Returning to Independence Following a Total Hip Replacement

Background:
Until the day he fell off the roof at a jobsite, 73-year-old James R. had been independent and still working. All that changed, however, when his injury remained unhealed after he underwent an open reduction internal fixation (ORIF) procedure. Six months later, he needed a bipolar hemiarthroplasty, that is, replacement of the femoral component of his hip.

Rehabilitation Needs:
By physician order, a Gentiva physical therapist assessed James's condition and recommended the LifeSmart^® Total Hip Arthoplasty Protocol-based on best practices and clinical experience-which began within 24 hours of hospital discharge at the home of James's son. James faced multiple challenges-debilitated overall health; reliance on a leg brace and walker; assistance with ADLs; and significant groin pain aggravated by exercise. He also needed to take Coumadin^® to reduce the risk of blood clots.

With the LifeSmart^® Care Protocols , the treatment team was able to share with James, his family and his physician the expected timetable for rehabilitation-four weeks-and the expected outcomes, which included safety in the home with modifications, devices and supervision, achievement of maximum levels of mobility, an understanding of how to manage his lifestyle within the limitations of his condition, and avoiding medical complications. .

The Rehabilitation Process:
The treatment team took a multifaceted approach, involving physical therapy, patient education and medication management. James's physical therapy program encompassed therapeutic exercises, gait training, and balance, endurance and coordination exercises. The physical therapist also focused on home safety by creating a barrier-free environment. In addition, the team instructed James and his family on all aspects of mobility, including fall prevention, and taught them how to recognize signs and symptoms that may require physician follow-up. Gentiva's RN performed blood work twice a week to monitor the Coumadin and updated the physician on the patient's status. She also trained James in pain management techniques and educated him about anticoagulant therapy, its side effects and the symptoms of thrombosis.

Recovery and Results:
James completed his LifeSmart^® program in the expected four weeks. Upon discharge, he could walk independently for about 400 feet using one crutch or a cane. He could make safe transfers, continue his home exercise program, and verbalize necessary precautions and signs of complications. He returned to his own home to live independently, and in subsequent follow-ups has reported no problems or limitations of ADLs.