Réadaptation après une chirurgie de la hanche

• Utilisez des soins culturellement adaptés qui tiennent compte des traumatismes et des violences. Expliquez pourquoi les questions sont importantes, demandez la permission avant d'aborder des sujets sensibles et adaptez la communication à la langue, à l'identité, à la culture, au handicap et aux expériences de soins de santé antérieures du patient (Agence de la santé publique du Canada, 2018).
• Informations sociodémographiques : age, sex, gender identity, language, living arrangement, occupation, caregiving responsibilities, health literacy, supports and communication or access needs.

Principales préoccupations

• Surgery and current plan: reason for surgery; operated side; procedure, date, approach, implant or fixation when known; operation and discharge records; surgeon and follow-up; weight-bearing status; movement precautions; wound plan; venous thromboembolism plan; and any postoperative complication or readmission.
• Current symptoms and course: hip, groin, thigh, knee or back pain; wound change; swelling or bruising; calf symptoms; fever or chills; shortness of breath or chest symptoms; fatigue; dizziness; numbness or weakness; sleep; and whether mobility or daily activities are improving, unchanged or worsening.
• Baseline and current functioning: mobility and gait aid before surgery or fracture; current bed mobility, transfers, walking, stairs, self-care, household and community activities; falls; work or caregiving; driving; recreation; social participation; and assistance needed.
• Hip-fracture context when relevant: fall or trauma mechanism, fragility-fracture history, time on the floor, other injuries, pre-fracture residence and mobility, osteoporosis care, prior falls, delirium and the person’s account of the event.
• Revue des systèmes corporels : cardiovascular and respiratory; neurological, cognitive and vestibular; musculoskeletal; skin and wound; vascular; genitourinary and gastrointestinal; nutritional; endocrine and metabolic; sleep; and mood symptoms that may affect safety, healing or rehabilitation.
• Santé, mode de vie et histoire : frailty; osteoporosis and previous fractures; venous thromboembolism or bleeding; diabetes; cardiovascular, respiratory, kidney, liver, neurological and musculoskeletal conditions; infection history; recent hospitalization; physical activity; nutrition and hydration; sleep; tobacco; alcohol or substance use; and current medications and supplements, including analgesics, anticoagulants, corticosteroids and psychotropic medicines.
• Cognition and communication: baseline cognition, new or fluctuating confusion, attention, memory, ability to learn or follow the plan, hearing, vision, communication aids, decision-making support and caregiver observations.
• Environment and supports: discharge destination, home layout, stairs, bathroom and sleeping setup, mobility and dressing equipment, transportation, access to food and medications, caregiver availability, home services and the person’s ability to summon help.
• Déterminants sociaux de la santé : housing, income, food security, discrimination, social support, caregiver strain, transportation, digital access and availability or affordability of rehabilitation, equipment and follow-up (Agence de la santé publique du Canada, 2026).
• Soins et interventions antérieurs : inpatient and community rehabilitation, education, exercise, gait aids, home modifications, pain care and other approaches tried; what helped, did not help, caused harm or was difficult to continue.
• Point de vue du patient : understanding of the operation and recovery plan, priorities, preferences, cultural context, acceptable risk, confidence, concerns, expectations and previous experiences of care.
• Signaler un avis : Vérifiez les signaux d'alerte et référez-vous aux modules distincts « Signaux d'alerte orange » et « Signaux d'alerte jaune » lorsque cela est pertinent.

​​Outcomes measures:

• Use measures that are meaningful to the patient, safe for the surgical phase and practical to repeat. Record the setup, gait aid, assistance and weight-bearing status so repeated results are comparable.
• Fonctionnement propre au patient : Échelle fonctionnelle propre au patient (PSFS).
• Handicap et participation : Échelle d'évaluation du handicap de l'OMS 2.0 (WHODAS 2.0).
• Qualité de vie : WHOQOL-BREF.
• Hip-specific symptoms and functioning: les Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) can be used after hip replacement when it fits the person’s age, goals and surgical population. It is not a universal measure after hip-fracture fixation.
• Mobility performance: a safe repeatable task such as the Timed Up and Go ou 10 Meter Walk Test, selected according to walking ability and the clinical question.
• Pain and other symptoms: a consistent pain rating plus symptom location, wound and swelling observations, medication use and effect on sleep, mobility and participation.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used when helpful but is not required.

