Rehabilitation and Postoperative Care
Domain 6: Rehabilitation and Postoperative Care
This domain tests early mobilization, weight-bearing orders, precautions, and recognition of postoperative complications.
Core rules
- Weight-bearing status must be explicit: non-weight-bearing, toe-touch, partial, or full. Ambulation begins early unless contraindicated.
- Total hip arthroplasty precautions depend on approach. Posterior approach: avoid hip flexion beyond 90 degrees, adduction past midline, and internal rotation. Anterior approach precautions differ; individualize.
- Total knee arthroplasty: early range of motion, quadriceps activation, edema control, and extension near zero are priorities.
- Shoulder arthroplasty or rotator cuff repair: sling protection and passive-only motion per surgeon protocol.
- Wound care: keep clean and dry per protocol; monitor for spreading erythema, drainage, fever, and dehiscence.
- VTE surveillance: unilateral calf pain, swelling, and warmth warrant duplex ultrasound; dyspnea or chest pain warrants urgent evaluation for PE.
- Rehabilitation progresses from protected motion to strengthening and functional training.
Worked example
On postoperative day 2 after posterior total hip arthroplasty, a patient reports a pop and severe groin pain, and the leg is internally rotated and shortened. This suggests dislocation. Do not attempt reduction in the hallway; immobilize, obtain radiographs, and notify the surgeon.
Traps
Applying posterior hip precautions to every approach; allowing immediate full weight-bearing when the order is toe-touch; and dismissing calf pain as a muscle strain.