Do you have an anterior or posterior hip replacement and are afraid of restricted movements? Don’t worry, it’s one of the most common fears of people who have undergone hip surgery!
Usually, a physiotherapist visits you the day after your operation and informs you of the movements to avoid to prevent the risk of hip dislocation. However, rest assured that dislocations are becoming increasingly rare, and there is no need to take extreme precautions.
In this article, I provide an overview of the movements that are prohibited, restricted, discouraged, or deemed dangerous after a hip arthroplasty, whether it was implanted due to coxarthrosis (hip osteoarthritis) or a hip fracture.
Based on my experience as a physiotherapist, I answer all the most frequently asked questions of people before or after the surgery. This article also relies on the most recent international scientific knowledge and publications (all references are at the end of the article).
Last update: May 2023
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- Why there are restrictions after a hip replacement?
- Movement restrictions after a hip replacement
- Restrictions after anterior hip replacement (less common)
- Restrictions after posterior hip replacement (more common)
- How do I know if I have dislocated my hip?
- How long do restrictions last after hip replacement? Permanent restrictions?
- Do I have to avoid sports or activities for the rest of my life to prevent dislocation? Lifelong restrictions?
- What is the treatment for a dislocation on a hip replacement?
Why there are restrictions after a hip replacement?
The hip joint is a very mobile joint. It moves in three planes:
- flexion and extension,
- abduction and adduction,
- and internal and external rotation.
Therefore, it is more at risk of dislocation. However, be reassured that dislocation is very rare, and becoming even rarer.
Dislocation occurs in only 1% of cases, or even less according to studies (Weegen, 2016). In 24% of cases, it occurs as a result of a fall, and not due to a “bad” or restricted movement (Reimert, 2020).
Dislocation should be distinguished from hip replacement loosening.
Movement restrictions after a hip replacement
The “restricted” (or rather, advised against) movements are not the same depending on how your hip replacement was done by your surgeon.
In the vast majority of cases, your hip replacement was done through a posterior approach. If nothing has been said to you about this, you can assume that it is a posterior approach.
To verify this, check your operative report. It indicates the approach used : anterior or posterior. The report is often sent to your general practitioner and physiotherapist. You may also have a copy in your discharge file.
Another way to know is to look at where your scar is located:
- if it is on the side of your thigh and goes from top to bottom, it is a posterior approach;
- if it is on the front of your thigh and goes from left to right, it is an anterior approach.
The pictures below may help you understand better!
The type of restricted movements depends on how your hip replacement was done: through the posterior approach (most common) or the anterior approach.
Restrictions after anterior hip replacement (less common)
Dislocation is actually very rare, occurring in less than 1% of cases! If it does happen, it usually occurs within the first three weeks after the surgery. These movements, called “dislocating,” should theoretically be restricted:
- bending the operated hip more than 90 degrees (for example, leaning forward while sitting);
- taking the leg into extension (backwards), external rotation (foot outwards), and abduction (leg spread apart from the other leg). These movements are rarely adopted, especially in the few weeks following surgery.
Restrictions after posterior hip replacement (more common)
For a hip replacement through the posterior approach (the most common), it is reasonable to avoid:
- flexing the operated hip more than 90 degrees, at least in the first few weeks after surgery;
- combining hip flexion with adduction (bringing the thigh inward) and internal rotation of the hip (turning the knee and thigh inward).
These movements often occur when trying to put on shoes while sitting on a chair and placing the foot on the side rather than inward, bending down to pick up something, or getting in or out of a bathtub.
However, there is no need to worry before performing each of these movements! If you take the time to do things slowly, without rushing, everything should be fine.
Moreover, the risk of dislocation is very low, no matter what you do.
In fact, studies have shown that there are no more complications and dislocations in groups of people trained in preventing risky movements than in those who are not aware of it! So, there’s no need to stress too much about all the specific advice you might receive about good postures to take.
It is even noticed that people who are not aware of this risk of dislocation:
- do not experience dislocations more frequently;
- resume their usual activities more quickly;
- are more satisfied with their care.
The Cochrane (an international organization of health research teams) says :
We do not know whether offering safety advice with or without additional equipment and functional restrictions is effective in preventing dislocations and improving outcomes after THA.Cochrane 2016
Dislocations are very rare, so just gradually resume your daily activities. You don’t need to pay particular attention to certain movements; just respect your pain.