Les signaux d'alerte orange indiquent qu'un problème de santé mentale ou de toxicomanie peut nécessiter une évaluation d'urgence ou rapide, voire une prise en charge partagée, et peut influencer la prise en charge musculo-squelettique. Ce n'est pas un diagnostic. En cas d'inquiétude, posez des questions directes et respectueuses en tenant compte de la sécurité immédiate, de la gravité du problème, de tout changement par rapport au fonctionnement quotidien habituel et du contexte. Les facteurs psychosociaux susceptibles d’affecter le rétablissement, mais ne nécessitant pas d’évaluation médicale ou psychiatrique distincte, sont abordés sous la rubrique « Signaux d’alerte jaune ».

ACTION : Organisez immédiatement une évaluation d'urgence en cas de danger immédiat ou de besoin médical urgent :

• Suicide, automutilation ou violence envers autrui : intention ou plan actuel, tentative récente, incapacité à rester en sécurité ou comportement suggérant un risque immédiat de préjudice grave.
• Changement grave de l'état mental : agitation extrême, confusion, désorganisation, psychose ou manie possible avec altération du jugement ou comportement dangereux, ou incapacité à satisfaire les besoins fondamentaux lorsque cela crée un danger immédiat.
• Urgence médicale ou liée à la consommation de substances : Suspicion de surdosage, intoxication grave, sevrage dangereux, délire ou autre changement soudain nécessitant des soins médicaux urgents.

En cas de danger immédiat, ne laissez pas la personne seule pendant que les secours sont organisés. Suivez les procédures d'urgence locales et composez le 911 en cas de danger immédiat ou d'urgence médicale. Si la personne a des pensées suicidaires, téléphonez ou envoyez un SMS. 9-8-8 : Ligne d’assistance en cas de crise suicidaire avec eux ou les aider à le faire.

En cas de violence, d'abus ou d'exploitation avérés ou soupçonnés, assurez immédiatement la sécurité des personnes concernées et respectez les procédures de sécurité et de signalement applicables.

ACTION : Organisez rapidement une évaluation médicale ou psychiatrique si :

• Pensées suicidaires ou d'automutilation : Des pensées sans danger immédiat.
• Symptômes ou effets importants : symptômes graves, persistants ou s'aggravant de dépression, d'anxiété, de traumatisme, de psychose ou de manie possible, de troubles alimentaires ou de consommation de substances qui affectent considérablement la vie quotidienne, la prise de décision ou la participation en toute sécurité aux soins.
• Autres motifs d’évaluation : un changement marqué par rapport au comportement ou au fonctionnement habituel ; une inquiétude concernant les effets des médicaments ou des substances ; une présentation qui dépasse les compétences du clinicien ; ou une demande d'aide.

Informer le patient des personnes à contacter, du délai de contact et de la marche à suivre en cas d'aggravation de son état. S'assurer que le patient a bien pris contact avec le service lorsque cela est cliniquement nécessaire.

ACTION : Adapter et coordonner les soins musculosquelettiques :

• Soins en toute sécurité : Les soins peuvent se poursuivre lorsqu'ils sont sécuritaires et acceptables et ne retardent pas l'évaluation nécessaire. Adaptez la communication, l'examen et les soins ; obtenir un consentement continu ; et coordonnez-vous avec les autres professionnels de la santé avec la permission du patient.
• Poursuivre l'évaluation musculosquelettique : Ne présumez pas qu'un problème de santé mentale ou de toxicomanie explique les symptômes musculo-squelettiques. Continuez à considérer les causes physiques et à tenir compte du récit du patient.
• Questionnaires: Ils peuvent soutenir la discussion et le suivi, mais ne permettent pas d’établir un diagnostic et ne remplacent ni les questions directes, ni le jugement clinique, ni les mesures à prendre.
• Soutien acceptable : Demandez à la personne quel type d’aide lui convient et si le soutien linguistique, culturel, familial, communautaire ou autre est important pour elle.

