Hip Core Decompression — KEVIN PARVARESH, MD

Pain Medications

In most cases local or regional nerve blocks will provide 8-12 hours of numbness. As soon as you start to feel the numbness wearing off, begin taking oral pain medication.
Take Tylenol 500mg one tab every 8 hours.
Take Aleve 220mg one to two tabs every 12 hours.
If you still have pain after Tylenol and Aleve, take one Norco tab (5mg/325mg).
If you still have pain after all of the above, take a second Norco tab.
Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.
DO NOT exceed 3500mg of Tylenol over 24 hours.
It is illegal to drive or operate machinery with narcotic medications.
Do not combine alcohol or other sedatives with narcotic medications.
You do not need to take Tylenol or Aleve once you no longer have pain. You should stop Norco first (usually after a few days).

Other Medications

Take Aspirin 325mg one tab once a day for the first 4 weeks to prevent blood clots.
Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).
Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

Use crutches to assist with ambulation.
You may progressively increase weight on your operative extremity with your foot flat on the ground.
Elevate your leg on pillows above the heart level as much as possible to decrease swelling.
Avoid prolonged periods standing to prevent excessive pain and swelling.

Recovery Equipment

Cold Therapy

We recommend cold therapy use as much as possible in the first two weeks.
Cold therapy units may be used continuously as instructed.
Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.
Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

You may perform ankle exercises as instructed in your preoperative packet.
You should lie on your stomach to stretch the front of your hip for 1-2 hours per day.
Your motion goal should be to have 0-90 degrees of hip motion at your initial postoperative visit.
Begin physical therapy as soon as possible, ideally the day after surgery.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Therapy Plan: Twice per week for 0-2 months, once per week for 2-4 months

ROM Progression

Progress ROM as tolerated after surgery with the goal of symmetric full motion at 6-8 weeks.

Weight Bearing Progression

Initial weight bearing as tolerated.

Progress weight bearing over weeks 0-2 with the goal of removing crutches at 2 weeks
Do NOT progress to one crutch - gait must be pain free and non-compensatory to remove both crutches

Initial Post-Operative Physical Therapy Visit

Correctly perform partial (or full, if tolerated) weight bearing with crutches
Instruct on upright (NO recumbent) stationary bike with NO resistance, pedal ONLY with opposite leg
Isometric exercises for core, glutes, quadriceps, hamstrings

Phase 1 Physical Therapy (0-4 weeks): non-compensatory gait and progression

NO open-chain exercises. Initiate closed chain strengthening at 2 weeks, advancing as tolerated
Manual therapy 20+ minutes per session, stationary bike 20-60 minutes/day (NO resistance)
Soft tissue mobilization, isometric exercises, core strengthening
Tactile and verbal cueing to enable non-compensatory gait patterning

Phase 2 Physical Therapy (4-8 weeks): progressive strengthening

Phase 3 Physical Therapy (8-12 weeks): return to pre-injury level and sport