How do I know if I have dislocated my hip?
You are at a greater risk of dislocating your hip prosthesis if (Guo 2017; Faldini 2018):
- Your hip prosthesis has been revised or replaced several times (at least twice).
- You have had a hip dislocation before receiving a prosthesis.
- You have a history of femoral head osteonecrosis.
- You have bone loss in the head of the femur.
- You are older.
However, dislocation is still very rare, even if you have several of these risk factors. Studies show that dislocation occurs in 0 to 2% of patients (Weegen 2016), and probably even less often with current procedures and materials.
A dislocated hip is hard to miss. You will experience:
- severe pain (even if you had some pain before the hip replacement surgery, it will be much more intense),
- your operated leg will be stuck in an unusual position with your foot turned completely inward,
- and your leg will seem shorter.
- You won’t be able to put weight on your foot,
- and you will barely be able to move your leg.
A doctor can confirm the diagnosis with an X-ray.
You can’t miss a dislocated hip. It’s very painful, you can’t put weight on the foot, and the leg is stuck in an unusual position.
How long do restrictions last after hip replacement? Permanent restrictions?
You may be wondering if you need to avoid certain sports or activities for the rest of your life with a hip prosthesis.
While your lower limb movements will be slightly more limited than before, this won’t interfere with your daily life or many physical activities and sports such as brisk walking, cycling, and swimming.
Three factors will determine whether you can engage in more demanding activities:
- Your level of physical activity before the hip replacement. The more active you were before, the more likely you’ll be able to resume a sport. If you’ve never done activities like judo or running before getting a prosthesis, it may not be a good idea to start now.
- Your age. The younger you are, the more likely you’ll be able to engage in intensive sports.
- Your body mass index (BMI). The slimmer you are, the better your chances of resuming sports without issues.
Some people even resume running and long-distance triathlons with a hip replacement. A study followed 48 people aged 28 to 59 who competed in Ironman with a hip replacement.
Within 5 years after receiving the hip arthroplasty:
- 85% resumed cycling,
- 79% resumed swimming,
- and 69% resumed running.
In those who resumed competition, performance wasn’t inferior after the operation compared to before (Girard 2017).
Do I have to avoid sports or activities for the rest of my life to prevent dislocation? Lifelong restrictions?
There’s currently no empirical evidence to show that modern hip replacement wear out faster based on the frequency and intensity of sports played (Meek 2020). However, you should weigh the benefits and risks in your particular case before resuming or starting a sport.
If you were already engaging in a sport before the hip replacement, you can resume this activity. Just make sure to do it progressively and adapt the frequency and intensity if you experience any discomfort or pain.
You will surely read: “After a hip replacement, there are some lifelong restrictions that a person may need to follow to ensure the longevity of the implant and prevent complications.”
In general, it is recommended to avoid high-impact activities such as :
- contact sports that can put excessive stress on the hip joint.
Why such strict advice?
This can be explained as follows: it is easier for a healthcare professional to err on the side of caution. Even though the probability of a problem is very rare, it can happen.
The professional prefers to be cautious so that the few people who might have a problem do not turn against them. As a result, others suffer from this overly cautious approach.
This applies to hip replacements as well as almost any other problem.
Let me tell you a recent personal anecdote about this.
My 7-year-old son has twice run a race and felt chest pain during and at the end. It took him between 10 and 60 minutes to recover. In our family, there are small cardiac malformations.
So, we consulted our doctor, who referred us to a pediatric cardiologist. At first, he recommended that we avoid endurance running until the appointment.
Then, a few days later, he advised us to avoid any physical exertion, such as playing at the park or having a soccer game with friends, even though our son had never had any issues in these activities for the past 7 years. Any parent knows that it is almost impossible to prevent a child from engaging in these activities.
This anecdote illustrates that as healthcare providers, we are trained to anticipate the worst-case scenario, even if the probability is low. The same applies to hip replacement!
What is the treatment for a dislocation on a hip replacement?
The treatment of a prosthetic hip dislocation is performed by a surgeon under general anesthesia.
However, you don’t need to undergo another surgery, and the scar doesn’t need to be reopened.
The surgical team simply reduces the dislocation, meaning they put the hip back in the right position. The treatment may differ in case of recurrence.