ACTION : Documentation et suivi :

Consignez la préoccupation, les questions pertinentes et les réponses de la personne, la décision relative à la sécurité et les raisons qui la justifient, les mesures prises, les conseils donnés et les références effectuées, les communications et le consentement, le suivi prévu ainsi que toute préoccupation non résolue. Respectez les exigences applicables en matière de confidentialité, de sécurité et de signalement.

Pour obtenir des renseignements sur les services provinciaux, territoriaux et nationaux, consultez : Soutien en santé mentale : obtenir de l’aide (Agence de la santé publique du Canada, 2026).

Les signaux d’alerte psychosociaux (drapeaux jaunes) sont des facteurs personnels, sociaux, professionnels, scolaires, liés aux soins de santé, environnementaux ou structurels qui peuvent influencer les symptômes, le fonctionnement, la participation aux activités ou la réponse aux soins. Ils sont liés au contexte et ne constituent ni des diagnostics ni des prédictions certaines. Ils ne signifient pas que les symptômes sont d’origine psychologique. Ils permettent d’adapter la prise en charge et ne nécessitent pas, à eux seuls, une orientation urgente vers un autre professionnel de la santé. Explorez ces facteurs par la discussion et le suivi continu des résultats, en tenant compte des priorités, des forces et de la situation de la personne. Il n’est pas nécessaire d’utiliser un score distinct pour les signaux d’alerte psychosociaux (drapeaux jaunes). Les nouveaux signes ou l’aggravation de signes d’une maladie physique grave doivent être traités selon la procédure relative aux signes d’alerte (drapeaux rouges). Les préoccupations liées à la santé mentale ou à la consommation de substances qui nécessitent une évaluation distincte, ainsi que toute préoccupation immédiate concernant la sécurité, doivent être traitées selon la procédure relative aux signaux d’alerte psychosociaux urgents (drapeaux orange) et aux protocoles d’urgence ou de protection applicables.

Explorez les facteurs pertinents :

• Compréhension, attentes et expériences en matière de soins de santé : Préoccupations liées aux blessures ou aux dommages, incertitude, attentes quant au rétablissement, confiance en ses capacités, conseils contradictoires, expériences antérieures de banalisation des symptômes ou de préjudices subis, et confiance envers les soins reçus.
• Réactions aux symptômes et à l’activité : Inquiétude, peur, évitement, alternance entre périodes d’activité excessive et périodes de repos prolongées, difficulté à gérer le rythme des activités, stratégies d’adaptation, sommeil, confiance en sa capacité à gérer ses symptômes et reprise des activités significatives.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change care. Adapt the examination to the patient’s surgical plan, presentation, comfort, consent and abilities.

