On the Mend
After months of pain, you have come to the decision to have your hip replaced. You have chosen a reputable physician and facility, and have also arranged to lay low for a few weeks following the surgery. These decisions, however, represent only a small portion of what having a hip replacement entails.
As a physical therapist, I find that all too often patients are unprepared for the weeks and months following surgery. A hip replacement is a major procedure with many life-changing side effects, so it's important to know ahead of time what you're getting into so you can plan and arrange your life accordingly.
Invariably, the biggest change following surgery is adjusting to your new "hip precautions." Hip precautions are a series of movements and activities you cannot perform because of the high probability of hip dislocation. While there are many different approaches to hip replacement, all warrant "precautions" to prevent additional surgeries and bracing if the hip dislocates.
There are three main precautions that need to be observed following replacement. The first is no bending at the hip and waist beyond 90 degrees. This means that your hip and waistline can never pass a right angle. It means not bending forward to tie your shoes, not picking things up from the floor and being selective about the furniture on which you sit.
The second precaution is not crossing your legs. While this seems comparatively easy to not bending forward, there are many activities that will require caution and forethought to prevent dislocation. For example, when sleeping at night many people lie on their side and let their leg fall over onto the bed. This will press the ball of the hip against the muscles that were cut and increases the risk of dislocation.
The third precaution is turning your toes inwards. Again, while this may seem simple, patients that have a significant lack of strength often walk and climb stairs with their toes turned inwards. It will take weeks of gait training to walk without having to make a conscious effort to keep your feet straight.
Here are some of the most commonly asked questions and answers about hip precautions following a hip replacement.
How long will my hip precautions last? Hip precautions last at least 12 months and many surgeons require you observe them for life. While this is not the answer many patients want to hear, when faced with the alternative of the permanent, grueling pain of hip arthritis, most consider it to be a fair trade.
What happens if I accidentally break my precautions? It depends on how badly they are broken. Small infractions into the motions you are supposed to avoid will probably be insignificant, amounting to no permanent damage. Combining motions, however, can cause serious complications. For example, bending fully at the waist while your leg is turned inwards is an easy way to dislocate your new hip.
What can outpatient therapy do regarding my precautions? Physical therapy can provide you with a list of safe and effective exercises to increase mobility of your hip while maintaining strict precautions.
I'm fairly young and was active before my surgery. Will my precautions prevent me from returning to the activities I like? If you rehab appropriately, there is no reason you shouldn't return to the things you love to do. Activities like golfing, jogging and going to the gym can usually be resumed well inside of six months. Activities that jeopardize hip precautions such as yoga may need to be postponed for several months.
Will my precautions prevent me from walking normally? Given the proper gait training, nearly all patients walk normally by the four-month mark.
Anything is possible with the right rehab following surgery. Just be sure to ask your surgeon or therapist about the months following replacement surgery so you know what's expected of you.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly. Questions may be submitted to Joe by e-mail: joedivincenzo@comcast.net.
