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Here is a structured summary of the discharge document:
Discharge Summary — Jayvantrao Amruta Magar
Hospital: Surya Hospital, Chikhali Pradhikaran, Pune – 411082
IPD No.: S/05/2026-000825 | UHID: PT19334
Patient Details
| Field | Detail |
|---|---|
| Name | Jayvantrao Amruta Magar |
| Age/Sex | 35 Years, Male |
| Address | Rutuja Heights, B Wing, Akurdi, Chikhali Road, Sane Wasti, Chikhali, Pune |
| Referred By | Self |
| Incharge Doctor | Dr. Ravindra L. Kulkarni |
| Admission Date | 04/05/2026, 12:45 PM |
| Discharge Date | 10/05/2026, 2:02 PM |
Diagnosis
- Right Hip Osteoarthritis
Presenting Complaints
- Right leg pain
- Backache
- Difficulty in walking
- Burning micturition
- Generalised weakness
- Reduced oral intake
- Newly detected Diabetes Mellitus (DM)
Vitals on Admission
- Temp: Afebrile | Pulse: 88/min | BP: 130/80 mmHg | SpO₂: 98%
- Tongue, Throat: Normal | No cyanosis, anaemia
- CNS: Conscious, oriented | RS: Clear | Abdomen: Mild tenderness | S1S2: Normal
Operation
Date: 05/05/2026
Procedure: Right Total Hip Replacement (THR) — MAXX COP implant
Surgeon: Dr. Tushar Choudhari
Anaesthesia: Spinal (SA)
Operative Notes:
- Patient placed in left lateral position, posterior approach
- Soft tissue dissection done; femoral head dislocated and femoral neck cut taken
- Acetabular reaming, trial implants placed; final acetabular cup and screws inserted
- Femoral broaching done; stem and head trialled; final implant inserted
- Wound sutured
Investigations
- CBC (6/5/26): Hb 12.4 g/dL, WBC 13,300, Platelets 1.85 (lakh)
- RFT: Normal
- Serum Electrolytes: Na 134.4, K 4.1, Cl 96.3
- Urine R/M: RBC absent, pus cells 4–2
- Post-op X-ray: Right hip AP done
Hospital Course
Patient had pain and oozing at the operated site post-operatively. Wound dressing was performed. Shifted to room, monitored. Treated with antibiotics, antacids, antiemetics, analgesics, and IV fluids. Ambulation initiated. Condition improved and patient was planned for discharge.
Treatment Given (In-hospital)
Cefoperazone (NOCEF 1g BD), Tramadol 100mg SOS, Diclofenac AQ + NS BD, Paracetamol IV SOS, Ondansetron 4mg BD, Glycomet GP 0.5 OD (for DM), Chymoral Forte BD, Cefuroxime (Supacef 1.5g BD), Amikacin 500mg 12-hourly, Lactulose (Duphalac), Apixaban 2.5mg BD (3 weeks — DVT prophylaxis), IV fluids, Cal 123.
Medicines on Discharge
| # | Medicine | Dose | Frequency | Duration |
|---|---|---|---|---|
| 1 | Tab. Zocef CV 500mg | 500mg | Twice daily after food | 5 days |
| 2 | Tab. Prand | — | Twice daily before food | 5 days |
| 3 | Tab. Chymoral Forte | — | Twice daily after food | 5 days |
| 4 | Tab. Glycomet GP4 | — | Twice daily before food | 5 days |
| 5 | Tab. Apixaban 2.5mg | 2.5mg | Twice daily after food | 3 weeks |
| 6 | Tab. Zerodol SP | — | Twice daily after food | 5 days |
Condition at Discharge
Stable; mild pain at operated site; ambulating.
