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 healthcare team will remind you often about following these precautions. Once you get home, you’ll have to remember to follow them on your own.
Before the day of surgery, 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 and the type of surgery that you underwent.
Your New 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.
Following a hip replacement surgery, the ball can slip out of the socket when the hip joint is placed into certain vulnerable positions before the soft tissues around the hip joint have had time to heal (hip anatomy). 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 access the joint. 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?
Hip precautions are needed to prevent dislocation of your new hip while it heals. The joint capsule and surrounding muscles help to 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 while these tissues 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; opened from the side is called a lateral approach. The posterior approach is the type performed most often although the use of the anterior approach is becoming more common. The precautions discussed here mainly 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.
For hip precautions your surgeon will say, “don’t internally rotate your hip too far.” So you think, “what does that mean, 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 in this case, “don’t turn your 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 (See below illustrations). If you turn too far inwards, your hip will pop out of place (i.e. dislocate). The safest position is maintained by keeping your toes pointing straight ahead. Whether you’re lying down, sitting, standing or walking—point those toes straight ahead.
If you underwent an anterior hip replacement, your surgeon or his handout might say “don’t externally rotate your hip too far.” External rotation means turning your toes outward, the opposite of pigeon-toed. Your toes mirror the position of the hip, so when the toes are outwards, the ball of your hip is turning inwards. If it turns too far, it can pop out the front (i.e. dislocate). Again, the safest position is maintained by keeping your toes pointing straight ahead.
Bottom line, try to keep your toes straight ahead at all times.
Be very sure to clarify what your individual hip precautions are with your health care team before and after surgery.
How Your Hip Can Dislocate
Let’s look at a couple of examples of how your hip can dislocate. You’ll have to use your imagination a little—but imagining it will help you to understand what happens in the joint and what you can do to prevent dislocation.
This image shows your hip joint — where your leg joins your pelvis. 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 is well covered within the acetabulum (the cup).
As you turn your foot out or in, your whole leg turns, changing how much of the ball on the femoral head is covered by the socket in your pelvis. For instance, when you turn your foot too far inward (pigeon-toe or internally rotated), the back part of the ball becomes less covered by the socket. On the other hand, if you turn your foot too far outwards (externally rotates), the front of the ball becomes less covered by the socket.
The following pictures will illustrate this more in detail:
In the image to the right, you are looking at the hip from the back — that is, as if you were looking at a person standing in front of you and they are facing forward. In this position, the person’s foot is pointing straight ahead. You can see how well the ball normally fits into the socket of the hip in this position. This is the most stable position of the hip.
Turning the toes inward (see below – the direction of the gray arrow) rotates the femur and the ball outward (the direction of the green arrow) i.e. less socket coverage on the back of the ball. In a healthy hip, the muscles and ligaments keep the ball in the socket. Right after surgery, however, these ligaments and muscles have been stretched and/or damaged and need time to heal in order to prevent dislocation. Because of this, if the ball is rotated far enough, it can pop out of the back of the socket (i.e. dislocate). That is why, while your hip is healing, you need to follow your hip precautions.
This specific scenario is true if you had a posterior approach (through the back). If you had an anterior approach (through the front), the tissues in the front are damaged and the opposite is true (i.e. imagine the arrows going in the opposite directions).
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. Again, if you’ve recently had surgery and the ball is rotated far enough, it can pop out of the socket. The same thing happens when you bend over.
So how far is far enough to pop out while bending over? A good rule of thumb is the 90-degree rule. This angle between the pink and black lines is 90 degrees (left). 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 more than 90 degrees (see hip precaution diagram 1 below)
Below are pictures of the hip precautions (mainly geared for a posterior hip approach). As you go through the list of Do’s and Do not’s — think about the pictures above and how following the precautions below will help to keep your hip in a safe position. NOTE: The “affected leg” is the leg with the new hip replacement.
Hip Precautions While Standing or Walking
- Don’t cross your legs or ankles at any time!
- Keep your toes forward
- don’t turn the foot of your affected leg inward (pigeon-toed)
- Don’t stoop or squat.
- Don’t twist your shoulders or turn at the waist toward your affected leg while keeping that foot still. Lift your foot on the affected leg and turn your whole body in the direction of your affected leg.
- Take small steps in the direction you want to turn mainly using your “good” leg.
- Don’t step up onto surfaces where your knee will be higher than your hips.
If you had an anterior approach:
- Do not allow the knee of the affected leg to go behind your hip when walking (also known as extending your leg).
- Keep your toes forward, don’t allow your toes to turn out
- No wide steps outwards or backwards (i.e. no hip abduction)
Hip Precautions While Sitting
- Don’t cross your legs at any time!
- Don’t sit where your hips are at the same level or lower than your knees.
- Add a pillow to your chair seat to keep your hips higher than your knees.
- Don’t lean forward when moving to sit down or rock forward when standing up from a sitting position.
- Don’t lean forward while sitting down, as in reaching for something.
- Sit in chairs that have arms. Use the chair’s arms for support and to control your movement when sitting or standing. This takes pressure off of your legs and hips. It can also prevent you from naturally wanting to lean forward for balance or rock forward to stand up.
