Recovering safely after a total hip replacement requires careful attention to how the new joint is moved, especially when getting in and out of bed. Adhering to specific mobility techniques is necessary because the tissues surrounding the hip need time to heal and stabilize the implant. Improper movement risks placing excessive stress on the surgical site, which could compromise the recovery process. Learning and consistently practicing these safe methods reduces the potential for a serious complication called dislocation.
Essential Post-Surgery Hip Precautions
All movement following hip replacement surgery must be constrained by specific guidelines provided by the surgical team or physical therapist. These precautions are temporary measures designed to protect the integrity of the new joint while the surrounding muscles and capsule recover. Violating these rules can force the hip into an unstable position, potentially leading to dislocation, which requires immediate medical attention.
The first and most recognized precaution is avoiding excessive hip flexion, meaning the hip should not bend more than 90 degrees. This angle is roughly equivalent to sitting upright in a standard dining chair, so the knee should never be raised higher than the hip when sitting or bending. Second, patients must prevent the legs from crossing the midline of the body, a movement called adduction, which includes crossing the ankles or knees. A pillow placed between the legs while sleeping helps maintain this separation.
Finally, twisting the operated leg inward or outward, known as internal or external rotation, must be prevented in all positions. When moving, the toes should always point straight ahead, and the body must move as a single unit without pivoting on the operated foot. These restrictions are typically maintained for the first six to twelve weeks post-surgery, allowing the soft tissues sufficient time to heal and provide natural joint stability.
Step-by-Step Guide for Getting Out of Bed
Moving from a lying position to a stable seated posture requires a deliberate, sequential approach that respects all hip precautions. To begin, position the body close to the side of the bed you plan to exit, ideally the side corresponding to the operated hip. Use the arms to push up onto the elbows, then onto the hands, keeping the back reclined to ensure the hip angle remains greater than 90 degrees.
Next, bend the non-operated leg and plant the foot firmly on the mattress for leverage. Using the strength of the arms and the non-operated leg, scoot the body toward the edge of the bed in small increments. The operated leg should remain mostly straight and extended throughout this movement.
Once the hips are near the edge, carefully pivot the entire body as a unit, allowing the operated leg to swing off the side of the bed first, followed by the non-operated leg. Use the hands to push off the bed surface and achieve a stable sitting position with both feet flat on the floor. Before attempting to stand, pause to ensure balance and verify that the knees are lower than the hips.
Safe Technique for Getting Into Bed
Safely entering the bed requires meticulous attention to hip positioning. Start by standing with the back to the bed, using a walker or crutches for support, and backing up until the non-operated leg touches the edge of the mattress. Extend the operated leg straight out in front of the body to keep the hip joint from flexing too much.
Reach back with both hands to the bed surface and slowly lower the body onto the mattress, keeping the operated leg extended forward. Once seated, maintain a semi-reclined position by leaning back onto the elbows and hands for support. The next step involves lifting the legs onto the bed one at a time, often starting with the operated leg, or using a leg lifter strap for assistance.
After both legs are on the bed, use the arms and the heel of the non-operated foot to carefully scoot the body backward toward the pillow. This movement must be done without twisting the trunk or the hips. The body should move as a single block to avoid rotation of the new joint.
Adjusting Your Sleep Setup for Recovery
Optimizing the immediate environment can make the complex movements of entering and exiting the bed easier and safer.
Bed Height
The height of the bed is a primary consideration; the mattress should be high enough that when sitting on the edge, the feet are flat on the floor and the hips are level with or slightly higher than the knees. Bed risers or an extra firm mattress may be necessary to achieve this height and prevent the hip from flexing past the 90-degree limit.
Assistive Devices
Assistive devices should be positioned within easy reach to minimize the need for bending or twisting. A grab bar or a trapeze attached to the bed frame can provide a secure anchor point to assist with the push-up and scooting movements. A long-handled reacher or a leg lifter strap should be kept close to the bed to help manage blankets or reposition the operated limb.
Sleeping Position
For sleeping, a firm pillow or an abduction wedge must be placed between the knees and ankles to prevent the legs from crossing during the night. Sleeping on the back is generally recommended initially. If sleeping on the side is permitted, it must be the non-operated side, with the pillow firmly supporting the entire length of the operated leg. Keeping necessary items close by minimizes the temptation to reach or twist out of a safe position.