• Consent and comfort: explain what you propose, provide choices about positioning, draping, pace, assistance and caregiver involvement, and confirm ongoing consent before examining the hip, groin, wound or other sensitive areas.
• Surgical plan and stability: confirm the procedure, date, weight-bearing status, movement precautions, wound instructions and medical clearance before loading or moving the hip. Defer or modify testing when these are unknown or the person is medically unstable.
• General observation and wound: alertness, distress, breathing, pallor, hydration, posture, spontaneous movement, swelling, bruising, dressing or incision condition, drainage, skin integrity and signs of pressure injury.
• Vital signs and medical screening when indicated: heart rate and rhythm, blood pressure, oxygen saturation, temperature, orthostatic response, pain behaviour and signs of acute illness, bleeding or medication adverse effects.
• Neurovascular examination: distal pulses, colour, temperature, capillary refill, swelling, sensation and motor findings when new pain, weakness, numbness, vascular symptoms or a surgical complication is plausible.
• Gait and mobility: bed mobility, sit-to-stand, transfers, gait initiation, step pattern, turning, walking distance, stairs, weight-bearing tolerance, assistance and safe use of the prescribed gait aid.
• Évaluation fonctionnelle : patient-prioritized self-care, dressing, toileting, household, vehicle, work or community tasks and the interaction among the person, equipment, environment and available support.
• Hip and lower-limb movement: active and passive movement only as needed and within the surgical plan, noting movement quality, pain, restriction and protective behaviour. Include the knee, ankle, lumbar spine or other regions when they may explain symptoms or limit mobility.
• Force et contrôle du moteur : safe functional loading and selected hip, knee and ankle muscle testing, with attention to hip abductors and extensors, quadriceps, asymmetry, inhibition and control during transfers, stance and gait.
• Balance and falls assessment: standing balance, turning, reaching and other tasks matched to safety and goals, especially after a fragility fracture or when falls, fear or unsteadiness are present.
• Imagerie : review available postoperative imaging and the surgical report when relevant. New imaging is not routine for expected recovery; arrange medical or surgical assessment when new trauma, deformity, inability to bear weight, worsening focal pain or another suspected complication is likely to change care.
• Repeat and adapt: repeat focused findings to review progress, check the fit of the working presentation and decide whether rehabilitation, medical assessment or surgical follow-up needs to change.

Working clinical presentations

These presentations can overlap or change. Use them to organize assessment and care, not as fixed stages or substitutes for the surgical diagnosis and plan.

• Uncomplicated recovery after primary elective total hip arthroplasty: expected postoperative pain, swelling, weakness and mobility change with a clear surgical plan, stable wound and gradual progress in walking and daily activities (NICE, 2020; Rehabilitative Care Alliance, 2026).
• Recovery after hip-fracture repair or hemiarthroplasty: mobility loss after a traumatic or fragility fracture, often with falls risk, frailty, osteoporosis, delirium or reduced pre-fracture reserve. Rehabilitation is coordinated with medical, geriatric, bone-health and falls care when relevant (American Academy of Orthopaedic Surgeons, 2021; NICE, 2023; Ontario Health, 2024).
• Self-directed recovery with planned review: the person understands the plan, manages exercises and daily activities safely, has suitable support and equipment, and is progressing toward goals without a need for frequent supervision.
• Mobility or daily-activity limitation requiring supervised rehabilitation: persistent gait, transfer, stair, balance, strength, endurance or self-care difficulty that is safe to address and not explained by a new surgical complication.
• Complex or slower recovery: frailty, multimorbidity, pain, fear, cognitive or sensory impairment, deconditioning, other musculoskeletal problems, limited support or access barriers slow progress or increase the need for coordinated care.
• Procedure-specific or surgically restricted recovery: revision, bone graft, osteotomy, fracture fixation, abductor repair, intraoperative complication or another surgical factor requires a plan that differs from routine primary arthroplasty care. Follow the surgeon’s restrictions and review points.
• Atypical or worsening post-surgical presentation: new systemic symptoms, wound change, marked pain increase, mechanical symptoms, neurological change, loss of weight-bearing tolerance or decline after earlier improvement. Recheck Red Flags and arrange medical or surgical assessment.

Fondez la prise en charge sur le tableau clinique, la sécurité, les objectifs, le contexte et la réponse aux interventions. Privilégiez des principes et des options adaptables plutôt qu’une séquence d’interventions prédéterminée, et réévaluez régulièrement les résultats pertinents afin d’orienter les ajustements à apporter à la prise en charge.