- Do get up and move around at least once every hour.
Hip Precautions While Lying Down
- Don’t cross your legs at any time
- Don’t pull your knees towards your chest.
- Don’t let the toes of your affected leg turn inward.
- Don’t lie on the side of your hip replacement. If you lie on your unaffected side, keep a pillow between your legs to keep them from crossing. Also, be sure your foot is on the pillow so that the toes don’t dangle and turn inward.
- Don’t lean forward when resting in bed i.e. to adjust blankets or pillows.
- Do sleep on your back with a pillow between your legs. Lots of people ask if they can lie on their stomach after hip replacement. The problem with lying on your stomach is that it causes your feet to turn too far out or too far in. Ask your surgeon if it is OK for you to sleep on your stomach.
Additional 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.
- Don’t use pain as a guide to what you can and cannot do. Use ice to reduce pain and swelling. Being as mobile as possible is encouraged!
- Use a raised toilet seat. A raised toilet seat can prevent you from rocking your body forward when standing up. This is a common cause of hip dislocation.
- Add temporary handrails or grab bars in areas where you need support, such as near the toilet, shower or tub.
- Don’t get down into the bathtub. A special bench can be used to straddle the side of the tub that you can sit on while you bathe. Adjust the bench so your hips are higher than your knees when sitting.
- Use reaching aids to bathe. You should not bend over or forward to bathe.
- Use an adjustable shower stool to prevent falls. Be sure to adjust the height so your hips are higher than your knees when sitting.
- Have someone help put your socks and shoes on. Bending over to do it yourself puts your hip joint in a position that could easily cause it to dislocate.
- Use a reaching aid to help with dressing. Don’t bend down to pull up your pants or tie your shoes.
- Don’t lift more than thirty pounds. Anything you lift adds weight that your new hip replacement must support.
- Don’t drive for at least six to eight weeks following hip surgery. When riding as a passenger, you may need to add a pillow in the seat to get your hips higher than your knees. Place a plastic bag on the seat. This helps you to slide out of the car easily without having to lean or rock forward.
- Do limit stair climbing. When climbing up the stairs, the “good” leg should step first and then bring the affected leg up to the same step. Then bring up your cane. When going down the stairs, put your cane on the lower step, then put your affected leg down to the next step, and finally, step down to the same step with your “good” leg.
In summary, to prevent dislocation in your new hip (performed through a posterior approach) there are three basic rules to follow (whether standing, sitting, or lying down):
- Always keep your hips higher than your knees.
- Never cross your legs at the knees or ankles. Keep your legs apart.
- Never turn your toes inward. When you’re lying down, keep your toes pointed toward the ceiling.
- Also important is to not turn your body towards the side of your surgery, as this puts the hip into the same position as if your toes were turned inwards.
Besides making a wrong move with your new hip, you can also dislocate your hip if you fall. Therefore, it is important to prevent falls not only while your hip is healing, but afterward as well. Here are some ways to prevent falls:
- Don’t climb stairs with your arms full. Hold onto the handrails.
- Make sure you can always see where you are walking.
- Don’t carry things that are too heavy for you.
- Use a step stool, don’t stand on chairs or furniture.
If Your Hip Dislocates
Dislocation of an artificial hip is uncommon, but may occur after surgery. It is most common in the first few months following 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,” experience 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. It is usually quite obvious when your hip dislocates because you will likely 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 dislocate without any significant pain or 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 your surgeon tells you to go to the hospital, call an ambulance to take you.
Having the dislocation addressed quickly is important:
- The hip joint can oftentimes be reduced without surgery (i.e. ball manipulated back into the socket). Light anesthesia and pain medication is often used.
- A brace is usually placed afterwards to prevent another dislocation. This is common practice when the dislocation happened without an obvious reason.
- In extreme cases, the surgeon will have to operate again. These cases typically include: dislocations that are ignored for a long time, multiple dislocations over a short time period, and dislocations that can’t be repaired without 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 your 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. 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. However, be sure to ask your surgical team regarding their specific sleeping instructions.
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.
Q. When can I put weight on my new hip?
A. In most cases, right away. In certain more uncommon situations, your surgeon may limit weight bearing.
Q. How long will I need a walker?
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 dislocations can go undetected as they are not always associated with pain. Following hip precautions is the best way to make sure a dislocation doesn’t happen and possibly go unnoticed.
Note that the information in this article is purely informative and should never be used in place of the advice of professionals.
More Articles About Hip Replacement
The information presented here—in timeline order—can help you learn what to expect when having a hip replacement from planning through recovery.
- Total Hip Replacement: a guide for surgery and recovery
- Your Visit with the Orthopedic Surgeon
- Minimally Invasive Hip Replacement
- Making Arrangements for Hip Replacement Surgery
- Pre-surgery planning and timeline
- Getting Ready for Hip Replacement Surgery
- The Hip Replacement Operation
- Complications of Hip Replacement Surgery
- On the Road to Recovery After Hip Replacement
- Hip Precautions After Hip Replacement