Rehabilitation after Hip Surgery: Efficiency and Management Plans

This assignment explores the efficiency of rehabilitation after hip surgery and discusses management plans for better outcomes. It includes a literature search on the topic and highlights the benefits of supervised and unsupervised rehabilitation programs.

Running head: GERONTOLOGOCAL NURSING
GERONTOLOGOCAL NURSING
Name of the student:
Name of the university:
Author note:

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Introduction and background:
Elderly people are seen to use a bigger part of the health as well as social services mainly
in the developed countries. One of the very common health injury like the hip fracture is seen to
be considered to be one of the major issue that old people face because of its high incidence.
High level of mortality and morbidity are also seen to be intricately associated with hip fracture.
Hip fracture is also found to be intricately associated with decrease in the quality of life with
reduction in the physical movement and increased cost of the healthcare required for the
treatment after the surgery and meeting their needs. The most commonly utilized intervention
after hip fracture is surgery that helps people to come back into their normal life and become
independent. Studies are of the opinion that hip replacement surgeries are also a treatment
intervention mainly for people with abrasion of hip joints for the reduction of the pain as well as
for increase in mobility. It has been stated by researchers that establishment of the rehabilitation
programs after that of hip surgery help by improving the quality of life of elderly people. It has
been found that patients who seek for the services of the outpatient rehabilitation had improved
strength and even better functional performance like that of better mobility and self-care abilities
after 1 year and 3 months respectively (Ling et al, 2017). This assignment would mainly include
a literature search that would try to find out the efficiency of rehabilitation as well as the
different associated aspects of rehabilitation after hip surgery. Different important databases like
Pubmed, Cochrane, Medline and others would be searched to find out important articles that
suffice the topic that needs to be researched on.

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Pathophysiology of hip replacement:
During the time of hip replacement, a surgeon mainly causes removal the damaged
sections of the hip joint and then replacing them with different parts that are mainly constructed
from metal as well as ceramic and very hard plastic. Studies have found that these artificial joints
also called prosthesis have the ability in reducing the pain as well as improvement in the
functions. Hansen et al. (2018) are of the opinion that hip replacement surgery is mainly an
useful option for those individuals where their hip pain interferes with that of the daily activities
and when more conservative treatment have not been able to help the patients or have proved to
be ineffective. During the time of hip replacement doctors are seen to make incisions over the
front side of the hip through different layers of the tissue (Tuncel et al., 2015). This is then
followed by the professionals removing the diseased as well as the damaged bone and cartilage
leaving all the healthy bone intact. The surgeon then implants the prosthetic socket in the pelvic
bones thereby replacing the damaged socket. They then replace the round ball like structure on
the top region of the femur with the prosthetic ball that is attached to the stem fitting into the
thigh bone (Esposito et al., 2018). Hutchinson et al. (2018) are of the opinion that different
techniques for hip replacement are always evolving and as the professionals are continuing to
develop less invasive surgical techniques, these techniques might cause reduction of the recovery
time and the pain.
Management plans:
After hip replacement surgeries, patients often start physical therapies. On the first days,
patients can be seen to perform minor physical therapies sitting on the chair. In course of time,

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the rehabilitation process is mainly seen to include stepping, walking, and climbing. Some of the
supportive devices like that of walkers or crutches are used in the initial phases. Pain is
monitored by the nurses when exercises are done by the patients. Many of the professionals are
of the opinion that some forms of discomfort are normal (Haas et al., 2018). Physical therapy is
found to be excessively important in the overall outcomes of any joint replacement surgery.
Coulter et al. (2017) are of the opinion that most of the goals of the physical therapy are to
prevent contractures, improvement in patient education, as well as in the strengthening of the
muscles around the hip joint through the interventions of controlled exercises.
Scarring of the tissues, surrounding the joint, results in contractures which can cause
limitation on the joint motion. Such contractures do not allow full range of motion and therefore,
they are seen to impede mobility of the replaced joint. Nurses should instruct patients not to
cause any form of strains to their hip joints with any activities like heavy lifting as well as other
activities at homes (Zhu et al., 2016). Patients are advised in not crossing the operated lower
extremity across the midline of the body and this might be because of the risk of dislocating the
replaced joint. Professionals should discourage them from bending at the regions mainly the
waist. They are also instructed to using of pillows between the legs when lying on the non-
operated sides form preventing the lower operated lower extremity from crossing over the
midline (Erlenwein et al., 2016). Patients at this time are given home exercise programs for
strengthening the muscles around the buttocks as well as the thigh. Most of the patients are also
seen to attend outpatient physical therapies for a period of time and at the same time,
incorporating home exercises into their daily living.
Evaluation of the management plans along with critical analysis of the knowledge:

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Bandholm, Wainright and Kehlet (2018) have added a dearth of information that
can be analyzed by nursing professionals when they would treat patients with hip replacement in
the rehabilitation centre. One of the valuable information provided by the authors were that
supervised, high volume, pre-operative and progressive strength training to the patients before
the operation enhance the recovery of development of condition of the hip joints and movements
resulting in better functional performance after the surgery. It has been also found by the authors
that exercise based rehabilitation is also found to be superior to no as well as minimal level of
exercise-based rehabilitation following hip replacement. They have also suggested that
individuals home based rehabilitation is also equally fruitful to that of outpatient as well as
supervised rehabilitation. Hence, from this information, nursing professionals can note down
three important evidences that they can include in their care planning procedures. These are
initiating pre-operative exercise based progressing strength training before surgery; include high
level exercised based rehabilitation after surgery to ensure functional recovery of the patient.
Nurses can also arrange for home based rehabilitation as it is found to be equally efficient at
outpatient rehabilitation (Haas et al., 2018). However, the paper has limitations that nurses need
to consider like the authors have not assessed the specific types of rehabilitation interventions
that needs to be applied for specific sets of patients as all patients differ from each other in
physical, mental, emotional and financial needs.
Another interesting insight has been developed from the research conducted by
Coulter et al. (2017). A randomized controlled trail had been developed by the authors as they
wanted to compare the efficiency of unsupervised home-based rehabilitation to that of supervised
group based rehabilitation after the surgery of hip replacement. It had been surprisingly found
that there were no marked differences between both the groups at any point of time during the

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entire 26 weeks when the rehabilitation sessions were continued. This study had clearly shown
that the low risk patients who were discharged to home within one week of surgery had similar
rehabilitation outcome when they conducted their own rehabilitation program independently in
their own homes without any supervision. They were given written as well pictorial instructions
for performing rehabilitation independently at home. Their outcomes were found to be similar to
the rehabilitation program provided to another set of individuals who were under supervision of
the physiotherapy. From this, the nurse can develop the knowledge that early rehabilitation
programs after educating the patients about effective patient education can bring out positive
outcomes even when not supervised by experts. This can help the healthcare organizations to
save their healthcare resources as well as healthcare funds on more severe cases thereby handling
the healthcare burdens of the nation successfully (Zhu et al., 2016).
Hutchinson et al.(2018) was supportive of the claims made by the previous article and
had found similar results that align with findings of the Coulter et al. here, the authors have
compared the patient reported outcomes after continuing for hip and knee arthropasty for about 6
months. One of the group was discharged home after a week following surgery and another
group had undertaken inpatient rehabilitation for the same number of months. Patient reported
outcomes were measured for both the groups and comparison of the data showed that there were
no specific differences between the patient related outcomes. The analysis of the data showed
that inpatient rehabilitation after that of knee replacement and hip replacement did not have any
specific positive results on patient reported satisfaction, pain and quality of life as well as
activities of daily living scores when comparison was made with the subjects who were
discharged direct to home. Therefore, these evidences can be utilized by the healthcare teams of
the rehabilitation center in order to assess the risks analyzed with the patients and if the patient is

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found to be at a lower risk of accidents and falls, they can be considered for discharge (Haas et
al., 2018). One of the benefits of implementing this evidence is that it can result in significant
average saving of about $5600 per patient with the intervention of home discharge and hence, it
can act as a promising avenue for health cost reduction.
Hansen et al. (2018) was also found to support the above claims. The researchers wanted
to explore whether the outcomes are positive or negative regarding supervised or unsupervised
rehabilitation programs. They wanted to compare the benefits of both the programs on the
recovery of health of the patients who had gone through hip replacement surgeries. Supervised
exercises were found to be significantly not similarly effective when not compared to non-
supervised home based exercises on “patient-reported function, pain, health-related quality of
life and performance-based function after primary total hip replacement”.
Hawke et al. (2018) has undertaken researches to find out the efficiency of rehabilitation
after hip and knee replacement. They wanted to mainly find out whether exercise delivered in the
group setting in the earlier stages of outpatient rehabilitation would help in development of the
physical activities in patients after hip replacement. Statistical analysis was undertaken and it
was found that by the researchers that the participants developed their skills both in both the tests
of fast paced walking as well as 6 Minute Walk Test. The mobility as well as physical fitness of
the individual continued to improve at 6 week follow-up sessions. Hence, from these nurses can
adapt the evidence in their practice that group dynamics present in the outpatient rehabilitation
exercises program might increase the physical activity levels during the time of group
participation but not after group cessation.

