Total hip replacement arthroplasties (THA) have come a long way when it comes to medical innovations. Surgeons have gotten to the point where they encourage their patients to get out of bed just a few hours after surgery AND put as much weight as possible on the operated hip while walking. Healing after a hip replacement has become less problematic and the results can be life-changing.
Of course, we need to discuss the false sense of security. Yes, you can walk relatively quick after surgery and yes, you can do some basic activities of daily living (ADLs). And no, you can’t expect to do everything right away.
Despite the ease that comes with the latest THAs, we are still talking about a major surgery in which you have had one of the largest joints in your body cut out and replaced. Don’t be surprised that there will be some limitations that you will have to endure until you fully heal. Also, the recovery timeline for each person that has a surgical hip replacement is going to vary based on other past medical history or complications.
Depending on the incision of your hip replacement, you will be discharged home from the hospital with several precautions as ordered by your doctor including weight-bearing precautions and range-of-motion precautions:
Surgical Approach To Hip Replacement And Weight Bearing Restrictions
Weight-bearing precautions: Your doctor will let you know how much weight he/she expects you to put through your operative leg after surgery. Typically, if the surgery goes well, you will be able to put down as much weight as you can tolerate (WBAT-weight-bearing as tolerated).
For those who have complicating conditions (i.e. osteoporosis, additional fractures, degenerative diseases, etc.), your doctor might say partial weight-bearing or no weight-bearing for a specific duration of time after surgery.
Range-of-motion precautions: This refers to the directions and distances in which you can move the hip joint (flexing, extending, internally and externally rotating, etc.). The standard rule of no bending and no twisting is not universal for all hip replacements because it depends on the incision:
- Posterior approach: If the incision goes through the back of the hip, then the precautions will include no bending over past 90 degrees, no pivoting on the feet, no crossing legs, avoid stepping backwards, and keep your toes pointed forward while walking.
- Anterior approach: This involves an incision into the front of the hip and precautions typically include no crossing of the legs, no walking backwards, avoid turning the hip outwards (pointing your toe out).
- Anterolateral approach: An incision into the front-side of the hip has become a popular method and includes avoiding stepping back with the operative leg, crossing the legs, and bending past 90 degrees at the hip.
Weight-bearing and movement precautions can come across quite technical until you actually apply the information to real-life participation at home. Use the precautions as an equation and figure out how to modify your home routine accordingly.
What Not to Do After Hip Replacement Surgery: When At Home
Avoid Climbing the Stairs: Only use the stairs if you absolutely HAVE to such as small entry steps into the house, or stairways to necessary rooms (the only bathroom in the house, the bedroom).
Full flights of stairs to rarely used basements or to extra rooms in the house should be avoided. If you have to climb stairs, make sure you are using the proper techniques and tips your rehab therapists showed you at the hospital before you were discharged: use the handrail at all times, lead with the non-operative leg going up, lead with the operative leg going down, etc.
Bathroom and Shower Activities: You can use the shower and the toilet after surgery, but with the proper precautions in order to avoid infection and injury. Consider purchasing and applying the following types of equipment during your bathroom tasks: shower chair, raised toilet seat, grab bars, a long-handled sponge, and a non-skid bath mat. The
Although you can technically stand in the shower or tub, your balance is still severely compromised and it would be wiser to sit on a shower chair or bench. It’s quite common for people to slip on wet surfaces, rupture their new joint, and be re-admitted for another surgery. This you want to avoid by all means!
Household Management: When you are fresh out of the hospital, there are certain tasks that you should just let go of doing or assign to a family member for a couple of weeks. This includes house management tasks like vacuuming, lifting heavy laundry bins, mopping the floor, driving, grocery shopping, shoveling the driveway, babysitting young children, etc.
Prioritize what you think you should be doing and what you need to do. If it’s not listed under basic needs (dressing, toileting, showering, eating) then you can probably ignore it or have someone else assist you temporarily.
Dressing Tasks: You can dress in the clothes you like, with the right tools. Avoid donning any lower-body clothes in standing. Learn about and apply dressing aids, long-handled reachers, sock aids, and shoehorns which all have extensions so that you can still get dressed without bending over too far beyond your hip restrictions.
Bed Mobility: Consult with your doctor or rehab therapist about what kind of movements you need to avoid when climbing in and out of bed as well as shifting around while laying down.
For example, most doctors say to avoid lying on your stomach or lie on the operative leg when side-lying. Ask about whether or not you are allowed to prop pillows around your hips and if you can place a pillow between your legs.
Sitting Activities: Consider what kind of chairs you should and shouldn’t sit in at home. For example, sitting in plush and low-riding sofas should be avoided due to the risk of dislocating the hip.
Sit on chairs that encourage a healthy sitting posture and that are slightly elevated. Your feet should be tip-toeing the floor and your hips bent less than 90 degrees.
These types of chairs are similar to what are called hip chairs. Hip chairs encourage the proper sitting angle while sitting and do not compromise your surgical hip to become dislocated.
Remember, you do not have to do everything once you get home from a hip replacement surgery. Risking a fall or a dislocation will only further complicate the process.
Make sure to avoid placing your surgical hip at risk for dislocation by using proper techniques and following your weight bearing precautions as told to you by your surgeon. With time and proper care, your joint will heal and you can go about resuming your activities of daily living.
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