Are there any Restrictions After Hip Replacement and are they Permanent?

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).

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:

1. 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.
2. Your age. The younger you are, the more likely you’ll be able to engage in intensive sports.
3. 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 :

• running,
• jumping,
• 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.