Counselling · Intermediate · Surgery

Hip Pain Post-Procedure - Discussion About Mobilisation and Recovery

Practise this PLAB 2 counselling station on Post-Operative Hip Hemiarthroplasty. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor on the orthopaedic ward. Mrs Mia Yuan, a 78-year-old woman, is two days post-operative following hip hemiarthroplasty for a fractured femoral neck. She is concerned about pain, mobility, and what happens next. Please discuss her recovery, mobilisation plan, venous thromboembolism prophylaxis, and rehabilitation.

Background notes: PMH: Type 2 DM, Hypertension, Osteoporosis, Previous angina (resolved, 20 yrs ago), Bilateral cataract surgery

What this station tests

  • Multimodal analgesia: regular paracetamol, NSAID if appropriate, opioid for breakthrough, avoiding opioid overuse in elderly
  • Early mobilisation rationale: reduces DVT, chest infection, and deconditioning risk
  • Hip precautions: no crossing legs, no bending past 90 degrees, no twisting on operated leg
  • Discharge planning: home environment assessment, equipment needs, care package, OT involvement
  • VTE prophylaxis continuation: 28 days post-surgery with LMWH, district nurse for home injections

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, establish what patient already knows and understands.
  • 1-3 min — Explain Condition: Explain diagnosis or condition using chunk-and-check technique. Use simple language, avoid jargon.
  • 3-5 min — Management Options: Discuss treatment options. Shared decision-making. Risks, benefits, alternatives.
  • 5-7 min — Address Concerns: Explore and address specific concerns. Check understanding. Discuss lifestyle implications.
  • 7-8 min — Closing: Summarise agreed plan. Safety netting. Arrange follow-up. Written information offer.

Consultation approach

The opening

Post-operative hip counselling requires practical advice about pain, mobilisation, hip precautions, and discharge planning. Mrs Yuan is 78, day 2 post-hemiarthroplasty for fractured neck of femur. She is frightened of pain, movement, and going home. Open with: 'Mrs Yuan, how are you feeling today? I want to discuss your recovery and answer your questions about getting back on your feet.'

Core approach

Address pain first (her primary concern). Day 2 pain is expected and normal. Reassure: 'Some pain is normal at this stage. It does not mean anything has gone wrong. The key is managing it so you can move and do your physiotherapy.' Ensure multimodal analgesia is optimised: regular paracetamol, NSAID if not contraindicated (check renal function, diabetes), and opioid for breakthrough. Avoid over-reliance on opioids (constipation, confusion risk in elderly).

Mobilisation is essential and should start day 1. The physiotherapist has already started. Explain why: 'Getting moving early reduces the risk of blood clots, chest infection, and muscle weakness. The physiotherapists will guide you safely.' She is frightened of falling again. Acknowledge this: 'We will make sure you have support when you walk. You will not be expected to walk alone until you are ready.'

Hip precautions depend on the surgical approach but typically include: do not cross your legs, do not bend your hip past 90 degrees (no low chairs, use a raised toilet seat), do not twist on the operated leg. Explain simply: 'These rules protect your new hip while it heals.'

Discharge planning. She lives in sheltered housing (ground floor, good). She will need a package of care initially, a raised toilet seat, and possibly a frame or sticks. OT assessment before discharge.

Closing and safety netting

Recovery timeline: walking with frame within days, independent with stick within weeks, return to most normal activities within 3 months. VTE prophylaxis continues for 28 days post-surgery (LMWH injections at home, or she may need district nurse visits). Bone health: she has osteoporosis, so ensure calcium, vitamin D, and bisphosphonate are prescribed or continued.

Address her concern about independence: 'The goal is to get you back to your sheltered housing, managing independently. Most people achieve that within a few weeks.' Safety net: signs of DVT (calf swelling, pain), wound infection (redness, discharge, fever), and dislocation (sudden severe pain, leg appears shorter or rotated). Follow-up: orthopaedic clinic at 6 weeks, physiotherapy ongoing.

How examiners mark this station

Examiners will assess your ability to explain post-operative hip hemiarthroplasty and its management in a patient-centred way. Domain 2 (Clinical Management) and Domain 3 (Interpersonal Skills) are equally weighted and primary. Expect marks for accurate information delivery, shared decision-making, chunk-and-check technique, and addressing the patient's specific concerns. Domain 1 (Data Gathering) is assessed through how well you establish the patient's baseline understanding and elicit their concerns.

Domain 1: Data Gathering, Technical and Assessment Skills (Supporting)

Scores well: Pain assessed and quantified. Current analgesia reviewed. Mobility progress checked with physio. Home environment assessed for discharge. Comorbidities reviewed (diabetes, osteoporosis).

Costs marks: Not assessing pain. Not checking home environment. Not reviewing comorbidities.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Multimodal analgesia optimised. Early mobilisation supported. Hip precautions taught. VTE prophylaxis for 28 days. Bone health addressed. Discharge equipment arranged. DVT and dislocation safety netting.

Costs marks: Inadequate analgesia. No hip precautions. No VTE plan for discharge. No bone health management.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Acknowledging fear of falling. Normalising post-operative pain. Providing realistic recovery timeline. Addressing independence concern. Simple language for hip precautions.

Costs marks: Dismissing fear. Not explaining why movement is important. Being vague about recovery. Using jargon.

Common examiner feedback (and how to fix it)

Did not provide adequate explanation or plan to the patient

Fix: Use chunk-and-check: deliver one concept, check understanding, then move to the next. Offer all relevant treatment options with risks and benefits before helping the patient decide.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Before and during counselling, explicitly ask what concerns the patient most. Respond to emotional cues with empathic statements before continuing with information.

Common mistakes in this station

  1. Not addressing her fear of falling. She fell and fractured her hip. Being told to walk again is terrifying. Candidates who push mobilisation without acknowledging this fear lose her trust.
  2. Not explaining hip precautions. Dislocation is a significant complication of hemiarthroplasty. Candidates who do not teach the precautions (no crossing, no bending >90 degrees) leave the patient at risk.
  3. Not planning VTE prophylaxis for discharge. LMWH for 28 days post-surgery is standard. Candidates who stop prophylaxis at discharge miss ongoing DVT risk.

Resitting PLAB 2?

If counselling stations have been a challenge, the most common issue is information overload: delivering too much clinical detail without checking understanding. Practise the chunk-and-check technique until it becomes automatic. Remember that shared decision-making, not lecturing, is what scores highly in Domain 3.

Example opening

Hello, my name is Dr [Name]. I understand you've come in today to discuss [topic]. Before I explain things, could you tell me what you've been told so far, so I know where to start?

Frequently asked questions

How do I open and run a post-Operative hip hemiarthroplasty counselling station in PLAB 2?

Post-operative hip counselling requires practical advice about pain, mobilisation, hip precautions, and discharge planning. Mrs Yuan is 78, day 2 post-hemiarthroplasty for fractured neck of femur. She is frightened of pain, movement, and going home.

What does a strong performance look like to the examiner in this station?

Strong performances show: Pain assessed and quantified. Current analgesia reviewed. Mobility progress checked with physio. Home environment assessed for discharge. Comorbidities reviewed (diabetes, osteoporosis). Weak performances: Not assessing pain. Not checking home environment. Not reviewing comorbidities.

What is the biggest pitfall in this post-Operative hip hemiarthroplasty station?

Not addressing her fear of falling. She fell and fractured her hip. Being told to walk again is terrifying.

How should I prepare for post-Operative hip hemiarthroplasty if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: Early mobilisation rationale: reduces DVT, chest infection, and deconditioning risk. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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