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Total Hip Replacement Precautions
By Maureen Bracken
Every year, nearly 200,000 Americans undergo
hip replacement surgery, mostly due to arthritis. The vast
majority of those surgeries are done with the
traditional method, using a posterior or lateral (side) approach
to gain access to the hip joint. With the traditional lateral
method, the chance of dislocating your new hip is
greater than with the minimally invasive anterior approach.
Hip dislocation after hip replacement surgery rarely
occurs, but to reduce the risk even further it's essential to
strictly follow your hip precautions (restrictions of certain hip
positions/movements) taught to you by your physical therapist.
Your new hip needs time to heal in place, particularly
during the first 6 weeks following surgery. During this
period, your hip muscles and bones are healing up around your
new hip joint to keep it securely in place.
There are usually three main total hip precautions.
1) Don't turn your toes inward, 2) don't cross your legs, 3) and
don't bend your new hip more than 60-90 degrees. Your surgeon
will also instruct you on how much weight he wants you to
place on your surgery leg while walking.
1) Don't turn your toes inward. Where your toes go, your hip
follows. If you turn your toes in on your surgery leg (pigeon-toed),
your hip will internally rotate. This motion can pop your
hip out of its new joint. Internal rotation can also occur while
standing in place and twisting toward the direction of your new hip.
Let's say your right hip was just replaced. If you reach across your
body with your left arm, maybe to answer the telephone or lay
an object down on the table, you're at risk of dislocating your
new hip due to internal rotation.
2) Don't cross your legs. Moving your surgery leg across your
body's midline can cause your new hip to dislocate. This includes
sitting in a chair with your ankles crossed or reclining in bed
with your legs crossed.
3) Don't bend your hip beyond a 60-90 degree angle. The best way
to know if you're complying with this precaution is to take a look
at your surgery leg when you're sitting down. Your knee should be
lower than your hip. If your knee and hip are level with each other,
your hip is at a 90 degree angle. The closer you move
your knee to your chest, the greater your risk of dislocating
your new hip. And reaching down toward your shoes or the floor
also creates this same risk of dislocation. One way to reduce
the chance of hip dislocation is to straighten your leg out in
front of you when you're sitting. This reduces the bend of your hip.
While you're in a standing position, don't bend down to retrieve
something from the floor or a low cupboard. There are devices,
called "reachers", that aid you in picking things up from the floor
or getting objects from high cupboard shelves. Your occupational
therapist will train you in the proper use of this equipment along
with equipment to aid you in putting on your socks, shoes, and pants.
If you have low chairs at home, use pillows to add height. Chairs
with arm rests make it easier to sit down and stand up. Don't sit
on a low couch. The top of your bed mattress should be 27" from the
floor. Getting on and off your toilet seat can be difficult and
hazardous if it's too low. While in the hospital, you'll be using
a raised toilet seat. You'll need one at home as well until your
hip has healed. Your physical therapist will order one for home
use before you get discharged from the hospital.
If you dislocate your hip, call 911. You want to get to the hospital
as quickly as possible so your surgeon can pop your hip back into place.
This will require another surgery and rehab. If your surgeon is
concerned about another dislocation, he can fit you with a hip brace.
Once the hip completely heals, the brace will no longer be needed.
After your hip replacement, your doctor will let you know how
much weight you can safely place on your leg while walking. This
is known as your "weight bearing status". It should be strictly
followed, as putting too much weight on the leg can damage your
new hip. Your doctor will allow you to increase your weight
bearing as the hip heals. The following are some common
"Weight bearing" terms:
-
non-weight bearing- no weight at all on the leg
-
toe touch or toe down weight bearing- only your toes
touch the floor, usually about 10% of your weight through your
surgery leg
-
partial weight bearing- toes and front part of your
foot down, about 25-50% of your weight through your surgery leg
-
weight bearing as tolerated- you're allowed to put as
much weight on your surgery leg as your pain level allows,
heel down when walking/standing (heel/toe gait pattern)
-
full weight bearing- no weight bearing restrictions,
heel down when walking/standing (heel/toe gait pattern)
Your surgeon will discuss your hip precautions with you before
and after your surgery. Your physical therapist will teach you
how to safely get in/out of bed, transfer, walk, sit, climb stairs,
and get in/out of your car while maintaining your hip precautions.
Following your hip precautions in the hospital and at home is an
important part of your rehab and will greatly reduce your risk of
hip dislocation.
Some of the above information may vary from patient to patient.
Your doctor and physical therapist will instruct you in all total
hip replacement precautions.
Maureen Bracken
http://www.relieve-arthritis-joint-pain.com/totalhipreplacementprecautions.html
View illustrations of
total hip replacement precautions.
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