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Bu et al. (2017) wanted to test the efficiency of rehabilitation outcomes after hip
replacement surgery on the re-admission rates of the hospitals for the same patients. His study
mainly aimed at investigating the status of the readmission within that of the one month after
discharge and other related health concerns in the elderly people who was 65 years old and
above. It had been found that pre-discharge rehabilitation among the patients who are aged 65
years and above undergoing hip replacement surgery helped in reduction of the admissions as
well as their efforts in increasing their daily living functions like that of the muscle strengths as
well as the walking ability (Esposito et al., 2018). This point can be used in arguing with the
article that had been put forward by Hutchinson where he claimed that early discharge of patients
brought out same patient reported outcomes like that of the inpatient who were provided
supervised rehabilitation. He stated that huge amount of healthcare resources can be saved by
early discharge. However, article by B shows reduction of the reduction rates after rehabilitation
following surgery which in turn can help in saving healthcare resources again. Therefore, both
the articles contradict each other’s points.
Monaghan et al. (2017) has conducted a randomized control trail in order to find out
effectiveness of the physiotherapy supervised functional exercise program between that of 12 to
18 weeks following that of hip replacement. Patients who were in the functional exercise cohort
were found to attend the supervised classes twice weekly from that of 12 to 18 weeks following
surgery whereas patients in the control group were seen to follow the usual care protocol with no
exercises and interventions. It has been found that patients who are undertaking a physiotherapy
lead functional exercise program had significant improvement in their functional abilities when it
was compared with those of the individuals who were receiving usual care (Zhu et al., 2016).
Hence, nurses can focus on rehabilitation of the patients following their surgery to ensure that the

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patient develop their functional capabilities and tend to come back into their normal lives
successfully.
Another study by Kang et al. (2018) had shown that a number of major determinants
always need to be considered by nurses in the rehabilitation programs for success rates to be
increased. The determinants are early, individualized rehabilitation, education for activities of
daily living, review of general medical conditions, and arrangement of discharge settings. Such
well-designed rehabilitation program help in improving the ambulatory function after hip
fracture surgery. It was also found that if cognitive impairment and poor balance control is not
monitored and evaluated, it may inhibit the recovery of ambulatory function of the affected
patients.
A very new concept of rehabilitation had been described by Lyp et al., (2016). He had
tried to investigate the efficiency of rehabilitation programs tailored with water exercises in the
patients with that of osteoarthritis before and even after total hip replacement. After examining
its efficiency in about 192 participants, it was found that the water exercises in the rehabilitation
programs reduced significantly in the patients with osteoarthritis before as well as after total hip-
replacement therapy. Another important aspect that was also noticed was that including the use
water exercises helped in reduction of the utilization of medications of osteoarthritis as well as
pain among the patients. This can be one of the ways by which nursing professionals can make
the patients interested in a new form of rehabilitation which traditionally mainly comprises of
physiotherapy and dry exercise programs (Erlenwein et al., 2016). This would help in the
development of health of patients as well as cut of the boredom that they might have from
exercising indoors.

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De Luca et al. (2018) had tried to investigate the effect of pain monitoring sessions and
pain management session in the rehabilitation setting after that of joint replacement. The study
had supported the above claims where it was found that very good control of pain with that peri-
operative anesthetic protocols, and pain treatment protocols after surgery had shown very good
control of pain among the patients. The patients were found to have reached their maximal
functional ability at a mean length of 8 days and also showed sufficient reduction of pain at the
time of discharge without any medicine related complications. Den Hartog et al. (2015) is of the
opinion that hip replacement surgeries are painful procedures and earlier post operative pain
management leads to better as well as earlier functional recovery and causes prevention of the
chronic pain. Hence, this form of rehabilitation would help the nurse to make the patient relieve
from pain thereby ensuring high level of patient satisfaction (Tuncel et al., 2015).
Conclusion:
From the above discussion, it can be seen that that there are contradictory results about
the efficiency of supervised or non-supervised rehabilitation. Many of the researchers are of the
opinion that inpatient rehabilitation does not allow any extra benefits to that of patients who
undertake independent unsupervised exercise regimes at their homes. On the other hands, more
papers are supportive of the efficiency of rehabilitation program after hip replacement as it had
directly been associated with better quality life of the patients. Rehabilitation after hip
replacement is found to be associated with increased functionality in life, development of
physical fitness, and reduction of pain from surgery, development of mobility and activities of
daily living. it has also been associated with reduction in the readmission rates of the patients.
Hence, nurses need to work with their healthcare teams and develop regulation planning that
help in development of health of individuals.

