A total hip arthroplasty (THA), commonly known as a hip replacement, is a successful procedure designed to restore mobility and eliminate pain. Patients frequently ask about returning to activities like kneeling after this major surgery. The ability to kneel is restricted initially due to the mechanics of the new joint and safety concerns. Whether you can kneel depends on your individual recovery, the type of surgery performed, and clearance from your medical team.
Understanding Why Kneeling is Restricted
The primary mechanical concern after a hip replacement is the risk of joint dislocation. Standard post-operative guidelines often impose a temporary limit known as the 90-degree rule, particularly in early recovery. Kneeling can easily cause the hip to flex beyond this 90-degree angle, placing stress on the implant and surrounding healing tissues. Deep hip flexion increases the likelihood of dislocation, especially within the first six to twelve weeks when soft tissues are still repairing. Furthermore, lowering to and rising from a kneeling position often involves twisting or pivoting motions that can also destabilize the hip.
Timing and Surgical Approach Considerations
The timeline for safely returning to kneeling is individualized but influenced by the surgical technique used for the total hip replacement. The two most common methods are the posterior approach and the anterior approach, each having different initial precautions. Generally, surgeons advise avoiding kneeling for at least three months while tissues achieve initial stability. The posterior approach requires cutting through muscles and tendons, leading to traditional restrictions on deep hip flexion and a potentially longer caution against deep kneeling due to a higher risk of dislocation. In contrast, the anterior approach is muscle-sparing, accessing the joint from the front, which allows some patients to experience a faster early recovery.
Clearance and Recovery
Patients who undergo an anterior approach often have fewer movement restrictions and may be cleared to attempt kneeling sooner, sometimes around the three to six-month mark. Regardless of the surgical method, the final decision to resume kneeling must come directly from the orthopedic surgeon or physical therapist. Clearance is based on individual factors like muscle strength, implant stability confirmed by X-ray, and overall progress in rehabilitation.
Techniques for Safe Kneeling
Once you have received clearance, you can adopt specific techniques to practice kneeling safely, minimizing stress on the operated hip. The most important modification is to only kneel on the knee of the unoperated leg. By placing the non-operated knee on the ground, the new hip remains in an extended position, avoiding excessive hip flexion past the 90-degree threshold. Use a thick cushion, folded towel, or garden kneeler under the knee contacting the floor to reduce discomfort. When lowering down and rising up, use a stable support, such as a counter or high stool, pushing up with your arms and the strength of your unoperated leg.