CHAPTER 26 Preoperative Rehabilitation
A variety of preoperative interventions before total hip arthroplasty can be used to improve the patient experience and outcome. Proper and realistic expectations about function and pain levels as well as general outcomes after total hip arthroplasty must be explained to the patient at the initial assessment. Education programs that include the patient’s family and preoperative rehabilitation may enhance postoperative satisfaction and outcome.1–4
Patient anxiety can also be reduced by preoperative programs. Anxiety is reduced when a patient completes a preoperative rehabilitation program and the patient meets and gets acquainted with the hospital staff and environment. The increased understanding of the experiences the patient will face during and after total hip arthroplasty reduces his or her anxiety.5–8
Clear benefits of early ambulation, decreased hospital stay, and decreased postoperative need for pain medicine are seen in those with proper preoperative education. Early ambulatory function, even in elderly patients, can be achieved when preoperative rehabilitation is instituted.9 Hospital stay is decreased for patients who have a better understanding of the process from preparation before surgery with these types of programs.10 Finally, the amount of postoperative analgesia required is lower for patients who have received preoperative counseling.4,10
PREOPERATIVE REHABILITATION PROGRAM
Initial Assessment
On the first clinical visit in which a patient is established as a candidate for total hip arthroplasty, the physician must explain the real expectations11 and the limitations a patient will have after surgery. The close family must be included as active participants along with the patient.
