Hip Precautions

Before you leave hospital you should be given a list of hip precautions. It is essential that you follow these for the first few months after your operation.

Depending on how your surgeon accessed your hip i.e. from the front, back or side and how much muscle and other soft tissue was cut during the procedure will affect your recovery time and the length of time you need to follow these precautions.

Only your surgeon or physiotherapist can tell you how long that is.

Although the duration might differ from patient to patient the basic total hip replacement precautions are pretty much the same for everyone.

Why Do I Need Hip Precautions?

In a nutshell; hip precautions are there to stop you dislocating your hip following surgery.

If you're very squeamish jump to the next section

In a standard operation your surgeon will cut through the muscle on the side of your hip to gain access to the joint. He will then twist your leg inwards and your hip will pop out of its socket. Great for the operation but please don't try this at home!

Sadly it is all to easy to do so inadvertently.

Whilst you are in the recovery phase post-op the muscles holding your joint in place will be weaker. If you then put any extra strain on them or move the leg in the same way the surgeon does to dislocate it - it will dislocate.

Following these hip precaution rules should keep you safe.

Pointing Your Toes Inwards

This mimics the process of surgical dislocation and is risky on its own but when combined with any of the other hip precautions it becomes dangerous. For instance breaking the rule of 90 degrees with your toes pointing outwards is relatively less dangerous than breaking it with your operated toes pointing inwards. (By inwards I mean pointing towards the mid-line of your body.)

The 90 Degree Rule

Imagine sitting bolt up right on a dining chair. The angle your hip is at should be 90 degrees and that is the narrowest the angle should ever be.

Breaking the 90 degree rule is very easy and you must constantly monitor your actions to ensure you keep safe. Examples

• Bending down to pick something off the floor
• Lifting your foot up onto a stool - for instance to tie your shoe laces
• Getting into a black cab
• Getting in and out of a chair
• Sitting in a low chair - usual suspects here are a sofa or car seat
• Getting into the bath
• Reaching for something across your desk or dining table
• Getting food out of your freezer or something out of a low cupboard

There are ways to get round some of these things but they involve balancing carefully - you have been warned.

In order to get something from a low shelf instead of bending from the hip with both feet planted firmly on the ground let your operated leg come off the ground behind you as you bend forward. That keeps the angle more than 90 degrees. operated leg

To reach your foot bend your knee and lift your foot up behind you - reach backwards to it. Do NOT twist your upper body to see what's going on you must do this my feel alone.

Remember medication may well affect your balance - please stay safe.

Crossing The Mid-Line

Crossing your leg over the mid-line - particularly if you twist your foot in at the same time must be avoided. Think about how you'd go about deliberately dislocating your hip and you'll realise why.

Watch out for

• How you sleep - I found this really difficult so have written a whole page on it called problems sleeping!
• Crossing your legs when sitting down even at the ankles. Some say its less risky to cross the non-operated leg over the operated but crossing your legs isn't great for your circulation so this is a good time to get out of the habit.
• Turning and changing direction - watch how you do this.

Weight-Bearing Turns

This is when you put all or most of your weight onto your operated leg and turn to face a different direction. This is particularly risky if you turn towards the mid-line (so if you're operated leg is your right one then turning anti-clockwise and vice-versa).

I didn't have much problem avoiding this during the first phase of my recovery. It was only as I started getting stronger and moving faster that it became and issue. Mostly it is obvious. The one warning I will give is when you walk past something that you meant to pick up and spin round to reach it. I definitely felt my hip straining when I did that as much as 12 weeks post-op.

Do Your Exercises

I've never seen this added to the list of hip precautions but to me it's the best bit of advice of all. If you do your exercises and strengthen your muscles you are far less likely to dislocate your hip and you'll be able to dispense with the hip precautions sooner.

Related Links: 

Preparing for Surgery 
Anesthetics 

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