what are the hip precautions for posterior approach

Posterior Hip Precautions

• Do not flex or bend your hip beyond 90*
• Do not cross your legs
• Do not internally rotate (pigeon toe) your foot
• Sleep with a pillow between your legs for at least 3 months after surgery.
• When sitting down or arising from a seat, always use a chair with armrests:

Full Answer

What are anterior hip precautions?

Anterior precautions (Dr. Attarian) Do not extend leg behind you. If backing up, lead with non-surgical leg. Do not lie on stomach. Do not rotate leg outward (no external rotation of operated hip). If this is a revision, patient cannot slide leg out to side without assistance (abduct with assistance only)

What are the precautions for total hip replacement?

What are the non-range-of-motion precautions for ALL total hip replacement procedures?

• No driving for 2 weeks after a left total hip replacement.
• No driving for 3 weeks after a right total hip replacement.
• No driving until the patient is off all opioids.
• No dental work for 3 months.
• Antibiotic before any dental work for life.

When you can bend over 90 degrees after hip replacement?

They must, therefore, ensure not to even try conducting these activities as it can hamper their recovery or damage/dislocate the hip implant. Bend beyond 90 degrees: It may sound painful as is, but bending at the waist beyond 90 degrees is completely a no-no for hip replacement patients.

What precautions should I take after hip replacement surgery?

avoid low chairs and toilet seats (raised toilet seats are available) You'll need to be extra careful to avoid falls in the first few weeks after surgery as this could damage your hip, which may mean you need more surgery. Use any walking aid, such as crutches, a cane or a walker as directed.

What is the difference between anterior and posterior hip precautions?

With an anterior approach, you are pushing the muscles to the side and not really cutting through any tendons or any muscles in order to access the hip. For the posterior approach, there are some muscles that you do need to detach in order to get down to the hip joint itself.

Do hip precautions after posterior approach total hip arthroplasty?

Interpretation — The review found no impact on dislocation rates following total hip arthroplasty performed through a posterior approach, regardless of the use of hip precautions. We also found no impact of the prescription of hip precautions on patient-reported outcome scores.

How long are posterior hip precautions in place?

The main downside of the posterior approach is the need to observe hip precautions in the first 4 weeks and the risk of dislocation down the road.

What are the 3 anterior hip precautions?

Hip precautions are very restrictive and usually include the following:Avoid the combined movement of bending your hip and turning in your foot.You should sleep with a pillow between your legs for 6 weeks.Avoid crossing your legs and bending your hip past a right angle.Avoid low chairs.More items...

What can you not do after posterior hip replacement?

The Don'tsDon't cross your legs at the knees for at least 6 to 8 weeks.Don't bring your knee up higher than your hip.Don't lean forward while sitting or as you sit down.Don't try to pick up something on the floor while you are sitting.Don't turn your feet excessively inward or outward when you bend down.More items...

Are posterior hip precautions necessary?

Conclusion: Preliminary analysis suggests that removal of hip precautions after primary THA using a posterior approach was not associated with early dislocation and facilitated return to daily functions. Investigation to appropriate power is warranted.

How long do I have to sleep on my back after hip replacement?

It's important to follow these sleeping precautions for 6 to 12 weeks after surgery, depending on your health and personal recovery. The best sleeping position for your hip is to lie on your back with a pillow between your legs.

Do I need a raised toilet seat after hip replacement?

After hip replacement surgery, you will need a raised toilet seat on your toilet at home. This is to make sure that your knees are not higher than your hips when sitting.

When can you bend over after posterior hip replacement?

When Can You Bend Past 90 Degrees After Hip Replacement? You should not bend your hip beyond 60 to 90 degrees for the first six to 12 weeks after surgery. Do not cross your legs or ankles, either. It's best to avoid bending to pick things up during this period.

What are hip precautions for anterolateral approach?

Anterior Lateral Hip Precautions.Do not move surgical leg out to the side. Do not move surgical leg backward.Use leg lifter or helper to bring leg out to the side.Do not cross or turn surgical leg/ toes outward.

How should I sleep after posterior hip replacement?

