THR post op rehab less important?

[dsommerl]

I am scheduled for a left THR in December---I had a right THR 9 years ago
Am using the same surgeon. When setting this up with his head nurse I asked if anything had changed with a THR since my last one 9 years ago. She said not really--except for the post op physical rehab. She said that over time--they figured out that less was more for a THR. That many over did the rehab and it ended up being more of a negative. She said that really simple rest and some walking as one recovered was the best approach. She said someone would do a couple of home sessions at first--which I guess would teach me some PT movements
Does this match with what others are being told--"less is more"--the hip will heal fine with rest with limited to none PT (physical therapy)

 

[djklaugh]

@dsommerl Welcome to BoneSmart! YES! What your surgeon's nurse told you is very much the way all of us here have found to work for hip replacements. You are very fortunate to have a surgeon who has come to this realization. Most hips really do not need PT. Occasionally, if you've limped for a long time on a bad hip, the muscles around thehip might need some PT help to get back to proper working order but that is best left until you've healed up ... and should be consistent with the "less is more" approach.

 

[Jaycey]

@dsommerl The approach your surgeon's office is now taking is very much what we recommend. Excessive PT should be reserved for strength training once that hip is healed. In the early days, rest, ice, elevation and walking are the best PT.

 

[CricketHip]

Oooh how I love hearing that your Surgeon shares this same philosophy of less is more.

Hence our favorite tip:


BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

 

[Eman85]

In my OS words, PT will hurt you. It's hard to accept but less is a whole lot better than more. I had a copied sheet of the basic exercises, they made us do them at the hospital, and even they were too much and a waste of time. I did them with my first THR and didn't do them with my 2nd.

 

[dsommerl]

I'm told that 90% of my guy's THR-s go home same day. My first one 9 years ago--I stayed one night and went home the next day. I don't recall that I had to pass any "tests"--walking up stairs etc to be released
I do recall they had me on my feet about an hour after I "came to".
Looks like consensus is less is more--thanks!

 

[Going4fun]

Sounds like you got a sharp surgeon.

 

[dsommerl]

wondering if maybe its insurance driven somewhat?--I'm on Medicare with a Plan G

 

[Eman85]

Not sure which thing you mean is insurance driven. My THR's were done prior to my Medicare days and I was given the choice to do the in and out or spend the night. I chose spend the night and was glad I did. As far as the PT goes it was the same, my OS said he'd write me a prescription for PT but warned against it. Insurance would have paid.

 

[Sohowarrior]

It’s only fair for you to consider the minority point of view. My surgery was on April 5. My HSS surgeon set up 4 at home PT visits for me which began immediately upon my discharge from the hospital the morning after surgery. Very basic and gentle, but got me up and moving. My surgeon basically left it up to me to decide if I wanted more outpatient PT, which he approved on my request (Medicare covers the cost).
I loved my PT. I won’t repeat my whole recovery thread here, you can read it if you are curious. I found it hugely helpful from both a mental and physical standpoint. Many people on this forum would likely say it was very aggressive and not necessary. For me, as someone who was and is very fit, exercised daily for most of my life, and had a fairly easy first two weeks post surgery, it was safe and effective. Everyone does heal differently and at different rates of recovery, I agree and respect that. I am away from my NYC home until September but I am planning on at least another 4 or 5 PT sessions on my return. I’m just saying it’s an option to consider if it’s a good fit for you.

 

[dsommerl]

Not sure which thing you mean is insurance driven. My THR's were done prior to my Medicare days and I was given the choice to do the in and out or spend the night. I chose spend the night and was glad I did. As far as the PT goes it was the same, my OS said he'd write me a prescription for PT but warned against it. Insurance would have paid.

I meant that some Dr-s will tailor their treatment where reasonable to fit within your medical insurer's rules/coverage

 

[Gerard2018]

Insurance, be it public, private, or a hybrid of both, will only compensate the providers if their treatment is evidenced based. Yes, it is a sort of ”cost cutting measure“, but why pay out for treatment that at best does little to help the patient, and at worse harms him or her, and is a further cause of unnecessary billing.

 

[Eman85]

Not sure which thing you mean is insurance driven. My THR's were done prior to my Medicare days and I was given the choice to do the in and out or spend the night. I chose spend the night and was glad I did. As far as the PT goes it was the same, my OS said he'd write me a prescription for PT but warned against it. Insurance would have paid.

I meant that some Dr-s will tailor their treatment where reasonable to fit within your medical insurer's rules/coverage

Of course that's how it works. No different than auto insurance. If you have a wreck the insurance company has the choice of whether the repair shop uses new OEM parts, new aftermarket parts or used parts.
I just went to a Podiatrist for treatment on my left foot. I had to go back 3 times, I'd bet I would have been fine after the first or second visit but I got 3 visits and 3 treatments because they know that's what they get paid for. That Dr. didn't even know or care if I had a right foot. He spent a very short period of time with me and kept looking at his watch, you only get so much time for a visit.

