Anterior Approach Total Hip Arthroplasty (THA) Protocol

My Home Nurses || NM
Home Health Care Intervention & Patient Teaching Template

Reviewed and approved 06/30/2026
Annie Tchinjo RN, MSN  |  Terri Lorenz, RN  |  Felix Leshey MRes

ANTERIOR CLINICAL PATHWAY DIRECTIONS: This standardized documentation template applies specifically to patients who have undergone an Anterior Approach Total Hip Arthroplasty (THA) under Dr. Edelstein, Dr. David Manning, Dr. Kevin Hardt, or Dr. Christian Thomas. Confirm approach documentation on the referral or After Visit Summary (AVS).

1. MANDATORY VISITING TIMELINES & PROTOCOLS

• Weekday Discharges (Monday–Thursday): The initial RN admission evaluation and the initial Physical Therapy (PT) visit must both occur on the next calendar day following patient discharge.
• Weekend Discharges (Friday–Saturday): Allow a strict 24–48 hour window for initial evaluations.
  • Discharged Friday: Initial RN and PT visits must be scheduled on a Saturday or Sunday.
  • Discharged Saturday: Initial RN and PT visits must be scheduled on Monday.
• Post-Operative Office Visit (POV): Confirm that the patient’s first follow-up clinic appointment is firmly verified and scheduled at the 3-week post-op mark.

2. ANTERIOR APPROACH PATHWAY SPECIFIC PRECAUTIONS

• NO STRUCTURAL HIP PRECAUTIONS: Instruct and reassure the patient that because they underwent an ANTERIOR approach THA, they do NOT have standard structural hip dislocation precautions (such as restrictions against crossing legs, turning toes inward, or bending past 90 degrees). Enforce progressive activity within reasonable baseline tolerance without structural range-of-motion limitations unless specialized sub-orders specify otherwise.

3. WOUND INTERVENTIONS & ADVANCED DRESSING SYSTEMS

Wound care pathways must be completely tailored to the specific advanced dressing mechanism applied in the operating suite:

• MEPILEX DRESSING (Dr. Edelstein standard): The primary dressing should remain completely sealed and intact until the 3-week post-op office visit. Do not remove unless specialized criteria are met. If the border becomes loose, saturated, or wet, remove it immediately, replace with dry gauze and a water-resistant cover (Tegaderm), and notify the surgical office right away (the patient will likely require an urgent clinic wound check). If mild localized drainage occurs, cover with a dry island dressing (Telfa) or gauze/tape to be changed by the patient every 1–2 days under clinical supervision. For showering, completely cover the Mepilex dressing with plastic wrap and protect it from the direct stream of water.
• AQUACEL OR SILVERLON DRESSING (Drs. Manning / Hardt / Thomas standard): The primary dressing must remain perfectly sealed and in place until precisely 7 days post-op. On Post-Op Day 7, the nurse or instructed patient should completely remove the dressing and leave the incision open to air. If any minor drainage persists after removal, cover with a dry island dressing (Telfa) or gauze/tape changed daily by the patient. Stop all cover dressings immediately once drainage completely ceases. If excessive drainage is identified, cover and contact the surgical office. If the incision is fully dry on day 7, the patient may shower normally over the bare incision (strictly no scrubbing, pat dry with a clean towel).
• PREVENA WOUND VAC SYSTEM: Keep the localized vacuum system clean, continuously powered, and sealed in place for 7 full days from the surgery date. The dressing must be removed by day 6 or 7, or immediately when the portable battery expires and negative pressure suction ceases. The RN or PT should carefully peel away the Prevena dressing and safely discard all electrical and single-use elements. Immediately apply a clean Telfa island dressing and leave it in place for 3 days (remove immediately if it becomes wet). Once that secondary dressing is removed at day 10, leave the fully dry incision open to air. Enforce strict showering protocols: Patient may shower with the Prevena dressing on but it must be kept entirely out of the direct stream of water. Prior to entering the shower, power the device box off, disconnect it from the line, and wrap the entire remaining site tightly in plastic wrap. After showering, remove the plastic wrap completely, reconnect the line, and power the device back on. The secondary Telfa island dressing is NOT waterproof and must also be wrapped in plastic wrap during showering (remove immediately and replace if it gets damp). Do not scrub the bare incision; let soapy water run over it gently, rinse well, and pat completely dry.
• ZERO WATER SUBMERSION WARNING: The surgical incision must NEVER be submerged in water (no baths, hot tubs, or swimming pools) under any circumstances until explicitly cleared by the surgical team at a minimum of 3 weeks post-op. Non-absorbable skin sutures or staples will be formally removed by clinical staff during the first follow-up clinic appointment 2 to 3 weeks following surgery.

