A total hip replacement (total hip arthroplasty) alleviates chronic hip pain and restores mobility by replacing the damaged joint surfaces with artificial components. This surgery involves removing the diseased ball and socket and implanting new parts, typically made of metal, plastic, or ceramic. The immediate post-operative period requires strict adherence to specific movement restrictions, known as hip precautions. These temporary limitations prevent the artificial ball from slipping out of the socket (dislocation) and ensure the longevity of the implant while surrounding tissues heal.
Essential Movements to Avoid Immediately After Surgery
The most immediate and strict limitations concern the mechanics of the operated hip, typically lasting for the first six to twelve weeks post-operation. These restrictions protect the joint capsule and surgically accessed muscles, especially following a traditional posterior approach. Ignoring these rules places excessive stress on the new joint, significantly increasing the risk of dislocation.
One important precaution is avoiding hip flexion past 90 degrees; the angle between the torso and the thigh should never be less than a right angle. This deep bending motion puts the hip joint in a vulnerable position, potentially causing the artificial femur head to lever out of the acetabular cup. Patients must be mindful of this limitation when sitting down, picking up objects from the floor, or bending forward at the waist.
Another critical movement to avoid is adduction of the operated leg, which is the action of crossing the leg over the midline of the body. This position, such as crossing the knees while sitting, pulls the femur inward and can force the joint out of place. To prevent this, patients are advised to keep a pillow or specialized abduction wedge between their knees when lying in bed.
The third major restriction involves internal rotation, the movement of turning the foot and knee inward toward the opposite leg. This twisting motion creates torque on the new joint, which can lead to instability and dislocation. Patients should keep their toes pointed straight ahead or slightly outward when standing, walking, or lying down, consciously avoiding any pivoting motion on the operated leg.
Adjustments for Daily Living
The anatomical movement restrictions translate directly into necessary modifications for daily activities during the initial recovery phase. Simple tasks like sitting and toileting require specific adjustments to prevent the hip from exceeding the 90-degree flexion limit. Patients must avoid sitting in low chairs, soft couches, or seats that cause the knee to be higher than the hip joint.
A raised toilet seat is often necessary, as a standard toilet height forces the hip into an unsafe angle. Dressing the lower body also requires modification; patients must use long-handled reachers and shoehorns to put on socks, shoes, and underwear without bending down. This temporary reliance on adaptive equipment ensures hip precautions are maintained while allowing the patient to regain independence.
Restrictions are placed on lifting and carrying heavy items to avoid undue strain on the healing hip and surrounding musculature. Patients are limited to carrying very light objects, such as a small book or phone, and must avoid heavy grocery bags or laundry baskets. This precaution helps prevent falls, protects the surgical incision, and allows the muscles surrounding the implant to recover without excessive load.
Driving presents another temporary restriction, as it requires quick, controlled movements and the ability to perform an emergency stop. Most surgeons recommend waiting a minimum of four to six weeks before resuming driving, especially if the surgery was on the right leg. A patient must also be off narcotic pain medication and possess the necessary reaction time and strength to safely operate the vehicle. The resumption of sexual activity is also advised against for the first six to eight weeks, requiring guidance on positions that maintain hip precautions and avoid deep flexion or internal rotation.
Activities Permanently Discouraged
Beyond the initial recovery period, a patient must adopt long-term lifestyle changes to protect the longevity of the artificial hip joint. Activities that involve high impact are discouraged for the life of the implant. Repetitive forceful loading can accelerate component wear or cause the implant to loosen from the bone over time. This category includes sports like running, jogging, and high-impact aerobics, which repeatedly subject the joint to forces several times the body weight.
Contact sports, such as football, soccer, or rugby, are permanently advised against due to the high risk of falling, sudden pivoting, or direct trauma to the hip. Any activity involving sudden rotational movements or jumping places excessive stress on the interface between the implant and the bone. Instead, patients should focus on low-impact activities like walking, swimming, and cycling to maintain fitness and joint flexibility without damaging the prosthetic.
Repetitive deep squatting or kneeling should be minimized or avoided entirely, as these actions consistently push the hip past the safe 90-degree angle. While occasional or modified kneeling may be permitted once fully recovered, regular activity requiring deep hip flexion is an unnecessary risk to the implant. The goal of these permanent limitations is to ensure the artificial joint can provide decades of stable function, not to restrict activity entirely.