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References:
Bandholm, T., Wainwright, T. W., & Kehlet, H. (2018). Rehabilitation strategies for
optimisation of functional recovery after major joint replacement. Journal of
experimental orthopaedics, 5(1), 44.
Bu, N., Kim, S., Choi, H., Kim, B. S., & Won, C. W. (2017). Pre-discharge rehabilitation after
hip surgery reduces 30-day readmissions in older adults: National Health Insurance
Service–Senior Cohort (2007–2012). European Geriatric Medicine, 8(5-6), 430-434.
Coulter, C., Perriman, D. M., Neeman, T. M., Smith, P. N., & Scarvell, J. M. (2017). Supervised
or unsupervised rehabilitation after total hip replacement provides similar improvements
for patients: a randomized controlled trial. Archives of physical medicine and
rehabilitation, 98(11), 2253-2264.
De Luca, M. L., Ciccarello, M., Martorana, M., Infantino, D., Mauro, G. L., Bonarelli, S., &
Benedetti, M. G. (2018). Pain monitoring and management in a rehabilitation setting after
total joint replacement. Medicine, 97(40).
Den Hartog, Y. M., Mathijssen, N. M. C., Hannink, G., & Vehmeijer, S. B. W. (2015). Which
patient characteristics influence length of hospital stay after primary total hip arthroplasty
in a ‘fast-track’setting?. The bone & joint journal, 97(1), 19-23.

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Erlenwein, J., Przemeck, M., Degenhart, A., Budde, S., Falla, D., Quintel, M., ... & Petzke, F.
(2016). The influence of chronic pain on postoperative pain and function after hip
surgery: a prospective observational cohort study. The Journal of Pain, 17(2), 236-247.
Esposito, F., Freddolini, M., Marcucci, M., Latella, L., & Corvi, A. (2018). Unassisted quiet
standing and walking after crutch usage in patients with total hip replacements: Does
crutch length matter?. Gait & posture, 64, 95-100.
Haas, R., O’brien, L., Bowles, K. A., & Haines, T. (2018). Effectiveness of a weekend
physiotherapy service on short-term outcomes following hip and knee joint replacement
surgery: a quasi-experimental study. Clinical rehabilitation, 32(11), 1493-1508.
Hansen, S., Aaboe, J., Mechlenburg, I., Overgaard, S., & Mikkelsen, L. R. (2019). Effects of
supervised exercise compared to non-supervised exercise early after total hip replacement
on patient-reported function, pain, health-related quality of life and performance-based
function–a systematic review and meta-analysis of randomized controlled trials. Clinical
rehabilitation, 33(1), 13-23.
Hawke, L. J., Shields, N., Dowsey, M. M., Choong, P. F., & Taylor, N. F. (2019). Physical
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Hutchinson, A. G., Gooden, B., Lyons, M. C., Roe, J. P., O'Sullivan, M. D., Salmon, L. J., ... &
Pinczewski, L. A. (2018). Inpatient rehabilitation did not positively affect 6‐month
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Ling, Y., Ter Meer, L. P., Yumak, Z., & Veltkamp, R. C. (2017). Usability test of exercise
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Monaghan, B., Cunningham, P., Harrington, P., Hing, W., Blake, C., O’Dohertya, D., & Cusack,
T. (2017). Randomised controlled trial to evaluate a physiotherapy-led functional
exercise programme after total hip replacement. Physiotherapy, 103(3), 283-288.
Tuncel, T., Simon, S., & Peters, K. M. (2015). Flexible rehabilitation times after total hip and
knee replacement. Der Orthopade, 44(6), 465-473.
Zhu, M., Feng, X., & Shen, Z. (2016). Motivational Interviewing affect rehabilitation and the
quality of life for patients undergoing artificial unilateral total hip replacement. Chinese
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