4. ANTICOAGULATION & PHARMACOLOGICAL RECONCILIATION

• Systemic Antithrombotic Prophylaxis: Audit and enforce compliance with one of the following order-mapped regimens:
  • Aspirin Only Regiment: Aspirin 81mg PO twice daily (BID) for 28 days. Take with meals to reduce gastric distress.
  • Lovenox Only Regiment: Lovenox 40mg subcutaneous injection daily (starting POD #1) for 21 days. Reinforce injection teaching with patient and family members.
  • Lovenox to Home Anticoagulation Bridge: Lovenox daily injections starting POD #1 for 3 to 5 days, followed by the immediate resumption of the patient’s pre-operative home Direct Oral Anticoagulant (DOAC) regimen.
  • Coumadin Regiment: Coumadin dosing as ordered. Perform mandatory home phlebotomy blood draws for PT/INR tracking every single Monday and Thursday without fail.
  • Compressive TED Hose Wear: White compressive thromboembolic deterrent (TED) hose must remain on both lower extremities continuously until the first post-op clinic visit at 3 weeks.
• Analgesics & Support Protocols:
  • Opioid Tapering: Transition the patient from PRN short-acting opioids (Roxicodone, Norco, Dilaudid) to standard Tylenol 1000mg every 8 hours scheduled or PRN. (Note: Tylenol will not be co-administered if the patient is actively taking Norco.)
  • Post-Op NSAIDs: Administer Celebrex 200mg PO BID for 21 days OR Naproxen 375mg PO BID for 21 days with meals. Enforce a strict ban on other NSAIDs for 2 months post-op.
  • Gastric Protection: If Naproxen is prescribed, the patient must take Pantoprazole daily before breakfast. Discontinue for acid reflux or severe stomach pain.
  • Constipation Protocol: Administer Senokot daily. Ensure a bowel movement occurs every 3 days at a minimum; increase water and fiber intake.
  • Prophylactic Antibiotics: For outpatient surgical cases or high infection risks, complete Cefadroxil 500mg BID for 7 days OR Bactrim DS 800mg–160mg BID for 7 days.

5. THERAPEUTIC MOBILITY & HOME PT BOUNDARIES

• Frequency: In-home Physical Therapy should be executed 2 to 3 times per week for a standard 2-week duration.
• DISCOURAGEMENT OF AUTOMATIC OUTPATIENT PT: We do NOT encourage or recommend that anterior approach THA patients automatically progress to outpatient physical therapy facilities. The clinical team will formally assess the patient at their 3-week follow-up clinic visit and determine if outpatient hip PT is required. Enforce a gradual increase in daily walking and continuation of the structured Home Exercise Program (HEP) following home PT discharge.
• Weight Bearing Check: Assume the patient is Weight Bearing As Tolerated (WBAT) and gait train to baseline unless specific constraints are explicitly documented on the referral or AVS (such as Protected walker/crutches-use, 50% stride weight limits, or flat-foot weight-bearing). Do not advance weightbearing restrictions until the follow-up clinic visit.
• Exercise Boundaries: Perform lower extremity strengthening as tolerated within reason. Enforce a strict ban on lunges or squats past a shallow 45-degree angle. Patients must engage in NO high-impact activities under any circumstances.
• Edema Control Modalities: Actively encourage and remind the patient to elevate the operative leg above the level of the heart at least 5 distinct times per day to reduce localized swelling and optimize venous circulation. Encourage continuous localized icing 3 to 4 times per day for 20 to 30 minutes per session.

