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Hip Precautions After Hip Replacement Surgery


Hip Precautions After Hip Replacement Surgery

Hip precautions are important guidelines for those who have recently had hip surgery to replace their hip joint and stop joint pain. Hip precautions are ways of moving around that help prevent hip dislocation or separation of the new joint until the joint has time to heal. While you’re in the hospital, your health care team will remind you often about following these precautions. Once you get home, you’ll have to remember to follow them on your own.

You might want to make a couple of “Follow Hip Precautions” signs and put them by your bed, your favorite place to sit, and in the bathroom. Hip dislocation can be very serious so it’s important to follow your hip precautions until your doctor says it’s OK not to. The common time for following hip precautions is about 6 weeks, but varies based on how quickly you heal.

Your New Hip Joint

Prosthetic hip joint
Prosthetic hip joint

The hip joint is a ball-and-socket joint. The socket is the acetabulum in the pelvis and the ball is the upper “knob” on the thigh bone or femur. The artificial ball and socket used in a hip joint replacement is smaller than the natural joint it replaced.

This means the ball can slip out of the socket when the hip joint is turned at a certain angle and pressure is applied before the joint has had time to heal. When performing hip surgery, the surgeon opens the soft tissues of the joint capsule and separates the thick muscles of the buttocks and upper thigh to get to the joint being replaced. After hip replacement these muscles and stretched tissues need enough time to heal around the new joint and strengthen to hold the joint in place.

Once the hip joint heals, the new joint will be held in place by muscles and scar tissue. The complete healing process can take up to six months or more depending on your health before your hip surgery. Following hip precautions can help make sure your hip replacement heals without complications from joint dislocation. Follow the hip precautions when sitting, standing and lying down. Following hip precautions will limit the movement of your new hip joint until it is fully healed and can help prevent dislocation.

Why Follow Hip Precautions?

Xray of dislocated hip prosthesis
Xray of dislocated hip prosthesis

Hip precautions are needed to prevent dislocation of your new hip while it heals. The joint capsule helps keep the ball portion centered into the socket of your new hip. Once these tissues have been cut or stretched during surgery, there is an increased risk that the ball can be forced out of the socket before these tissues have a chance to heal. Hip precautions are used to keep your hip joint in safe positions that will prevent dislocation by keeping the ball from pressing against the healing tissues. Depending on your situation, your surgeon may have you follow these precautions for 6 to 12 weeks after surgery while the tissues get stronger.

The approach your surgeon used to open the joint capsule will decide which precautions you need to follow. If the capsule is opened from the front edge, it’s called an anterior approach; opening from the back of the capsule is called posterior approach. The posterior approach is the type performed most often. The precautions discussed here apply to the posterior approach.

Understanding Your Surgeon’s Language

Let’s face it, we’ve all gotten the take-home packet or handout that tells us how to care for ourselves. But most of the time we can only read half of it and what we can read, we can’t understand. You would think they wrote it for a medical journal.And, they may have. Surgeons speak in the language they know and they don’t have a lot of time to edit and prepare handouts in the best way for you to understand. That’s why I built this site. To write it so you can read it and understand it. For hip precautions your surgeon will say, “don’t internally rotate your hip too far.” So you think, “what is internally rotate and how far is too far?” Too far is easy – that’s when your hip pops out of the socket. You don’t want to do that. Very painful and dangerous. Rotate means turn, internally rotate means turn toward the inside – or easier to understand is “don’t turn you toes inward (pigeon toed).” Your toes are a good gauge of the position of the head of your new joint. If your toes turn in, the head turns out. POPS OUT—if it turns to far. So the best thing to do is keep your toes in a safe position. That safe position is toes pointing straight ahead. Whether you’re lying down, sitting, standing or walking—point those toes straight ahead.

Your surgeon or his handout might also say “don’t externally rotate your hip too far.” External rotation means turning your toes outward, the opposite of pigeon toed. Your toes gauge your hip, so the ball of your hip is turning inward. If it turns to far, it can POP OUT. Again, you don’t want that. Got it? Toes straight ahead.