Follow-up
- Follow-up Date: 15/05/2026
- Dressing after 3 days
- Physiotherapy advised
Discharge card prepared by: Dr. Sanjivani Pol, MD, DNB, ESCA (Cardiology)
Consultant: Dr. Ravindra L. Kulkarni, MD, DNB, MACC, FSCAI, FICA
In case of emergency: 8983834555 / 7272095555
Physiotherapy exercises protocol for the same acc to the phases
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Here is a comprehensive, phase-based physiotherapy protocol tailored for Jayvantrao Magar — 35M, Right THR via posterior approach (MAXX COP implant), discharged Day 6 post-op.
Physiotherapy Protocol — Right THR (Posterior Approach)
⚠️ Posterior Approach Precautions (Maintain for 6–12 weeks)
These apply throughout all phases:
- No hip flexion > 90°
- No hip internal rotation or adduction beyond neutral
- No crossing legs
- No combination of the above motions
Practical tips: Use raised toilet seat, avoid low chairs/sofas, do not bend forward to pick objects from floor, sleep with abduction pillow between legs.
Phase 1 — Acute Inpatient / Early Post-op
Timeframe: Day 0–5 (hospital stay, applicable to him until discharge on Day 6)
Goals
- Prevent post-op complications (DVT, PE, pneumonia)
- Control pain and swelling
- Begin bed mobility and transfers safely
- Initiate early muscle activation
Exercises
| Exercise | Position | Sets × Reps |
|---|---|---|
| Ankle pumps (up/down + circles) | Supine | 10 reps, every 1–2 hrs |
| Quadriceps sets (quad squeeze) | Supine | 3 × 10 |
| Gluteal sets (squeeze buttocks) | Supine | 3 × 10 |
| Hamstring sets | Supine | 3 × 10 |
| Short arc quads (SAQ) | Supine (towel roll under knee) | 3 × 10 |
| Heel slides (assisted, within precautions) | Supine | 3 × 10 |
| Hip abduction (slide leg out) | Supine | 3 × 10 |
| Diaphragmatic deep breathing | Supine | 5–10 breaths hourly |
Mobility / Functional Goals
- Sit to stand transfers with walker
- Standing within 12–24 hrs of surgery (Day 1)
- Walk short distances with walker (partial weight-bearing → weight-bearing as tolerated)
- Bed mobility with leg lifter as needed
Modalities
- Ice pack over hip 15–20 min after exercises
- Elevation of limb to reduce swelling
- Compression stocking / foot pumps
Phase 2 — Early Outpatient / Home Program
Timeframe: Week 1–6 (from discharge — his follow-up starts 15/05/2026)
Goals
- Restore basic hip strength and ROM within precautions
- Normalize gait with walking aid
- Achieve independent basic ADLs
- Continue DVT prophylaxis (Apixaban prescribed for 3 weeks)
Exercises
| Exercise | Position | Sets × Reps |
|---|---|---|
| Ankle pumps (continue) | Supine | 10 reps, 3×/day |
| Quad sets + Gluteal sets | Supine | 3 × 15 |
| Short arc quads (SAQ) | Supine | 3 × 15 |
| Long arc quads (LAQ) — seated knee extension | Seated | 3 × 10 |
| Hip abduction — sliding on bed → side-lying | Supine/Side-lying | 3 × 10 |
| Hip extension (standing, holding support, kick back gently) | Standing | 3 × 10 |
| Standing marches (hip flexion <90°) | Standing | 3 × 10 |
| Standing heel raises | Standing | 3 × 15 |
| Terminal knee extensions | Standing | 3 × 15 |
| Mini squats (shallow, no >90° flexion) | Standing | 3 × 10 |
| Step-ups — low step (4–6 inch) | Standing | 3 × 10 |
| Seated knee flexion/extension | Seated | 3 × 15 |
Gait Training
- Progress: Walker → Crutches → Single cane as tolerated
- Focus: equal step length, heel-toe pattern, avoid Trendelenburg (lateral trunk sway)
- Stair training: step-up with uninvolved leg first ("up with the good, down with the bad")
Home Advice
- Exercise 2–3×/day
