Serious Inactivity Follows Hip Surgery

I had planned to wait a few months before I revisited the topic of hip surgery recuperation. However, so many of you e-mailed and phoned me with questions that another column is in order.

Many were perplexed by the “activity restrictions” that immediately follow a posterior surgical, primary total hip replacement. I couldn’t imagine them either until I awoke on my back after surgery, with a huge blue foam wedge strapped between my legs.

Why a wedge? It prevents dislocation of the new hip by keeping the legs wide apart.

Why all this concern over dislocation? There are two important reasons. First, during this surgery the orthopedic surgeon actually dislocates the surgical leg in order to work on the pelvic cavity and femur. The doctor does this by bending, say, the right surgical leg at the knee and then forcing the flexed leg all the way up to the right shoulder. Next, the surgeon gives it a good muscular push toward the left shoulder. These movements force the right femur out of the right socket. As my physical therapist quipped, “You’re lucky you didn’t see all that!”

After the orthopedic surgeon has finished and closes the leg up, the surrounding tissues must heal. Most important is the joint capsule ligament, because it holds the hip joint in place. Until this ligament heals, at approximately six to eight weeks, there is a considerable risk for dislocation, which means a 911 call and ambulance trip to the hospital emergency room.

How do you prevent dislocation? For six to 12 weeks after surgery, you can’t perform any movements that would force the hip out of the socket. You must maintain a 90 degree angle—or more—between your surgical thigh and shoulder. When bending over, reaching, or sitting down, you don’t want your shoulders anywhere near your knees. You can’t reach down to the floor to pick up your shoes. You can’t sit on low couches, or sit on standard toilets. In bed, you can’t reach toward your feet to pull up the covers. You can’t turn your surgical leg or foot inward, twist your body, or cross your legs.

You will sleep on your back during the first few weeks, with the wedge or pillow between your legs. When you are permitted to sleep on your nonsurgical side, you will still sleep with a pillow between your legs. Your doctor should request that a physical therapist visit you at home right after being discharged. Ask both professionals to further explain these rules.

The home equipment you will need includes a walker, crutches, foam wedges to boost up your favorite chairs, a long-handled shoe horn, a long-handled grabber to retrieve fallen objects from the floor and to help you dress, elastic shoelaces, a sock donner, a portable commode with arm rests, grab bars and a shower chair. Many readers also recommend a hospital bed.

Your hospital discharge planner should order this equipment. If not, use these resources: