Maintaining Hip Precautions Following Hip Replacement

Maintaining Hip Precautions Following Hip Replacement

 

 

For a few months following a Total Hip Replacement with a Posterior Surgical Approach, the 3 main precautions are: No hip flexion greater than 90 degrees, no hip internal rotation, and no hip adduction past neutral. 

Avoid crossing your legs to minimize hip adduction. 



Avoid standing and crossing your ankles, as this also adducts the hip past neutral

 

When seated, if your knees are in this position, you are in neutral hip rotation

If your knees are in the position shown above, then your hips are internally rotated 

 

 

The photo above shows an acceptable seated hip position.  If you look at the femur bone (thigh) and approximate the spine location, you can see that the hips are flexed less than 90 degrees. 

 

Bending too far forward while sitting in a chair will cause you to flex your hips more than 90 degrees.  This is not good

Seated marching will also flex your hips more than 90 degrees - Also not good

For some patients, these precautions may be difficult to maintain due to forgetfulness.  However, not abiding by these "rules" may lead to hip dislocation during the time immediately following surgery.  Sometimes, the surgeon is very emphatic about these precautions, especially with patients who have already experienced a dislocated hip post-op and have needed a hip revision.  When treating these patients, I am very cautious and follow the precautions as closely as possible.  These precautions should also be considered when the patient is walking, particularly upon changing directions.  If the hip replacement was on the right side, I will advise patients to make all 180 degree turns to the left, avoiding turning to the right.  Or, I will encourage smaller "baby steps" if they must turn to the right, using a marching technique.  With this, I am trying very hard to teach my patient to avoid planting the foot on the operative side prior to turning toward that side, because doing so will create a relative internal rotation of that hip. 

Assuming my right hip was replaced, the following pictures will demonstrate how planting the right foot and turning to the right is actually creating right hip internal rotation:

Standing with hips in neutral
 

Slight right hip internal rotation in stance



This shows what maximum hip internal rotation looks like in stance without attempting to turn.  Notice the angle of my feet are at 90 degrees

 

Maintaining right foot planted, and continuing to turn to the right by leading with the left foot, it can be seen that the right hip is internally rotate excessively.  Again, the angle of my feet is about 90 degrees

 So if you are trying to stick to the surgeon's precautions as closely as possible, remember not only to assess your patient when he/she is in the sitting position but also during dynamic activities such as walking.