Surgical plan and care transitions

• Procedure-specific plan: obtain and follow the operation and discharge information, including weight bearing, movement precautions, wound care and surgical follow-up. Do not apply a standard set of hip precautions or range-of-motion restrictions to every person (NICE, 2020; Rehabilitative Care Alliance, 2026).
• Communication across settings: share current mobility, assistance, equipment, medication, wound, restriction and goal information with the person, caregivers and relevant surgical, medical and rehabilitation providers at each transition (NICE, 2023; Rehabilitative Care Alliance, 2026).
• Fragility hip-fracture follow-up: for adults aged 50 years or older after surgery for a fragility hip fracture, confirm scheduled primary care follow-up within 2 weeks of inpatient discharge and orthopaedic follow-up within 12 weeks of surgery. Arrange shared care when these appointments or the osteoporosis assessment are missing (Ontario Health, 2024).

Éducation, autogestion et participation aux activités

• Recovery plan: explain the procedure-specific plan, expected day-to-day variation, safe activity progression, exercise, use of aids, wound care, medication coordination, follow-up and who to contact with questions. Pace information and include caregivers when the person agrees (NICE, 2020; NICE, 2023; Rehabilitative Care Alliance, 2026).
• Return to valued activities: use patient-defined goals and graded practice for self-care, household tasks, community mobility, work, driving, sexual activity and recreation. Match advice to surgical guidance, ability and risk rather than a universal calendar (NICE, 2020).
• Recognizing complications: review the wound, deep vein thrombosis, pulmonary embolism, infection, dislocation and fracture features in Red Flags and make clear whom to contact and when emergency care is needed.

Activité physique et exercices

• Early safe mobility: after elective primary hip replacement, mobilization can begin on the day of or day after surgery once the person is medically stable, has appropriate assistance and is cleared under the surgical plan. After surgery for a fragility hip fracture, mobilization to weight-bearing as tolerated within 24 hours and daily mobilization are care standards unless the documented surgical or medical plan requires modification. Progress bed mobility, transfers, walking and stairs according to tolerance and safety (NICE, 2020; NICE, 2023; Ontario Health, 2024).
• Progressive exercise after hip replacement: options include hip and lower-limb range of motion within the surgical plan, progressive strengthening, balance, gait, endurance and task practice. Select and progress exercises according to baseline capacity, current impairments, goals and response (Rehabilitative Care Alliance, 2026; World Health Organization, 2023).
• Mobility training after hip fracture: gait, balance and daily-task practice can form the core, with strengthening and endurance added to identified needs. Coordinate interprofessional rehabilitation across inpatient and community settings toward pre-fracture functioning, accounting for frailty, cognition, medical conditions and pre-fracture mobility when setting the starting level and supervision (Fairhall et al., 2022; NICE, 2023; Ontario Health, 2024).
• Delivery and dose: individual, group, home, community, virtual or hybrid formats can be used. Match frequency, progression and supervision to safety, learning needs, support, access and observed response; a fixed number of visits is not required (NICE, 2020; Rehabilitative Care Alliance, 2026).

Mobility aids, daily activities and environment

• Gait aids: assess, fit and teach the use of a walker, crutches or cane. Review weight-bearing technique, turning, stairs and use in the person’s actual environment, and reduce support only when gait remains safe and consistent (Rehabilitative Care Alliance, 2026).
• Daily activities and equipment: occupational therapy, home assessment and equipment such as a raised seat, rails, dressing aids or bathing equipment can form part of care when they improve safety or independence. Review whether the home setup and caregiver plan remain workable (NICE, 2020; Rehabilitative Care Alliance, 2026).

Thérapies manuelles et interventions visant à soulager les symptômes

• Cold, positioning and swelling care: cold and comfortable positioning can be used for short-term symptom relief. Use compression or elevation only when consistent with wound, vascular and surgical guidance, and stop if symptoms worsen (Rehabilitative Care Alliance, 2026).
• Hands-on care: gentle soft-tissue or movement-based care away from the healing incision can be used when it is consistent with the surgical plan and helps a specific symptom or movement goal. Avoid deep pressure over the surgical site and do not use hands-on care in place of progressive mobility and exercise (Rehabilitative Care Alliance, 2026; World Health Organization, 2023).

