Hip replacement precautions — what you can and can't do

Many patients have heard about the “hip precautions” that follow hip replacement — the rules about not bending too far or crossing the legs. What is less widely known is that these restrictions depend heavily on the surgical approach used, and that the direct anterior approach often allows far fewer of them.

Why precautions exist

The traditional precautions are designed to reduce the risk of dislocation in the early weeks, before the soft tissues around the new joint have healed and tightened. A dislocation is when the ball comes out of the socket, and it is more likely in certain extreme positions while healing is still underway.

The approach makes the difference

In a posterior approach, the surgeon works through the muscles at the back of the hip, and these patients are typically advised to avoid bending the hip beyond 90 degrees, crossing the legs, and turning the foot inwards for several weeks.

In the direct anterior approach (DAA), which Dr Mooney uses, the hip is reached from the front between muscle planes rather than cutting through them. Because the major stabilising muscles at the back are left intact, the risk of dislocation is lower and many anterior patients have few or no movement restrictions. This is one of the reasons the approach is associated with a quick, confident early recovery.

The direct anterior approach preserves the muscles that stabilise the hip, which is why many of these patients need few or no movement precautions.

General early advice

Whatever the approach, some sensible early guidance applies. Use the walking aid you are given until your balance and strength return. Take care on stairs and uneven ground. Avoid low, soft chairs that you sink into in the very early period, as getting up can be awkward. Keep the wound clean and dry, and watch for signs of infection.

Sleeping, sitting and daily tasks

Most patients are able to manage daily tasks early, using simple aids if needed. A raised toilet seat and a long-handled shoehorn can help in the first weeks. Sleeping is usually comfortable on the back early on; sleeping on the side becomes comfortable as healing progresses.

The key message

Your surgeon and physiotherapist will give you advice specific to your operation — follow that above any general rule you read online, because the right precautions depend on your approach and your individual hip. For anterior approach patients in particular, recovery is often less restricted than people expect.