- Ice for 15–20 min after each session
- No sitting >30–45 min continuously; get up and walk briefly
- Continue prescribed physiotherapy from Day 3 (as advised on discharge card)
Phase 3 — Strengthening Phase
Timeframe: Week 6–12
Goals
- Restore full hip strength (target 4+/5 MMT)
- Normalise gait without assistive device
- Return to basic daily and occupational activities
Exercises
| Exercise | Position | Sets × Reps |
|---|---|---|
| Hip abduction with resistance band | Side-lying / Standing | 3 × 12–15 |
| Clamshells | Side-lying | 3 × 15 |
| Hip extension with resistance band | Standing | 3 × 12 |
| Hip flexion with band (< 90°) | Standing | 3 × 12 |
| Lateral band walks | Standing | 3 × 10 steps each way |
| Double-leg squats (progress depth gradually) | Standing | 3 × 12 |
| Step-ups (higher step — 8 inch) | Standing | 3 × 12 |
| Lateral step-ups | Standing | 3 × 10 |
| Heel-toe raises (bilateral) | Standing | 3 × 15 |
| Standing single-limb stance (balance) | Standing | 3 × 30 sec |
| Hip hike | Standing at step edge | 3 × 10 |
| Bridges (double-leg) | Supine | 3 × 12 |
Cardiovascular Conditioning
- Stationary cycling: start 5–10 min, gradually increase to 20–30 min
- Walking program: increasing distance and pace
Phase 4 — Advanced Strengthening & Proprioception
Timeframe: Week 12–20
Goals
- Achieve symmetrical lower limb strength (>80% compared to uninvolved side)
- Improve neuromuscular control, balance, proprioception
- Return to work and recreational activities
Exercises
| Exercise | Position | Sets × Reps |
|---|---|---|
| Single-leg squats (progress depth) | Standing | 3 × 8–10 |
| Split squats / lunges (forward, controlled) | Standing | 3 × 10 |
| Single-leg bridge | Supine | 3 × 10 |
| Romanian deadlift (bilateral → unilateral) | Standing | 3 × 10 |
| Side bridge / lateral plank | Side-lying | 3 × 20–30 sec |
| Dynamic balance — BOSU ball, wobble board | Standing | 3 × 30 sec |
| Single-leg stance with perturbation | Standing | 3 × 30 sec |
| Tandem walking | Walking | 3 × 10 m |
| Lateral resisted walking | Standing | 3 × 10 steps |
| Elliptical trainer / swimming (if wound healed) | — | 20–30 min |
Phase 5 — Return to Full Function
Timeframe: Week 20+ (surgeon clearance required)
Goals
- Full pain-free ROM
- Return to desired recreational / occupational activities
- Independent without assistive device
- Long-term joint protection
Activities
- Continued low-impact aerobic conditioning (cycling, walking, swimming)
- Progressive return to daily work activities
- Avoid high-impact activities (running, jumping) — requires surgeon clearance
- Criteria for plyometrics/running: quad/hamstring symmetry ≥95%, pain-free ROM, single-leg squat control
Key Milestones for Jayvantrao (Age 35 — Younger, Active Patient)
| Milestone | Target Timeframe |
|---|---|
| Walking with walker, independent | Day 1–2 (already achieved) |
| Dressing change / wound check | Day 3 (15/05/2026 as instructed) |
| Follow-up with surgeon | 15/05/2026 |
| Walking with single cane | ~4–6 weeks |
| Walking without aid | ~8–12 weeks |
| Return to light work / sedentary job | ~6–8 weeks |
| Return to moderate activity | ~3–6 months |
| Full recovery | 6–12 months |
Note: Given his young age (35 years), diabetes (Glycomet GP prescribed), and newly detected DM — wound healing should be closely monitored. Blood sugar control is essential for optimal recovery. Physiotherapy sessions should be supervised by a licensed physiotherapist, especially in the initial phases.
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