Preparing for Surgery
Prior to surgery, the team recommends the following:
- Maintaining a balanced diet (including calcium and Vit D)
- Cessation of nicotine and marijuana use (if applicable)
- Maintain cardiovascular fitness and strength as able prior to surgery
- Identifying a trusted person to take you home from surgery
- Shower the day before or of surgery
- Drink plenty of fluids
Hip Arthroscopy Surgery
For instructions specific to Hip Arthroscopy surgery, please see details and watch the video on the Hip Arthroscopy procedure Page.
PAO and DFO Surgeries
For instructions specific to PAO and DFP surgeries, please see details and watch the video on the PAO procedure page.
Hip Replacement Surgery
For instructions specific to Hip Replacement surgery, please see details and watch the video under the Total Hip Arthroplasty Procedures Page
Knee Replacement Surgery
For instructions specific to Hip Replacement surgery, please see details and watch the video under the Total Knee Arthroplasty Procedures Page
Post-Operative Instructions
At discharge you will receive a post op folder with instructions on how to care for your dressings and when you may bath or shower. We ask that you do not remove your dressings unless they are saturated or leaking. Please review our instructional videos and call if needed. The post op folder will also include your medication instructions, a Persons With Disabilities parking privileges application and your hip arthroscopy photos (if applicable). There is a pain/medication tracking sheet you will be asked to fill out and bring to the first post op appointment. A hip preservation team contact list will also be provided; use this to reach out with urgent matters.
Rehab Protocols
It’s critical to maintain a consistent, appropriate physical therapy routine post-surgery to achieve the best results.
Post-Op Life Hacks
The below suggestions have been gathered from multiple patients over the years. These life hacks are not required, though many patients have mentioned benefitting from them. Please note that, though many of the below items may be purchased new, used or loaned items may be acquired.
Helpful Tools:
- Toilet riser with handles
- Grabber (to grab out-of-reach things)
- Shower bench
- Slip on shoes with good friction sole
Other Advice:
- Bring loose fitting clothing to the hospital
- Pre-make and freeze healthy meals
- Identify your support system in advance
- Proactively complete FMLA/Short Term Disability forms, if applicable
- Consider travel plans, events, activities when scheduling your surgery date
- If coming from out of state be sure to arrange return travel for follow up appointments
- Book physical therapy (PT) sessions in advance and make sure your preferred therapist is familiar with our rehab protocols
- Prepare your home to accommodate your post surgical precautions
About Steroids
Our practice of avoiding intra-articular steroid injections for hip preservation patients stems from several studies demonstrating non-negligible risk of rapidly destructive arthritic progression, risk of infection perioperatively, among other high consequence outcomes (1). A recent study demonstrated a 5.4% incidence of rapidly destructive hip disease diagnosed at an average of 5 months following intra-articular hip injection (2), and risk was observed to be dose dependent. Although single lower dose injections did not carry the same risk as higher dose or multiple injections, the high stakes consequence of end stage arthritic disease is enough to warrant extreme caution when attempting to palliate or temporize a painful hip joint for which hip preservation surgery is still an option. For this reason, our preference is to utilize only local anesthetics for diagnostic purposes, or biologics intra-articularly.
For patients with existing hip arthritis and plans for a total hip arthroplasty, steroid injections may be a good treatment option for pain relief, understanding that this will likely deteriorate the joint further. However, steroid injections need to be at least 3 months before anticipated total hip arthroplasty as multiple injections and injections in close proximity to replacement surgery are associated with higher risk of infection.
- Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Andrew J. Kompel, Frank W. Roemer, Akira M. Murakami, Luis E. Diaz, Michel D. Crema, and Ali GuermaziRadiology 2019 293:3, 656-663
- Okike K, King RK, Merchant JC, Toney EA, Lee GY, Yoon HC. Rapidly Destructive Hip Disease Following Intra-Articular Corticosteroid Injection of the Hip. J Bone Joint Surg Am. 2021 Nov 17;103(22):2070-2079. doi: 10.2106/JBJS.20.02155. PMID: 34550909.
- Forlenza EM, Burnett RA, Korrapati A BS, Yang J, Forsythe B, Della Valle CJ. Preoperative Corticosteroid Injections Demonstrate a Temporal and Dose-Dependent Relationship with the Rate of Postoperative Infection Following Total Hip Arthroplasty. J Arthroplasty. 2021 Jun;36(6):2033-2037.e1. doi: 10.1016/j.arth.2021.01.076. Epub 2021 Feb 2. PMID: 33618958.
FAQs
If using a preferred physical therapist after a hip arthroscopy you may begin physical therapy 10-14 days from the surgery date. You may begin 2-3 weeks after an osteotomy procedure (after first post op visit) if using a preferred provider. If you live outside of the Boulder area we will work with you to establish care locally as our preferred provider list includes both local and non-local therapists.
For total hip arthroplasty, you will start therapy 2-3 months following surgery unless your surgeon makes another recommendation. Your bone needs to grow into the implant and the muscles need to heal. For this reason, you will mostly be walking with a walker for the first 6 weeks for optimal ingrowth. The rest of your activity will be focused on gait training (walking with your toes and knees pointing straight), so physical therapy is more important if you are having trouble with this initially, and later when you are trying to develop stronger muscles.
For total knee arthroplasty, you will start therapy 10-14 days after surgery primarily to work on maintaining as much knee range of motion as possible. It is much harder to get knee extension (getting the leg fully straight), than bending the knee. Following surgery for the first two weeks, it is imperative that you keep your leg straight when laying down with a pillow behind the ankle or a specific wedge for surgery.
The typical length of stay is between 3-5 days and is dependent upon pain control, physical therapy and occupational therapy clearance.
We do not require a pre-surgery physical for clearance. Some patients may have health concerns that we will address on an individual basis, at which time clearance from your PCP may be required.
Patients who smoke, vape, use e-cigarettes, smokeless tobacco, marijuana or THC products are required to stop use and obtain negative lab results 4 weeks prior to surgery. Please consult with your PCP for assistance.
