Hip Precautions

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

Introduction

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 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. The hip precautions below mainly apply to the posterior or posterior lateral hip replacement procedure. The anterior hip replacement procedure has fewer precautions and they are outlined later in this article.

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.

General Rule

• 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. 

Dressing

• Do not stand when dressing, you can either sit at the edge of your bed if it is stable or on a chair
• Never bend over, raise or cross legs when dressing
• Use an aid when donning or shoes (a reacher or a long-handled shoehorn) or socks
• When undressing ensure you remove clothes from the surgery side last

Sitting

• Never sit for too long in the same position, you can change position every 30 minutes interval
• Always ensure your feet are 6 inches (15cm) apart
• Do not cross your legs
• Avoid rocking chairs, cushion chairs, stools or sofas. Sit in a firm chair with straight back and armrests
• Avoid sitting on chairs that are too low, use pillow if necessary

The video below outlines the above issues and a few more

Bathing/Toileting

• Use a special tub seat for sitting in the shower
• Use a rubber mat on the tub or shower floor. Ensure to keep bathroom floor clean and dry
• Never bend, squat or reach for anything while showering. Use a shower sponge with long handle and have someone wash the part of your body that are hard for you to reach.
• Ensure you use an elevated toilet seat. It will be difficult to get up safely if the seat is too low.

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.

Lying in bed

• Do not sleep on the side of your new hip or on your stomach. Ensure you place two pillows in between your thighs if you are sleeping on the other side.

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

Walking

• Ensure you use your crutches or walker until your doctor or physical therapist tells it is OK to stop using them
• Do not bear over the amount of weight your doctor or physical therapist tells you to bear on the operated hip
• Take small steps when turning.
• Avoid wearing slippers that can make you fall. Go slowly when walking on wet and uneven surfaces. 

Anterior hip approach precautions

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.

Evidence relating to hip precautions

The use of hip precautions have been questioned in studies in recent years. A 2017 study reported that routine use of hip precautions in the primary setting appears unnecessary and potentially detrimental. A 2015 systematic review concluded that in anterior lateral THR approach the rate of dislocation is low and is not improved by hip precautions. They noted that these precautions are associated with a slower return to activities, significant expense, and decreased patient satisfaction.

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.