Soutien psychologique, social et interdisciplinaire

• Confidence, mood and cognition: address concerns about falling or movement with clear information, graded practice and caregiver support. In hospital and after transitions or changes in medical status, follow the local standardized delirium screening and management process. New or worsening delirium follows Red Flags; persistent mood, cognitive or behavioural needs can be managed with the appropriate medical, geriatric or mental-health provider (Ontario Health, 2024).
• Prise en charge interdisciplinaire : surgical and primary care, geriatrics, nursing, physiotherapy, occupational therapy, pharmacy, dietetics, home care and social services can be coordinated around medical stability, mobility, self-care, nutrition, cognition, bone health, falls and transition needs (American Academy of Orthopaedic Surgeons, 2021; NICE, 2023; Ontario Health, 2024; Rehabilitative Care Alliance, 2026).
• Fragility-fracture follow-through: after a fragility fracture, connect rehabilitation with falls assessment, osteoporosis and bone-health care, nutrition, medication review and community supports rather than treating mobility in isolation (NICE, 2023; Ontario Health, 2024; World Health Organization, 2024).
• Access and feasibility: transportation, cost, housing, language, technology, caregiver availability and service access can shape the plan. Select options the person can use and revisit barriers when participation is difficult.

Medication coordination

• Analgesia and postoperative medicines: coordinate with an authorized prescriber or pharmacist when pain limits rehabilitation, adverse effects such as sedation, dizziness, nausea or constipation occur, or questions arise about anticoagulants, venous thromboembolism prevention or other postoperative medicines. Medication changes remain within the appropriate provider’s scope (NICE, 2020; NICE, 2023).

Suivi et réévaluation

• Agree on a reassessment point based on the surgical phase, safety, goals, care being tried, patient needs and access rather than a fixed visit schedule.
• Repeat the small outcome set recorded at baseline and review pain, wound and swelling, relevant neurological and vascular findings, mobility, functioning, participation, benefits, harms, treatment burden and progress toward patient-defined goals.
• Continue what is useful and acceptable; adapt or stop what is not; and revisit the clinical presentation, surgical plan, differential diagnosis, referral or shared care when progress differs from expectations or new safety concerns emerge.

• Évolution attendue : recovery varies with the operation, reason for surgery, baseline mobility, health and support. After uncomplicated elective primary total hip arthroplasty, pain and daily mobility often improve over the first weeks and months, while strength, endurance and confidence may continue to change over a longer period. After hip-fracture surgery, recovery is more variable and return to pre-fracture mobility is not guaranteed (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023; Fairhall et al., 2022; NICE, 2023).
• Facteurs associés à une évolution moins favorable : frailty, cognitive impairment or delirium, multimorbidity, poorer mobility before surgery or fracture, surgical or medical complications, persistent pain, fear of falling or movement, limited caregiver support and barriers to rehabilitation may be associated with slower or incomplete recovery. These are group-level patterns, not certain individual predictions (American Academy of Orthopaedic Surgeons, 2021; Rehabilitative Care Alliance, 2026; World Health Organization, 2024).
• Facteurs pouvant favoriser le rétablissement : a clear surgical and rehabilitation plan, early safe mobility, appropriately progressed gait and exercise, adequate pain relief and nutrition, suitable aids and home setup, caregiver involvement and coordinated medical, bone-health and falls care may support recovery (NICE, 2020; NICE, 2023; Ontario Health, 2024; Rehabilitative Care Alliance, 2026).
• Discussion du pronostic : explain what is known about the person’s procedure and current progress without promising a date or outcome. Compare change with the person’s baseline and goals, discuss uncertainty plainly, and update the outlook when symptoms, repeated outcomes, support or the surgical plan changes.