. Patients want and need to hear that they are do-

FIGURE 18.2. Inspection of the wound demonstrates the position of the standard portals. These are placed lower than many patients expect when conceptualizing the location of their hip joint.

ing well and are on schedule in their recovery. Patients are often impatient and may expect to recover more quickly than they actually do. Many prefer to have guidelines by which to gauge their progress. They want to know how other patients normally respond under the same circumstances.4 Remember that patients often latch on to misinformation and often revert to this misinformation, despite the clinician's best effort at education. Patients and their caregivers may simply exhibit selective hearing or may forget to read postoperative instructions; therefore, frequent contact by telephone is one of the keys to the successful recovery of the hip arthroscopy patient.8 The frequent contact between the clinical nurse and the patient can have a positive effect on patient satisfaction and also provides a mechanism for feedback from the patient and caregivers.3

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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