This is a really useful and inexpensive series of videos on hip replacement
This is a really useful and inexpensive series of videos on hip replacement

How Your Hip Can Dislocate

Let’s look at a couple of examples on how your hip can dislocate. You’ll have to use your imagination a little—but imagining it will help you understand what happens in the joint and what you can do to prevent dislocation.

How hip and leg work together
How hip, leg, and foot work together

This image shows the relationship of your hip joint — where your leg joins your pelvis — to the rest of your leg. (Click on the image to see a larger one.) As you can see in the area inside the red circle, when your toes point straight ahead, the ball on the head of the femur fits well in the hip socket because at this angle the most surface of the ball sits in the socket.

Bones of the hip
Turning toes inward
Hip dislocation bringing knees up

As you turn your foot out or in, your whole leg turns, changing how much of the ball on the femoral head fits into the socket in your pelvis. When you turn your foot too far inward, the ball can pop out of the socket — which means your hip dislocates. Normally, your muscles and ligaments hold the joint together. But they were stretched during surgery and need to heal and tighten up. While they heal, use your toes as a guide to the safest fit of the ball in the socket. Keeping your toes pointed straight ahead is the safest position for your hip until your new hip heals, usually 6 weeks.
In the image to the right, you can see how the ball fits into the socket of the hip. This view is from the back — that is, as if you were looking at a person standing in front of you and they are facing forward. Imagine further that the femur (thigh bone) — the one with the ball on the end — extends down to the foot. In this view, their foot would be pointing straight ahead and the ball fits nicely into the socket and the hip joint is stable.
Turning the toes inward (the direction of the gray arrow) rotates the femur and the ball outward (the direction of the green arrow). If the ball is rotated far enough, it will pop out of the socket. In a healthy hip, the muscles and ligaments keep the ball in the socket. Right after surgery these ligaments and muscles have been stretched and need time to heal. While your hip is healing you need to follow your hip precautions.
Bringing your thigh up toward your chest (the direction of the green arrow) rotates the femur and the ball in the direction of the gray arrow. If the ball is rotated far enough, it will pop out of the socket.

90 Degree Angle

Bending over does the same thing but instead of moving the ball it moves the socket. Bending your chest and pelvis toward your knee rotates the socket, and if the socket is rotated far enough, the ball pops out.
So how far is far enough to pop out? A good rule of thumb is the 90-degree rule. This angle between the pink and black lines is 90 degrees. One line represents your chest, and the other is your thigh — it doesn’t matter which one is which. If you are standing or sitting, your back would be the pink line. If  you are lying down, your back would be the black line. To protect your hip, never let the angle between your chest and your thigh be less than 90 degrees.
To prevent dislocation in the new hip there are three basic rules to follow:

  1. Always keep your hips higher than your knees.
  2. Never cross your legs at the knees or ankles. Keep your legs apart.
  3. Never turn your toes inward or outward. When you’re lying down keep your toes pointed toward the ceiling. The direction of your toes can generally tell you the position of your hip.

The movements and positions listed below should be followed since not following them can cause joint dislocation. NOTE: The “affected leg” is the leg with the new hip replacement. As you go through the list of Do’s and Dont’s — think about the pictures above and how following these precautions will keep your hip in a safe position.

Always sit with your hips higher than your knees.
Always sit with your hips higher than your knees.
Point your toes straight ahead, don't turn your toes inward.
Point your toes straight ahead; don’t turn the toes of your affected leg inward.

Hip Precautions While Standing or Walking

Hip Precautions While Sitting

Hip Precautions While Lying Down

Do not bend your hip more than 90 degrees.
Do not bend your hip more than 90 degrees. Don’t pull knees to your chest.
Do not turn your toes inward.
Do not turn your toes (or knee) inward.
Do not cross your legs. Don't let your leg cross the midline of your body.
Do not cross your legs. Don’t let your leg cross the midline of your body.

