Total Hip Arthroplasty (THA) Home Health Care Standard Protocol

My Home Nurses || NM
Clinical Intervention & Patient Teaching Guide

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

CONFIRMING ATTENDING SURGEON DIRECTION: This template applies to standard THA pathways under Dr. Edelstein, Dr. Manning, Dr. Hardt, and Dr. Thomas. Always cross-reference individual discharge paperwork for patient-specific modifications.

1. MANDATORY SCHEDULING

• Weekday Discharges (Mon–Thu): Initial RN and PT evaluations must occur the next calendar day.
• Weekend Discharges (Fri–Sat): Initial evaluations must be scheduled within a 24–48 hour window (Fri discharge = Sat/Sun; Sat discharge = Mon).
• Follow-Up: Verify the first post-op clinic appointment is scheduled for the 3-week mark.

2. SURGICAL PRECAUTIONS

• Anterior Approach: No standard structural hip dislocation precautions.
• Posterior Approach: Strict precautions enforced: No hip flexion > 90°, no adduction (crossing legs), and no internal rotation of the operative foot/knee.

3. WOUND ADHERENCE & DRESSING PROTOCOLS

• Mepilex: Remains sealed until the 3-week POV. If loose/saturated, replace with dry gauze/Tegaderm and notify the surgical office.
• Aquacel/Silverlon: Remove at 7 days post-op and leave open to air. If drainage persists, cover with dry island dressing (Telfa) and change daily.
• Prevena Wound Vac: Keep active for 7 days. Remove at day 6 or 7, apply Telfa for 3 days, then leave open to air by day 10.
• Submersion Warning: Never submerge incision in water (baths, hot tubs, pools) until cleared at 3+ weeks.

4. PHARMACOLOGICAL MANAGEMENT

• Anticoagulation: Enforce the specific regimen (Aspirin, Lovenox, or Coumadin) and keep TED hose on both legs until the 3-week clinic visit.
• Pain Management: Transition to Tylenol 1000mg; use narcotics only for severe pain. Administer scheduled NSAIDs with meals and Pantoprazole (if on Naproxen) before breakfast.
• Bowel Regimen: Administer Senokot daily for narcotic-induced constipation; ensure a bowel movement at least every 3 days.

5. REHABILITATION & EXERCISE

• Therapy: 2–3 times per week for 2 weeks.
• Weight Bearing: Follow status as documented (WBAT, Protected/Walker, 50%, or Flat Foot).
• Safety: No lunges or squats past 45 degrees. Elevate operative leg (5x/day) and apply ice (3–4x/day).

6. DAILY VISIT NOTE INSERT

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NM HOME HEALTH - DAILY THA VISIT NOTE
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[ ] APPROACH: [ ] ANTERIOR (No precautions) [ ] POSTERIOR (Strict Precautions)
[ ] SCHEDULING: Initial visit done [ ] | 3-week POV scheduled [ ]
[ ] DRESSING: [ ] Mepilex [ ] Aquacel/Silverlon [ ] Prevena 
    - Verified status/seal [ ] | Shower/submersion education done [ ]
[ ] PHARMA: [ ] Anticoagulant [ ] TED hose [ ] NSAID/Pantoprazole 
    - BM frequency/Senokot compliance [ ]
[ ] REHAB: Weight bearing status audited [ ] | Ice/Elevation [ ]
    - No lunges/squats > 45 degrees [ ]
[ ] RED FLAGS: Drainage/redness [ ] | Calf pain/asym. swelling [ ]
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