What does the process look like leading up to hip arthroscopy?
Dr. Ramkumar has a detailed process and checklist to ensure your safety prior to undergoing hip arthroscopy, a specialized operation that requires specialized attention. Once you have decided to proceed with surgery, we check the following:
- CT scan for the Stryker HipMap – this allows Dr. Ramkumar to fine tune his surgical planning
- Brace: you must get this before surgery and bring it with you on the day of surgery
- Physical therapy appointment: you should have an appointment made within the first 2 days after discharge
- Medications: you should have these picked up before you are discharged from the hospital
- For the full postoperative recovery protocol, you may view this here
What equipment do I need?
Dr. Ramkumar requires a brace for at least 2 weeks to protect your soft tissue repair after surgery. This brace is locked from 30 degrees of flexion to 70 degrees of flexion. You must wear this brace at all times. Dr. Ramkumar does not want any external rotation or extension of your leg in the early healing phase. This brace should be picked up before surgery. Dr. Ramkumar’s office will help you receive authorization, should your plan need this.
Because your weight bearing status will be 20% foot-flat, you will also need crutches or a walker upon leaving the hospital for the first two weeks. The hospital will help you with this equipment. You can progress your weight bearing the second week and be off crutches or walker by 4 weeks.
Do I need physical therapy?
Dr. Ramkumar believes early physical therapy is absolutely critical. You must have an appointment for your first postoperative appointment before showing up for surgery! This will be important for you to learn how to move safely, fire your stabilizing hip muscles, and slowly progress your weight bearing off assist devices. Remember, the first week you are only putting 20% of your weight down. You will build up to full weight bearing after week 2. By week 4, you will be off all crutches or walker and walking normally. You will require the expertise of an experienced physical therapist. to guide you through this.
What exercises can I do the first 2 weeks after surgery?
Dr. Ramkumar encourages you to do a stationary bike with no resistance to keep your hip moving and awaken your hip stabilizer muscles.
How do you address pain management and nausea after hip arthroscopy?
Dr. Ramkumar prescribes you the following medications
- Ondansetron (4-8mg) for the first week of surgery: anti-nausea
- Indomethacin (75mg) daily for the first 4 days after surgery: anti-inflammatory medication specifically prescribed to prevent abnormal bone growth around your hip that can later become bothersome
- Naproxen (500mg) twice daily for the first two weeks after surgery: anti-inflammatory medication to be used on the 5th postoperative day after completing the course of indomethacin; do not take naproxen and indomethacin on the same day
- Omeprazole (20mg) once a day: anti-reflux for the prescribed anti-inflammatory medications (Indomethacin, Naproxen)
- Tylenol three times a day (never exceeding 4000mg in 24 hours) for the first month after surgery for baseline/mild pain and fever
- Tramadol (50mg-100mg) every 8 hours for the first week after surgery: medication for moderate to severe pain
- Hydromorphone/Dilaudid (2-4mg) every 4 hours for the first week after surgery: medication for breakthrough pain
- Colace (100mg) twice a day while on narcotics (tramadol, hydromorphone): stool softener medication
- Senna (8.6mg) twice a day while on narcotics (tramadol, hydromorphone): anti-constipation medication
- Aspirin 81 mg twice daily: to prevent harmful blood clots for the first two weeks when you are less mobile
Between all the medications and physical therapy, what do the first few days look like after hip arthroscopy?
Below is a table that has been designed as a guideline. If you do not have some medications listed here, you may ignore them or take as directed on your discharge instructions.
GENERIC (BRAND): Hydromorphone (Dilaudid), Acetaminophen (Tylenol), Omeprazole (Prilosec), Tramadol (Ultram), Naproxen (Aleve), Docusate (Colace), Sennosides (Senna), Ondansetron (Zofran), Indomethacin (Indocin)
| Time | Activity | Detail |
|---|---|---|
| 0100 | Medication | Dilaudid 2-4mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours) |
| 0500 | Medication | Dilaudid 2-4mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours) |
| 0600 | Wake up Medication |
Tylenol 1000 mg (Take two 500 mg tabs, or three 375 mg tabs (depending on what you have) Tramadol 50 mg (As needed for moderate pain; can take up to 100 mg every 8 hours) Omeprazole 20 mg (To help with digestion, take before breakfast) |
| 0700 | Breakfast | Indomethacin 75 mg (Drink at least 8 oz. of water) – Postop days 1-4 |
| 0800 | Medication | Aspirin 81 mg (Prevent blood clots- take with breakfast) Colace 100 mg (Stool softener- take with breakfast) Senna 8.6 mg (Take two tablets for 17.2 mg total dose- take with breakfast) |
| 0900 | Medication | Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours) |
| 1000 | PT | Walk |
| 1030 | PT | Strength exercises |
| 1100 | PT | Stationary bike without resistance |
| 1130 | PT | Ice and Elevate (Ice-20 min on, 20 min off) |
| 1200 | Lunch | (Drink at least 8 oz. of water) |
| 1300 | Medication | Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours) |
| 1400 | Medication | Tylenol 1000 mg (Take two 500 mg tabs, or three 375 mg tabs (depending on what you have) Tramadol 50 mg (As needed for moderate pain; can take up to 100 mg every 8 hours) |
| 1430 | Nap | |
| 1700 | Medication PT |
Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours) Walk |
| 1730 | PT | Strength exercises |
| 1800 | PT | Stationary bike without resistance |
| 1830 | PT | Ice and Elevate |
| 1900 | Dinner | (Drink at least 8oz of water) |
| 2000 | Medication | Aspirin 81 mg (Prevent blood clots- take with dinner) Colace 100 mg (Stool softener- take with dinner) Senna 8.6 mg (Take two tablets for 17.2 mg total dose- take with dinner) |
| 2100 | Medication | Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours) |
| 2200 | Medication | Tylenol 1000 mg (Take two 500 mg tabs, or three 375 mg tabs (depending on what you have) Tramadol 50 mg (As needed for moderate pain; can take up to 100 mg every 8 hours) |
| 2230 | Bedtime | (Try to get 8 hours of sleep) |
***On the 5th postoperative day, do not take Indomethacin anymore. Switch from this to Naproxen 500mg once in the morning (with food) and in the evening (with food).
When can I drive after hip arthroscopy?
Patients usually feel comfortable to drive between 4-6 weeks after surgery. Dr. Ramkumar cannot formally know when you are safe to drive but he has the following criteria:
- No longer taking prescription narcotic medications such as Ultram, Dilaudid, Oxycodone
- Walking without assist devices for a week.
- You feel comfortable enough to slam on the brake.
