Following a total hip replacement, the immediate period after surgery presents a unique challenge for patients, especially when performing seemingly simple movements like getting out of bed. Safe mobility is a primary concern, as specific movements can place the new joint at risk of dislocation. Patients must adopt precise techniques taught by physical therapists to protect the hip while the surrounding soft tissues heal and stabilize, ensuring a successful recovery and preventing complications.
Understanding Post-Surgical Movement Restrictions
The underlying reason for strict movement protocols is the vulnerability of the new hip joint before the surgical site fully heals. For patients who undergo a posterior approach hip replacement, the risk of dislocation is highest when the hip is placed in certain positions. This surgical approach requires specific “Hip Precautions” to be followed rigorously, typically for six to twelve weeks after the procedure.
A primary precaution is the 90-degree rule, which mandates that the hip should not bend more than 90 degrees. This means the knee should never be raised higher than the hip when sitting or bending, and this restriction must be observed during all daily tasks. Furthermore, patients must avoid crossing the operated leg past the midline of the body (adduction), as this stresses the joint capsule. Finally, internal rotation of the operated leg, which involves turning the toes inward, must be prevented to avoid twisting the new joint out of its socket.
Step-by-Step Guide for Safe Bed Mobility
Safely moving from a lying position to a seated position requires a coordinated movement pattern that protects the hip joint from violating the precautions. The preferred method is the “log roll” technique, which ensures the spine and hips move as a single unit, preventing twisting or excessive bending. Before beginning, the patient should be lying on their back with the operated leg kept straight.
To begin exiting the bed, the patient must first move their body toward the edge of the mattress, using their elbows and the non-operated leg to gently scoot their hips over. Once positioned near the edge, the patient should roll onto their side, moving their shoulders, trunk, and legs simultaneously. If rolling, a pillow should be maintained between the knees. The operated leg must remain in a neutral or slightly externally rotated position, keeping the toes pointed forward or slightly outward.
The physical act of sitting up is achieved by pushing down with the elbows and hands while simultaneously dangling the legs off the side of the bed. The non-operated leg is used to gently assist the operated leg off the mattress, ensuring the operated hip remains relatively straight and extended. Once fully seated, the patient must consciously lean back slightly and place their hands behind them to prevent the torso from flexing forward and violating the 90-degree precaution.
The safest side to get out of bed is usually the non-operative side, as this allows the operated leg to remain extended and supported during the transition. However, some surgeons or therapists may recommend rolling onto the operative side to help maintain correct hip alignment and prevent internal rotation. The decision depends on the specific surgical approach and the patient’s anatomy, making it important to follow the instructions provided by the physical therapist.
Returning to bed involves reversing the steps. The patient sits on the edge, supports their weight on their hands, and lifts the operated leg first with the assistance of the non-operated leg or a helper. They then slowly lower the torso back into the bed.
Essential Tools and Aids for Getting Up
A variety of specialized equipment is recommended to help patients adhere to movement precautions and safely navigate their environment. A long-handled leg lifter is one of the most beneficial tools, providing an easy way to move the operated leg without bending or twisting the hip. This device is particularly useful for lifting the leg into and out of bed or a car, movements that commonly challenge the 90-degree rule.
For sleeping, a high-density foam wedge or a firm pillow placed between the knees is frequently used to prevent the legs from crossing while the patient is resting. This measure helps maintain the required hip abduction and prevents the operated leg from rotating inward. To assist with standing transfers, a sturdy bed rail or a trapeze bar mounted above the bed can provide secure leverage, reducing strain on the hip and preventing sudden, uncontrolled movements.
Dressing and undressing also pose a risk of violating the 90-degree rule, so long-handled aids are necessary to maintain independence. A sock aid allows a patient to pull on socks without bending forward. A long-handled reacher or grabber can be used to pick up items from the floor, eliminating the need to flex the hip. Furthermore, a raised toilet seat or commode is often installed to ensure the hip angle remains greater than 90 degrees when toileting.
When Can Normal Movement Resume?
The duration of strict movement precautions is not permanent, but it is highly variable depending on the surgical approach and the speed of soft tissue healing. For patients following the posterior approach, the initial, most restrictive phase typically lasts between six and twelve weeks. This time frame allows the muscles and joint capsule cut during the surgery to heal and regain tensile strength around the new implant.
The surgeon and physical therapist will determine when it is safe to begin easing these restrictions, often based on radiographic evidence of healing and the patient’s demonstrated strength and stability. Patients should not unilaterally decide to abandon the precautions, even if they feel significant improvement in comfort and mobility. Full recovery, allowing a return to most regular, low-impact activities, often takes three to six months, sometimes extending up to a full year for pre-surgical activity levels.
The process of resuming normal movement is gradual, with the physical therapy program slowly introducing greater range of motion and strengthening exercises. While high-impact activities like running are avoided long-term to prevent excessive wear on the implant, most patients eventually regain the ability to perform daily activities without concern for the initial precautions. The final clearance to discontinue all precautions is a medical decision made by the surgical team.