CafeDoor

Range of motion by PT begins on the day after surgery while teaching the family how to do it as well. No casts. We sit up as soon as comfort allows. On post operative day one, a Dulcolax suppository is used to help stimulate full bowel motility. Water stool softeners are not used as they bloat in the absence of brisk peristalsis. Dual anesthesia is used during surgery. General and local. This wards off “ileus” (reflex shut down of intestines in reaction to pelvic surgery). It also allows much less use of narcotics. No paralytics (curare-like) are used to allow better intraoperative tension appreciation. Temporary filaments are implanted in the wound to deliver superficial and deep local anesthesia which nearly eliminates narcotic use altogether. This way many complications that are known to cause more need for hospital care are avoided. Hospital stay is greatly reduced. There are newer rods which can lock in place as well as many options for wound dressings. Although Cafe'Door hip rebuilding is bigger surgery than a single side VRO, the VRO is seldom ever done to one side only as it would leave the patient lop sided by its very nature. The scope of Cafe'Door is much less than BILATERAL VRO and rarely done to both sides but never, if needed, at the same time. Big surgery requires good metabolism and a healthy nourished preoperative state. Gastrointestinal problems, if present, should be handled first. A preoperative urine screen having a high specific gravity is a warning that there may be blood volume contracture from chronic dehydration.