6. RN VISIT NOTE INSERT & DOCUMENTATION CHECKLIST

The home health RN must insert the following standardized charting checklist directly into daily electronic progress notes to track compliance and capture clinical parameters:

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MHN/NM HH - DAILY ANTERIOR APPROACH THA VISIT NOTE
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[ ] VERIFIED SURGICAL APPROACH & PATHWAY:
    - Confirmed ANTERIOR Approach THA documented on referral/AVS [ ]
    - Instructed and re-verified: Patient has NO structural hip precautions [ ]
[ ] VERIFIED COMPLIANCE WITH SCHEDULING SEQUENCE:
    - Initial RN/PT evaluation visits completed next day (Mon-Thu discharge) 
      or within a 24-48h window (Weekend discharge) [ ]
    - Confirmed 3-week clinic follow-up appointment is verified [ ]
[ ] AUDITED CHOSEN SURGICAL DRESSING PROGRAM:
    [ ] MEPILEX: Inspected border seal. Intact [ ] Saturated >=50% [ ] Loose [ ]
        *Action: If wet/loose, replaced with gauze/Tegaderm and notified office.*
    [ ] AQUACEL/SILVERLON: Verified POD #7 removal timeline. Left open to air [ ]
    [ ] PREVENA VAC: System active and pressurized. Dressing removed at Day 6-7 [ ]
        - Telfa secondary dressing applied for 3 days [ ] Re-verified open to air at Day 10 [ ]
    *Audit Point: Reinforced strict zero water submersion ban for minimum 3 weeks.*
[ ] MANAGED PHARMACOLOGICAL & DVT PROPHYLAXIS COMPLIANCE:
    - Current Anticoagulant: [ ] Aspirin 81mg BID | [ ] Lovenox Injections | [ ] Coumadin
    - Injection technique audited / Coumadin home blood draws completed (Mon/Thu) [ ]
    - Verified white compressive TED hose applied correctly to both legs [ ]
    - Confirmed scheduled NSAID taken with meals; Pantoprazole taken before breakfast [ ]
    - Evaluated bowel movements: Senokot compliance checked. Minimum BM q3 days met [ ]
[ ] AUDITED HOME REHABILITATION INTERVENTIONS:
    - Confirmed plan to discharge from home PT to self-care walking / HEP [ ]
    - Instructed patient: No outpatient PT facility enrollment until 3-wk POV check [ ]
    - Enforced weight-bearing limits (WBAT / Protected Walker / 50% Restricted).
    - Verified leg elevated above heart level (at least 5x/day) and ice applied 3-4x/day.
    - Instructed patient: No lunges or squats past 45 degrees; zero high-impact actions.
[ ] ASSESSED RED FLAGS & RECOVERY DEVIATIONS (NOTIFIED OFFICE FOR ANY MATCH):
    - Localized incisional drainage/open borders, redness, excessive warmth, or fever.
    - Calf pain, sudden asymmetrical lower extremity swelling, or respiratory distress.
    - Uncontrolled pain or complete drug intolerance (acid reflux, severe stomach pain).
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7. CLINICAL ESCALATION & SECURE CHANNELS ROUTING

All immediate patient questions, protocol deviations, admission adjustments, or severe wound concerns must be directed to the patient’s primary orthopedic surgeon or assigned clinical representative:

• Assigned Orthopedic Support Staff: Lizzie Bazzetta, PA-C; Jessica Sperling, PA-C; Becke Schmidt, PA-C; Alicia Lew, PA-C; Teri Heywood, RN; Meg Van Dyke, RN; Rachel Doyle, RN.
• Primary Contact Phone: 312-695-6800
• Primary Secure Fax Lines: 312-472-4871 / 312-695-2772