Hip Precautions

March 16, 2007 at 2:52 am 12 comments

For one of my Level II fieldworks, I did a three-month internship in an acute orthopedic unit at an area hospital. As such, I saw predominantly hip and knee replacements, as well as several limb-lengthening patients. One day, I was looking something up on Wikipedia about something hip related and noted that there was no article on hip precautions. As occupational therapists, we’re worried about patients being able to complete their ADL‘s while being safe. I figured that I would write an article about hip precautions on Wikipedia, and it hasn’t been edited since I created it, so I’m happy it was well written. Hopefully, it was well described as well.

Here is the article:

Hip precautions refer to certain things that one should not do after having a hip replacement. Since the hip joint is very weak from surgery, doing any of these three things can greatly increase the risk of hip dislocation.

The three hip precautions are:

Bend

Cross

Twist

One should not bend the hip past an angle of 90 degrees (L-shaped). This is especially difficult when sitting on toilet seats, which tend to be low. Therefore, an occupational therapist will educate patients in techniques on sitting on low toilet seats, as well as telling them to obtain raised toilet seats.

Crossing refers to any time one leg crosses the other. Since it is difficult not to cross your legs when sleeping, many doctors will recommend that a patient sleep with abductor pillows, which keep the legs separated.

Twisting refers to putting a lot of weight on one leg and twisting to retrieve an object. For example, if one is cooking a light meal, they should not twist their bodies to retrieve a pot from a high shelf, rather, they should shuffle over sideways, retrieve the pot, and then shuffle back to the starting point.

I’m thinking that I should add a bit about how because of these precautions, patients with hip replacements can’t do basic ADL’s like putting socks on. After all, that is why we give them our wonderful hip kits.

Entry filed under: fieldwork, hip replacement, occupational therapy, ortho, OT, precautions.

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12 Comments Add your own

1. Spinal Precautions « Occupational Therapy - A Blog about OT | March 7, 2008 at 8:07 am

[…] 5, 2008 I have previously blogged specifically about sternal and hip precautions but only briefly mentioned spinal precautions. Every day, I get visitors to this blog […]
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2. abigail | August 14, 2008 at 6:19 am

i ahev just failed my first year in occupational therapy and am re doing an assignment, i have been seraching the web to find a simplstic website on hip precautions and couldn’t find one, so i was very pleased when i came across this article. the article was easy to understand with no complicated diagrams ect.
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3. Smita Amin | September 1, 2008 at 10:23 am

Hi, thanks for this information, I have an interview working in orthpedics as an OT technician and this will help alot. I will look up pre care for OT to include in your article.
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4. DOMINIC | April 17, 2009 at 12:29 am

i’m a PT and with regards to THA’s, i’m not clear about ‘anterior vs. posterior approach type of surgery’ and also is there a difference towards the usual hip precautions….
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5. Laura | July 10, 2009 at 9:32 pm

there is a difference in anterior vs posterior and it sucks when Dr.’s just put “hip precautions” and then you have to look through the notes to find out which type. The posterior is the most common and apparently the easiest for the Dr.’s. With a posterior approach there is no flexion past 90 degrees at hip, no internal rotation of hip and no adduction (no bending, crossing of legs, or squeezing legs together). With anterior there are less precautions: no extension of hip (pt cannot bring that leg backward) (pt can bend forward), no external rotation of hip and no abduction – usually much easier for pt’s to perform ADL’s with.
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6. galen | May 17, 2010 at 9:21 pm

which hip surgeries don’t require hip precautions?
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- 7. Amanda | November 15, 2010 at 10:24 am
  
  All hip surgeries require hip precautions. If a patient doesn’t follow the precautions related to from surgery, the fixation in the joint can be undone, and thus, more surgery needed to fix it. The purpose of the precautions is to keep the joint still so it is immobilized and will not ‘pop back out’.
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- 8. Shaani | May 3, 2011 at 9:56 pm
  
  If the surgeon takes an anterior approach, there are less precautions. Like Laura stated, no extension or external rotation at the hip which is easier for patients to adhere to when they’re in the hospital. Also, with ORIF (open reduction internal fixation) there are generally no hip precautions, but there are usually weight bearing restrictions.
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9. Smartkathy | March 8, 2011 at 7:33 am

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10. New Grad | June 28, 2011 at 6:50 pm

I agree with most of you. Posterior approach has hip precautions however, anterior approach has less precaustions such as no active abduction. There is something called direct ant. aproach, which has NO precautions at all.

If i get a hip pt with ant. approach, i explain to them that they cannot do active abd. however, at any point if they feel pain, i tell them not to push it too much esp. bending to put the socks on.

Also one more thing to keep in mind… if a pt post surgery is sweating profusely, i would talk to the doc or nurse immediately.
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11. Hip Replacement | January 20, 2012 at 6:12 pm

Excellent article. There are so many patients going through hip surgery and the information about precautions are scarce. I know from experience how hard it was dealing with daily activities after my surgery. Rearranging things in our home, to be much more easily accessible (without bending) helped me a lot.
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12. Melissa Spurling-Purkis | April 22, 2015 at 6:33 am

Thanks for this article it reminded me of my first placement in trauma orthopaedics. I did some research on hip precautions and actually found there is not that much evidence base for observing hip precautions (obviously this depends on the patient. In the UK there are a few hospitals that don’t observe hip precautions- I seem to remember it being down to the surgeons recommendations. Physiologically it makes sense as the less muscle use around the hip area, means a decrease in muscle mass which could result in dislocation. I wonder if anyone else has experience of this?
Melissa OT Student
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