Hip Precautions During Activities of Daily Living

Restrictions on your movement have an effect on your daily activities and how you do them. These are changes that can help you manage these new limitations.

Preventing Falls

Besides making a wrong move with your new hip, you can also dislocate your hip if you fall. Therefore, it is important to not only while your hip is healing, but afterward as well. Here are some ways to prevent falls:


If Your Hip Dislocates

Dislocation of an artificial hip is uncommon, but may occur during the first 3 months after surgery.  If the hip dislocates out, it will happen in a fraction of a second, without warning. If hip dislocation occurs you may have a “slipping feeling,” a popping sound, or see your affected leg get shorter and turn inward, causing pain in your thigh or knee. The dislocated hip may no longer be able to support weight. People usually know right away when a hip dislocation happens because you will feel severe pain in your groin and be unable to move your new hip fully. If this happens to you, call 911.

However, in rare cases the new joint can become just slightly dislocated presenting no symptoms. If you think your hip has dislocated it is important that you seek medical attention as soon as possible. Call your surgeon right away. Do not try to stand up or walk with a dislocated hip—standing with a dislocated hip puts weight on the joint and could lead to more damage. Have someone call your surgeon right away. If you surgeon tells you to go to the hospital, call an ambulance to take you.

Do not try to stand up or walk with a dislocated hip.
Do not try to stand up or walk with a dislocated hip. Have someone call your surgeon.

Repairing the hip joint quickly can prevent another surgery. If treated promptly there are several methods used to put the ball back into socket that don’t require surgery.

Questions About Hip Precautions

Q. Is it OK to have a baby after having a hip replacement?
A. In general, it is OK to have a baby after having a hip replacement. You should talk with your surgeon about you concerns and be sure to let your OB/GYN know that you have a prosthetic hip.

Q. How long should I use the raised toilet seat?
A. The purpose for the raised toilet seat is to keep your hips higher than your knees when sitting (in this case, on the toilet) which is one of your hip precautions. You should use the raised toilet seat for as long as your doctor has you following hip precautions that is usually for 6 weeks.

Q. Can I sleep on my stomach after hip replacement?
A. One of your hip precautions is not to turn your toes inward to prevent dislocation of your hip. When lying on your stomach, it’s natural for your feet to turn inward. It’s OK to sleep on your stomach after your doctor says it’s OK to stop following your hip precautions. Put a pillow between your knees when rolling or turning over onto your stomach or from your stomach to your back.

Q. Is it OK to lie or sleep on my side that has the new hip?
A. Yes, you can lie or sleep on the operative side but not for the first 6 weeks as there may be some discomfort in the scar area. If you are a side sleeper and sleeping on the non-operative side, you should sleep with a pillow between your knees for the first 6 weeks. Lying on your affected side will not cause dislocation. Dislocation occurs with bending at the operated hip of more than 90 degrees, turning your toes inward (of the affected leg), or your knee going past your belly button (of the affected leg).

Q. When can I put weight on my new hip?
A. If you have a cemented hip you can put weight on it right away. If it is a cementless hip then wait 6-8 weeks.

Q. How long will I need a walker to crutches?
A. You will need some help with walking for about 6 weeks. You will start with a walker and then use a cane based on how quickly you progress with healing.

Q. Can I get a handicapped parking permit?
A. Your surgeon’s office can help you get a permit.

Take Care of Your New Hip Joint

It’s very important that you take care of yourself by following hip precautions after joint replacement for as long as your doctor tells you to. Ignoring hip precautions after hip surgery increases your risk of hip dislocation. Hip dislocation can go undetected. Hip or joint pain is not always associated with the dislocation. Following hip precautions is the best way to make sure a dislocation doesn’t happen and possibly go unnoticed. | Anatomy, Surgery, Pregnancy, Nutrition, Fitness