Department of Rehabilitation Services
Physical Therapy
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2022 The Brigham and Women's Hospital, Inc., De
partment of Rehabilitation Services. All rights reserved
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• Observe for signs of hip dislocation
o Signs include uncontrolled pain, an obvious leg length discrepancy, and/or the leg
may appear rotated as compared to the non-operative extremity
• Observe the patient’s hip dressing and wound
o Note skin discoloration, edema, and dressing integrity
o If large amount of drainage or blistering/frail skin, discuss with nursing
o Contact surgical team if excessive bleeding or poor incision integrity
• Monitor for signs of pulmonary embolism, deep vein thrombosis, and/or loss of
peripheral nerve integrity
o In these cases, notify the MD immediately
Positioning Considerations:
• Bed position:
o Posterior/Global Precautions
▪ Foot of the bed shoulder be locked in a completely flat position
▪ Nothing placed behind/under the knee
o Anterior Precautions:
▪ Foot of the bed may be unlocked and flexed while in supine
▪ Pillow under the knee to maintain slight hip flexion
thereby promote knee extension. A
trochanter roll is a towel roll that is placed next to thigh just
proximal to the knee.
A hip abduction pillow may be indicated in bed with posterior precautions or global
precautions. Most often ordered with revision surgeries.
Therapeutic Exercise and Functional Mobility:
• Active/active assisted/passive (A/AA/PROM) supine and seated exercises including
ankle pumps, heel slides, hip internal and external rotation,
long arc quads, seated hip
flexion, and hip abduction/adduction (if no troch off precautions)
• Isometric quadriceps, hamstring, and gluteal exercises
• Lower extremity range of motion (ROM) and strengthening as indicated based on
evaluation findings
• Closed chain exercises (if patient demonstrates good pain control and muscle strength)
o Consider bilateral upper extremity support to maintain weight bearing precautions
• Bed mobility on a flat bed and transfer training
• Gait training on flat surfaces with an appropriate assistive device
• Progress to stair training with upper extremity support if the discharge plan is home
• Patients are seen by Occupational Therapy (OT) for education regarding how to
perform activities of daily living (ADLs) with modified independence
o If the patient is discharged to a rehabilitation facility, they will receive OT at rehab
Criteria for Progression to the Next Phase and Discharge to Home:
• Minimal pain and inflammation
• Independent bed mobility, transfers, and ambulation at least 100 feet with appropriate
assistive device