THE BOTTOM LINE
Dislocations and complications are very rare after a hip replacement. There are not really any forbidden/restricted movements as long as you respect the gradual resumption of activities.
Do you have any comments or questions? Your comments are welcome 🙂 !
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Since 2015, more than 1000 publications dedicated to hip replacement have appeared in international medical journals, compared to around thirty in the 1950s.
To update my knowledge on the subject, I regularly consult:
- The Cochrane Collaboration’s study syntheses, an association of international research teams that summarizes high-quality studies on a topic;
- Other study syntheses indexed in Medline (PubMed), the largest database of medical studies;
- The works of Prescrire (french medical & independant journal) and HAS (french health institution).
Here are the publications on which I relied to support this article.
Smith TO, Jepson P, Beswick A, Sands G, Drummond A, Davis ET, Sackley CM. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev. 2016 Jul 4;7(7):CD010815. doi: 10.1002/14651858.CD010815.pub2. PMID: 27374001; PMCID: PMC6458012.
Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthop. 2020 Dec;91(6):687-692. doi: 10.1080/17453674.2020.1795598. Epub 2020 Jul 28. PMID: 32718213; PMCID: PMC8023879.
Risk factors for dislocation
Guo L, Yang Y, An B, Yang Y, Shi L, Han X, Gao S. Risk factors for dislocation after revision total hip arthroplasty: A systematic review and meta-analysis. Int J Surg. 2017 Feb;38:123-129. doi: 10.1016/j.ijsu.2016.12.122. Epub 2016 Dec 31. PMID: 28043927.
Faldini C, Stefanini N, Fenga D, et al. How to prevent dislocation after revision total hip arthroplasty: a systematic review of the risk factors and a focus on treatment options. J Orthop Traumatol. 2018;19(1):17. Published 2018 Sep 10. doi:10.1186/s10195-018-0510-2
Reimert J, Lockwood KJ, Hau R, Taylor NF. Are hip movement precautions effective in preventing prosthesis dislocation post hip arthroplasty using a posterior surgical approach? A systematic review and meta-analysis. Disabil Rehabil. 2020 Nov 15:1-7. doi: 10.1080/09638288.2020.1845404. Epub ahead of print. PMID: 33190554.
Tamaki T, Oinuma K, Miura Y, Higashi H, Kaneyama R, Shiratsuchi H. Epidemiology of Dislocation Following Direct Anterior Total Hip Arthroplasty: A Minimum 5-Year Follow-Up Study. J Arthroplasty. 2016 Dec;31(12):2886-2888. doi: 10.1016/j.arth.2016.05.042. Epub 2016 May 31. PMID: 27378635.
van der Weegen W, Kornuijt A, Das D. Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil. 2016 Apr;30(4):329-39. doi: 10.1177/0269215515579421. Epub 2015 Mar 31. PMID: 25834275.
Sport & hip replacement
Morse KW, Premkumar A, Zhu A, Morgenstern R, Su EP. Return to Sport After Hip Resurfacing Arthroplasty. Orthop J Sports Med. 2021 May 6;9(5):23259671211003521. doi: 10.1177/23259671211003521. PMID: 33997077; PMCID: PMC8113959.
Meek RMD, Treacy R, Manktelow A, Timperley JA, Haddad FS. Sport after total hip arthroplasty: undoubted progress but still some unknowns. Bone Joint J. 2020 Jun;102-B(6):661-663. doi: 10.1302/0301-620X.102B6.BJJ-2020-0208. PMID: 32475237; PMCID: PMC7241060.
Girard J, Lons A, Pommepuy T, Isida R, Benad K, Putman S. High-impact sport after hip resurfacing: The Ironman triathlon. Orthop Traumatol Surg Res. 2017 Sep;103(5):675-678. doi: 10.1016/j.otsr.2017.04.004. Epub 2017 May 25. PMID: 28552834.
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.
2 thoughts on “Are there any Restrictions After Hip Replacement and are they Permanent?”
Kindly mention which precautions or restrictions should b demanded at workplace for beeter life of the joint?
It depends a lot on the job. For office work, there is none.
For a very physical job that requires a lot of weight to be carried, the life span of the prosthesis will probably be a little shorter. But since some people return to the Iron Man after a hip replacement (if they were already trained before), it is necessary to see what can be done on a case-by-case basis with the employer.