A total hip arthroplasty, or hip replacement, is a highly effective procedure that replaces a damaged joint with an artificial one. The recovery process involves temporary movement restrictions designed to protect the new joint while surrounding tissues heal. These prohibitions prevent the prosthetic femoral head (ball) from slipping out of the acetabular cup (socket), a complication known as dislocation. Following specific guidelines significantly reduces the risk of mechanical failure and ensures a successful long-term outcome.
The Essential Hip Precautions
The immediate post-operative period requires strict adherence to avoid specific mechanical movements that create a high risk for joint dislocation. These movements can force the joint out of the socket before the soft tissues have stabilized the implant. The three main movements to avoid are deep hip flexion, adduction across the midline, and internal rotation of the leg.
Patients must avoid bending the hip past a 90-degree angle, meaning the knee should never be raised higher than the hip joint. This restriction impacts common actions like bending over to pick up objects, leaning forward while sitting, or sitting in low chairs. Deep flexion can leverage the joint out of place.
It is strictly prohibited to cross the operative leg past the body’s midline, including crossing the ankles or knees. This motion, known as adduction, can strain the joint capsule. Rotating the foot or leg inward (internal rotation) must also be prevented, as this can twist the femoral head out of alignment.
Temporary Prohibitions on Daily Activities
Many everyday tasks require significant modification or temporary prohibition to respect hip precautions. Activities of daily living (ADLs) are often difficult to manage in the initial weeks due to the 90-degree flexion limit. Assistive devices like long-handled reachers and shoehorns are necessary to avoid bending over when dressing or retrieving dropped items.
Driving is typically restricted for four to eight weeks, depending on the surgeon’s guidance and whether the operated hip is the driving leg. This prohibition avoids the extreme hip flexion required to enter or exit a low car seat and ensures the patient has sufficient reaction time to operate the pedals.
Sitting surfaces must be firm and high enough to keep the knees at or below the level of the hips, often requiring a raised toilet seat or extra cushions. When sleeping, patients are advised to lie on their back for the first several weeks to maintain proper alignment. If side sleeping is permitted, a pillow must be placed between the legs to prevent the operated leg from crossing the midline or internally rotating.
Patients must also refrain from lifting heavy objects, generally defined as anything heavier than 10 to 15 pounds, for a specified period to avoid strain on the surgical site. These temporary limitations ensure soft tissues have adequate time to heal and strengthen around the new implant.
Long-Term Limitations on High-Impact Activities
Once the initial healing phase is complete (typically six to twelve months), most patients can return to a high level of activity, but some high-impact actions remain permanently discouraged. These limitations protect the artificial joint from premature wear and loosening, which can lead to revision surgery. The repetitive stress of certain sports can degrade the implant surfaces over time.
Activities involving aggressive jumping, jogging, or running are prohibited because they transmit significant shock loads across the joint. High-impact sports like football, basketball, and racquetball are avoided due to the combination of sudden starts, stops, twisting, and potential for falls or contact. These actions accelerate the breakdown of the implant materials.
Instead of high-impact exercises, patients should focus on low-impact alternatives that maintain muscle strength and joint flexibility without excessive stress. Recommended activities include swimming, water aerobics, walking on level surfaces, and cycling (especially on a stationary bike). These modifications allow for an active lifestyle while respecting the mechanical limits of the prosthetic joint.
Recognizing Signs of Dislocation
While adherence to precautions minimizes risk, recognizing the signs of a hip dislocation is important for immediate safety. A dislocation occurs when the artificial joint separates from the socket, often due to a sudden movement that violates the hip precautions. This mechanical failure is a medical emergency requiring prompt attention.
The most noticeable sign of dislocation is a sudden onset of severe pain in the hip or groin area. The patient will be unable to bear weight on the affected leg or move it normally. A visibly abnormal appearance of the leg, such as it appearing shorter or rotated severely inward or outward, indicates a dislocated joint.
Some patients may also report a distinct “popping” or “snapping” sensation at the moment of the dislocation. If any of these symptoms occur, do not attempt to move or reposition the leg. Immediate emergency medical services should be contacted for safe transport and reduction of the joint.