Sleeping Position Tips After Total Hip Replacement SurgerySleep on a firm bed or mattress.Use a pillow(s) between your knees to avoid crossing your surgical leg across the middle of your body.Change positions as you become uncomfortable.

What is the 90 degree rule in hip replacement?

To minimize the risk of dislocating your hip replacement, keep in mind the 90-Degree Rule: Do not bend your leg at the hip past 90 degrees (a “right angle”). Also avoid crossing your legs and squatting.

When are hip precautions indicated?

Hip precautions are a common component of standard postoperative care following THA. The precautions are prescribed for 6 weeks postoperatively to foster proper healing and prevent hip dislocation.

Are there permanent restrictions after hip replacement?

That's right, no restrictions. After an anterior hip replacement you can do anything you want to.

What are the precautions to remember for a patient recovering from hip surgery that you want to employ before assisting him?

Hip Precautions While Standing or WalkingDon't cross your legs or ankles at any time!Keep your toes forward. ... Don't stoop or squat.Don't twist your shoulders or turn at the waist toward your affected leg while keeping that foot still. ... Don't step up onto surfaces where your knee will be higher than your hips.

What are hip precautions for anterolateral approach?

Anterior Lateral Hip Precautions.Do not move surgical leg out to the side. Do not move surgical leg backward.Use leg lifter or helper to bring leg out to the side.Do not cross or turn surgical leg/ toes outward.

New posterior hip protocol for PT and OT

In this new study, Dr Sulco explains “Minimizing precautions and simplifying the postoperative recovery is part of the larger simplification of surgery where we are using more selected resources and interventions for people, instead of blanketing everyone with the same kind of protocols.”

Standard Hip Precautions vs Minimal Hip Precautions

As per evidence based practice, the reasons why minimal posterior hip precautions can be used are:

Surgeon Factors

As you can see, these new hip precautions are not for everyone. It’s best to have a conversation with your surgeon to see what he or she thinks about implementing this program.

How long do you have to take precautions after hip replacement?

Hip precautions are a common component of standard postoperative care following total hip replacement surgery Depending on individual health and mobility a prior surgery, one may need to maintain these precautions for 60-90 days and some as far as 6 months. The hip precautions below mainly apply to the posterior or posterior lateral hip replacement ...

When sitting or standing from a chair, bed or toilet, must you extend your operated leg in front of you?

When sitting or standing from a chair, bed or toilet you must extend your operated leg in front of you.

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How to avoid rocking chairs?

Avoid rocking chairs, cushion chairs, stools or sofas. Sit in a firm chair with straight back and armrests

Can you bear weight on an operated hip?

Do not bear over the amount of weight your doctor or physical therapist tells you to bear on the operated hip

Can you step backwards with a surgical leg?

Do not step backwards with surgical leg. No hip extension.

Can you bend while showering?

Never bend, squat or reach for anything while showering. Use a shower sponge with long handle and have someone wash the part of your body that are hard for you to reach.

What are the range-of-motion precautions for Anterior total hip surgical approach?

No extreme hip extension combined with external rotation such as kneeling on the operated leg with foot turned in, then moving body weight forward onto the opposite foot.

Why is the posterior approach restriction in addition to the posterior approach restrictions?

This restriction is in addition to the posterior approach restrictions because of the cutting or splitting of the hip abductors during surgery.

How does a comfort height commode help?

Comfort height commodes greatly decrease the patient’s tendency to lean more forward than allowed and makes it easier to come to standing without bending the hip more than 90 degrees. Raised toilet seats or a 3-in-1 commode chair may be required for the patient to be compliant with flexion restrictions.

What is the lateral approach to hip replacement?

The lateral approach to hip replacement, like the posterior approach, cuts the joint capsule in the posterior of the hip and the surgeon dislocates the femoral head through that incision to expose the femoral head and acetabular socket for preparation to receive the replacement components .

How is the hip dislocated?

The hip is dislocated through this posterior incision in the joint capsule by the surgeon taking the patient’s leg into flexion, internal rotation (pigeon-toe), and adduction (across mid-line of the body) to expose the femoral head and acetabular (hip) socket for preparation to receive the replacement components.

