Hip replacement surgery

Hip replacement surgery

Following a total hip replacement surgery (THR), there are often precautions that patients must follow to prevent dislocation of the hip. With the most commonly used approach, the posterior approach, patients are required to avoid flexion > 90 degrees, adduction, and internal rotation (Saskatchewan Health Authority, 2018; Twogood, 2021). While these terms are familiar to those within the medical community, these instructions are difficult for patients to comprehend. As such, layman’s terms must be used. 

For example, to explain the precaution of avoiding hip flexion > 90 degrees, patients can be told to avoid low bending activities such sitting/squatting on low chairs or beds, sitting on soft furniture, bringing their knees to their chest, reaching forward towards their toes while sitting, and bending to put on socks or shoes (Saskatchewan Health Authority, 2018). 

For explaining the precaution of avoiding adduction, patients can be told to avoid crossing their legs at the knees or ankles (Saskatchewan Health Authority, 2018). They can also be told to use a pillow between the legs when lying on their side and avoid having the operated leg fall over the unaffected leg. 

Lastly, to explain the precaution of avoiding internal rotation, patients can be told to avoid twisting on the operated leg (Twogood, 2021). Patients can be told to avoid turning, pivoting, and twisting in both sitting and standing, and to keep their nose and toes facing the same direction (Saskatchewan Health Authority, 2018).

How long is a hip surgery and Hip replacement recovery time?

The average short-term recovery time for a total hip replacement is 10 to 12 weeks. Long-term hip replacement recovery involves the complete healing of surgical wounds and internal soft tissues. When a patient can return to work and the activities of daily living, they are on the way to achieving the full term of recovery. Here are some hip replacement surgery pictures:

What the Research Says

Routine hip precautions are being questioned. A 2023 review pooled 4 randomized trials and 5 other studies with 8,835 people who had a posterior-approach hip replacement for osteoarthritis. Dislocation in the first 3 months was not clearly different with or without precautions (low to very low certainty evidence), and pain, quality of life, self-reported function and return to work were similar. The authors concluded that the evidence does not support routinely prescribing hip precautions after surgery. Practice still varies between surgeons, so follow the instructions your own surgical team gives you (Korfitsen et al., 2023).

Most people get back to activity. A 2018 review of 37 studies found that people returned to sport at, on average, 82% of the level they had before their hip symptoms began, and that return to sport took about 16 to 28 weeks across studies. On average, 69% of people returned to work, after about 1 to 17 weeks across studies (Hoorntje et al., 2018).

Key Takeaways

• After a posterior-approach hip replacement, precautions usually mean avoiding deep bending, crossing the legs and twisting on the operated leg.
• Recent research suggests routine precautions may not lower the risk of early dislocation, but always follow your surgeon's advice.
• Most people return to sport and work, often within a few months.
• A guided rehab program helps you rebuild strength and confidence step by step.

For more on recovery, see our pages on post-surgical total hip rehabilitation and hip osteoarthritis.

References 

Saskatchewan Health Authority (2018). Patient and Coach Information Total Hip Replacement 

Twogood, T. (2021, October). The Hip: Clinical Skills Lab [Lab notes, PowerPoint slides]. Quercus. 

Hoorntje, A., Janssen, K.Y., Bolder, S.B.T., Koenraadt, K.L.M., Daams, J.G., Blankevoort, L., Kerkhoffs, G.M.M.J., & Kuijer, P.P.F.M. (2018). The effect of total hip arthroplasty on sports and work participation: A systematic review and meta-analysis. Sports Medicine, 48(7), 1695-1726. https://doi.org/10.1007/s40279-018-0924-2

Korfitsen, C.B., Mikkelsen, L.R., Mikkelsen, M.L., Rohde, J.F., Holm, P.M., Tarp, S., Carlsen, H.H.F., Birkefoss, K., Jakobsen, T., Poulsen, E., Leonhardt, J.S., Overgaard, S., & Mechlenburg, I. (2023). Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: A systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthopaedica, 94. https://doi.org/10.2340/17453674.2023.11958

Image 1- https://www.saintlukeskc.org/condition/total-hip-replacement

Image 2- https://hughston.com/wellness/surgical-approaches-to-knee-and-hip-replacement/