Hip Precautions

Original Editor - Adu Omotoyosi Johnson Top Contributors - Lucinda hampton, Kim Jackson, Adu Omotoyosi Johnson and Lauren Lopez

Introduction

Post THR often up on day 1

Hip precautions refer to certain things that one should not do after having total hip replacement (THR) surgery .Hip precautions are a common component of standard postoperative care following a THR.  The precautions are prescribed for 6-12 weeks postoperatively to encourage healing and prevent hip dislocation. Physiotherapists and nurses in conjunction with surgeons usually teach these precautions to the patient in the perioperative period. Hip precautions mainly apply to the posterior or posterior lateral hip replacement procedure. The anterior hip replacement procedure has fewer precautions.

There are additionally

• Environmental modifications that are recommended to prevent hip dislocations including removing tripping hazards from home and installing grab rails around the house.
• Equipment exists for patients to make adherence to hip precautions easier. For example raised toilet seats and chairs to prevent bending at the hip more than 90 degrees, sock aids and dressing sticks for dressing and changing clothing easier, "easy reachers" to help them get items from the ground.

Outmoded ?

Food for thought. Recent evidence suggests hip precautions provide no added benefits.

• Hip precautions may needlessly increase patients’ anxieties and fear about dislocation following THR.
• Recent studies have found that hip precautions impact patients’ recovery both physically and psychologically.

Trends in Implementation

• 44% of surgeons universally prescribing precautions while about one-third never prescribed precautions.
• Using the posterior approach was deemed a significant risk factor for implementing postoperative hip precautions.

Hip Precautions

General Precautions:

• Never cross legs or ankle on sitting, standing or lying down
• Avoid bending your leg greater than 90 degrees
• When sitting or standing from a chair, bed or toilet you must extend your operated leg in front of you. 

Posterior Approach Precautions

The provocative position for hip dislocation is: hip flexion, adduction, internal rotation. Precautions include:

• Do not bend the hip more than 90 degrees
• Do not cross legs or feet
• Do not roll or lie on the unoperated side for the first 6 weeks
• Do not twist the upper body when standing
• Sleep on the back for the first 6 weeks
• The patient may benefit from a shower chair or elevated seat for home use
• Avoid bathing for 8 to 12 weeks (flexed and bent down in the tub)

This 2 minute video reviews the three main “hip precautions” used for several weeks after posterior THR to prevent complications such as dislocation.

Anterior Approach Precautions

The provocative position for hip dislocation is: hip extension, external rotation. This approach has fewer restrictions

• Do not step backwards with surgical leg. No hip extension.
• Do not allow surgical leg to externally rotate (turn outwards).
• Do not cross your legs. Use a pillow between legs when rolling.
• Sleep on your surgical side when side lying.

This 1 minute video shows the precautions.

Mobility Precautions

Ascending/Descending stairs

• When ascending, step first with the unaffected leg (the side that was not operated on)
• When descending, step first with the leg that you had surgery on.

Getting into/Riding a car

• Ensure you get into the car from street level, not from a curb or doorstep
• Ensure the car sit is not too low, use pillow if necessary
• Don’t go for long car rides, stop get and walk at about every 2 hours