What is the position of the leg when the surgeon dislocates the femoral head?

This is the position the surgeon places the leg in when they are dislocating the femoral head from the acetabular socket (hip socket), which they do to be able to remove the femoral head and prepare the acetabulum to receive the socket component of the total hip replacement surgery.

How long does it take for a hip capsule to heal?

The first 6 weeks are critical to maintaining these range of motion restrictions and these restrictions will remain precautionary for the rest of life. After 6 weeks the capsule is usually well-healed but 12 weeks is usually considered the time frame for the hip capsule to fully heal.

What are some precautions for self-care after hip replacement surgery (posterior)?

Keep your toes pointing forward or slightly out. Don't rotate your leg too far to the inside.

How to keep hips from dislocating?

Try to keep your hip within the safe positions while it heals. Some leg and foot movements may increase the risk of dislocating your hip. Try to avoid those positions.

How to get a swollen leg to go down stairs?

Then bring the affected leg up to the same step. Bring your crutches or cane up. To go down stairs, reverse the order. First, put your crutches or cane on the lower step. Then bring the affected leg down to that step. Finally, step down with the unaffected leg.

How to get into a car with your legs?

When you get into a car, back up to the seat of the car, and then sit and slide across the seat toward the middle of the car with your knees about 12 inches apart.

What is hip replacement surgery?

Hip replacement surgery replaces the worn parts of your hip joint. You will need to be careful to protect your new joint after hip replacement surgery. Along with doing your physiotherapy exercises, there are many things you can do to help your hip heal. Your recovery may be faster if you follow these precautions.

How far should you bend your hip?

Do not bend your hip more than 90 degrees.

What is follow up care?

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How to expose hip joint?

Expose the hip joint by creating and reflecting a full thickness, broad-based flap of the posterior hip capsule. Heavy (eg #2) non-absorbable sutures in its free corners aid retraction and subsequent repair.

What muscles are exposed during hip arthroplasty?

Reflection of the short rotator muscles exposes the hip capsule. Next, enter the joint with a broad-based, 3-sided capsulotomy as shown. Preserve the acetabular labrum, unless total hip arthroplasty is intended.

What is posterolateral approach?

The posterolateral approach to the hip may be done with the patient in lateral decubitus or prone positions. For arthroplasty, a lateral decubitus position is usually chosen. The approach is essentially the same as the Kocher-Langenbeck, but exposure is limited to the hip joint, respecting but not displaying the sciatic nerve.

Where is the PSIS incision?

Posterior superior iliac spine (PSIS) Greater trochanter. Shaft of femur. Start the skin incision posterior to the lateral side of the greater trochanter and carry it distally about 6 cm along the femoral axis.

What happens after posterior capsulotomy?

After posterior capsulotomy, the hip is dislocated with internal rotation.

What is the risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip?

Low risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip replacement.

Which incision is used to rotate the hip?

Posterior. The main incision goes through the gluteus maximus and will heal without repair. Muscles that are used to externally rotate the hip are detached during the procedure and later reattached to bone and will heal without complication. Anterior. This procedure is not entirely muscle sparing.

What is low risk of dislocation?

Low risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip replacement. Dislocations are usually anterior and can occur with external rotation of the leg during any activity.

How long does it take to get hip surgery?

The surgeon makes a 4-6 inch incision just behind the hip, along the buttock area. The surgery takes 60-70 minutes. It is the most common approach and provides the greatest patient safety.

What is total hip replacement?

For patients with osteoarthritis or that have experienced trauma to their hip, a total hip replacement can restore function and decrease pain. This is done by replacing the damaged or diseased bone with a metal or plastic implant, which is designed to replicate a healthy hip joint. The most commonly utilized total hip replacement is ...

Why is the patient positioned on his or her back on a special surgical table?

The patient is positioned on his or her back on a special surgical table so the surgeon can manipulate the leg during surgery.

What is the risk of sciatic nerve damage from excessive retraction during surgery?

Very small (less than 1%) risk of sciatic nerve damage from excessive retraction during surgery.