 

[DGrant]

I've had it both ways. My first THR(posterior)almost 7yrs ago I had formal outpatient PT, and quit after about 3 appointments because it left me in great pain every time. I did my own thing with simple walking, leg lifts, heal slides, and other activities. My hip healed wonderfully after that.
My second THR(anterior)about 14 months ago, no PT prescribed(yes I was relieved) except for written exercise instructions I did as my abilities increased and pain levels decreased. It was glorious, and much less pain overall, and would ya know my hip healed great as well.
Today I have no pain at all, and total harmony in hip land. I can walk/hike indefinitely if I want, and am more active than I've been in 15yrs. Weight loss as well played a factor for me. Both combined really changed my life.
Best wishes on your journey.

 

[zauberflöte]

@dsommerl that sounds like a very sensible OS! As to same-day surgery, I cannot imagine having to leave the hospital the same day. I had very little anxiety before each surgery, but the 24 hours after were just the beginning of constant trepidation and nervousness. I know that you will be glad when December comes and you can look forward to two happy hips!
My hips are 9 and 5 this summer. The older one had in-home PT for a few visits, which I performed assiduously for a couple of weeks and then gradually dropped off. My younger hip did nothing but walk just as much as #1 had, and maybe some movements that felt good at the time. They both healed about the same. I was forbidden to rotate ( turn in, turn out) the first hip in its socket by both the OS nurses and my insurance's"concierge nurse", for many weeks. When resting I was to keep the toe pointing straight up. This regimen felt AWFUL, as though I were in a cast of my own making. The consequences are that while I can turn in and turn out now, the turnout is a lesser degree than the other hip, which had no concierge nurse to obsess over her own performance ratings. The younger one, which I moved as I felt inclined (gently at first!!) has a great turnout, and no in-turn. In fact, that's painful. Go figure.
So, I now feel that I'd finally like PT for each, for soft tissue ...quirks! I've been doing the type of exercise class called "Barre" (which is not a ballet barre class at all) for over three years now, and it's pointed up some things which I feel could be improved in the "yowee that hurts to do that!" department. The anterior scars cause pain in the tissue under them. There is a particular move I can do really well on one side but not the other. Other little things that stand out as I age (I'm 70). Having a pro look into these issues feels like it could be rewarding. My next step is to find out if my OS has an opinion on dry needling of the scar tissue. I have a feeling that opinion would be "absolutely not!" but have to ask anyway.

 

[Zoebichon]

wondering if maybe its insurance driven somewhat?--I'm on Medicare with a Plan G

Back in 2020, Kaiser Permanente led the way in developing techniques and protocols to pave the way for THR same day surgeries. It was heavily researched and followed up on. Same day patients did not have any more hospital readmissions or dislocations or infections or complications than patients who stayed in the hospital a night or two.

Of course, no OS department would send any patient home who was not safe to be discharged. Blood loss, blood pressure, mobility and pain all have to be well controlled.

And the research also showed that most patients loved being discharged to the comfort of their own homes, provided it was safe to do so.

Kaiser Permanente readily admitted that keeping costs down was a plus in same day surgeries.

 

[Going4fun]

Well there is an insurance element to outpatient surgery. Surgeons get penalized for infections and complications. Being in a hospital is highly risky. You're around sick people.

Most surgeons want you gone the day after the surgery. It is far safer than hanging around a hospital. There is a psychological element involved as well. People going home quickly get the message that they can trust the hip and they can start a healthy process of recovery.

Outpatient surgery is just an extension of releasing people the next day. And outpatient surgery can always be reversed--the stay extended--if the patient has complications or problems. Also surgeons who do outpatient definitely screen for this, screen for people who seem healthy enough for this--they don't do outpatient on everyone. One surgeon I know who does a lot of outpatient surgeries has an aggressive monitoring protocol for after the patient goes home. It's not like "see ya."

But yes, to answer your question: as I understand things surgeons do get penalized (pay wise by insurance companies and by Medicare) when their patients have serious complications, including infections and readmissions. I don't exactly know if this is surgeon by surgeon or by hospital. But getting the patient out of the hospital is one way to keep infections and problems down.

There are studies coming out on outpatient vs inpatient outcomes and from what I can tell outpatient people do fine.

 

[benne68]

wondering if maybe its insurance driven somewhat?--I'm on Medicare with a Plan G

Honestly, I don't think so.

I'm also on Medicare. I had the same surgeon for both my THR and TKR. For the hip replacement, he advised that no PT is needed. He citied some studies that tracked patients' recovery success and concluded that walking is the best therapy.

However, with my knee replacement, he said that -- unlike with the recovery from the THR -- I was going to need some PT to help my knee recover.