What Are The Benefits Of Home Occupational Therapy For Elderly Seniors After Total Hip Replacement Surgery?

A total hip replacement (THR), also referred to as a total hip arthroplasty (THA), is a major joint surgery that requires recovery time and lifestyle modification. Hip precautions prescribed by the surgeon can guide seniors on how to best go about moving around at home.

Precautions vary depending on where the surgical incision is: posterior (back), anterolateral (front-side), direct anterior (front), and direct lateral (side). The posterior THR comes with more precautions than the other surgical approaches.

What Are The Expectations After Hip Replacement Surgery?

If an individual’s hip joint, which is a ball-and-socket combination, fails due to injury or wear-and-tear (commonly from osteoarthritis) to the point where they can no longer safely and effectively walk, then it may be time for a replacement. The surgeon will go in and remove the damaged bone and replace it with actual hardware.

After completing surgery, the patient will transfer to inpatient recovery for typically 1 to 3 days.

Length of inpatient stay depends on recovery as well as co-morbid diagnoses that could slow the healing process.

Once the anesthesia effects wear off and pain gets under control, the patient can begin occupational and physical therapy just a few hours after surgery.

The patient can even put full weight on the operative hip if tolerated as per the surgeons surgical protocol.

Being Discharged Home and Receiving Occupational Therapy Services

Once an elderly patient completes their inpatient stay, they are often discharged home immediately with home health services in place.

Contacting and arranging for home health is usually done at the hospital with the assistance of social workers and medical staff. Home health services involve nursing care as well as physical and occupational therapy.

While physical therapy offers interventions to promote walking, strengthening, and increasing range of motion of the hip.

Occupational therapy will likely take a more functional approach. The focus of Occupational Therapy intervention will include instructing the patient (and caregivers) in getting around the home and completing activities of daily living in the safest manner possible.

This will include getting hygiene when in the bathroom, applying clothing and shoes with adaptive equipment, feeding, grooming and other self care activities.

What Are The Limitations Experienced by Seniors as a Result of Having a Hip Replacement?

Posterior hip precautions include: avoid bending at the hip past 90 degrees, no crossing of the legs, no pivoting on the operative hip, and keeping the operative leg neutral with the toes pointed forward while walking.

Anterior hip precautions don’t typically require these precautions. However, patients need to lead with the non-operative foot when walking backwards in order to avoid pain with weight bearing. Going up and down the stairs is usually taught as an inpatient and at home.

The occupational therapist or physical therapist will instruct patients on using proper stair climbing techniques and side-rails, if available, when ascending and descending stairs.

Why Home Occupational Therapy is Important to Address Activities of Daily Living (i.e Dressing, Bathing, Toileting, Sitting on Specific Surfaces to Prevent Hip Dislocation ).

Some elderly patients may require very little occupational therapy intervention after surgery because they are already veterans when it comes to joint replacement recovery.

However, for seniors who are experiencing a hip replacement for the very first time, it is essential to actively participate in occupational therapy services at home.

Occupational therapy provides intervention and instruction in strengthening the joint, enhancing mobility with a walker, modifying the home with  adaptive equipment, reinforcing the use of hip precautions, and preventing falls, joint dislocation, and incisional infection.

When Can You Return to Driving, Doing Self Care Activities, Climbing Stairs After Having a Total Hip Replacement?

An elderly patient can often return to participating in these activities sooner than expected. However, there are some unique circumstances to consider.

Oftentimes, surgeons will recommend that patients completely avoid driving, if the operation took place on the right hip, for at least 4 to 6 weeks.

If the left hip was operated on, patients can return to driving as soon as they are comfortable, if their car is an automatic transmission, and if they are weaned off of narcotics or other meds that can impair driving ability.

Patients can return to completing activities of daily living and stair-climbing relatively soon after surgery, but within reason.

Elderly patients, especially, should still be taking frequent breaks, ask for help, monitor pain levels, and use compensatory strategies when needed.

For example, using a shower chair for several weeks until you regain the strength in your lower extremities is recommended to prevent falling in the shower stall or tub. Other examples include limiting walking distances and stairs at first, but then building up a tolerance for those activities over the course of a few weeks.

What Things Should You Remember to Avoid After Having Total Hip Replacement Surgery?

Dislocation can occur if elderly patients do not adhere to their hip precautions and if they are already at a high risk for falls.

Sometimes, dislocations happen anyway despite the precautions due to underlying medical conditions. Nonetheless, patients can still proactively avoid joint dislocation and readmission to the hospital.

Avoid activities that severely compromise standing balance such as walking around the home without a walker, walking on variable or unpredictable surfaces outside (i.e. the lawn, gravel, sand, etc.), and activities that force the patient to balance on one foot.

If the patient underwent a posterior THR, then avoid sitting in low chairs, bending past 90 degrees to stand from a low chair, leaning forward to tie a shoe or retrieve an item from the floor, or planting and pivoting quickly on the operative hip.

Which Equipment Should Be Used To Assist With Performing Functional Activities of Daily Living After a Total Hip Replacement?

It’s common for therapists at the hospital to recommend specific adaptive and durable medical equipment for patients to use at home.

However, patients can also wait to hear recommendations for home health occupational therapists in order to make sure equipment will fit in their home.

Equipment that should be used to perform functional activities of daily living after a total hip replacement should include raised toilet seats shower chairs or benches, long reachers and grabbers, extended shoe horns, bathroom and shower grab bars and hip chairs.

What Are The Benefits of Having Home Occupational Therapy Versus Not Having It After Total Hip Replacement Surgery?

As mentioned previously, some seniors can get away with not having occupational therapy at home due to prior experience with joint replacement recovery.

However, seniors who are new to joint replacement recovery benefit highly from receiving occupational therapy services post-hip surgery.

Occupational therapy helps patients fill in the gaps that were not noticed before such as following safety tips in the home, mobility with and without hip precautions, education on fall risk before and after surgery, and having in-home support systems such family members or caregivers.

In many cases, it’s worth it to have a trained eye in the home in order to speed up healing and to decrease risk for injury and infection. Occupational therapist help facilitate this and can educate both patient and family members when they spot something that can be detrimental to the recovery process.

What Are Some Recommendations For Caregivers Taking Care of Seniors With Total Hip Replacement Surgery and Are Living at Home.

These days, seniors are able to return home after a total hip replacement surgery and participate in certain activities of daily living after a very short hospital stay.

However, this does not mean that the patient should be left alone to fend for themselves. Another thing to keep in mind is that home health services will not be at the patient’s house 24/7.

Family members and caregivers need to be prepared to be present in the home and to be able to assist with complex tasks  such as laundry, cooking, housecleaning, and running community errands.

Caregivers, with the permission of the patient, should also attend home health therapy sessions in order to receive instruction on how to carry out transfers in and out of bed, to the toilet or shower, and performing exercises with the patient during the hours that the occupational or physical therapists are not in the house.

Conclusion:

Elderly patients that have total hip replacement surgery are usually require several weeks of recovery after leaving the hospital.

Home health occupational therapy can help patients return to daily life sooner and in the safest manner possible with intervention and instruction.

Caregivers and family members can also contribute to their loved one’s speedy recovery by being present and by proactively encouraging and guiding them during the rehabilitative process.