Total Hip restrictions

  1. 0
    I'm not an ortho nurse, so I need your help. In patients who've had a total hip, there is a restriction on flexion. It is my understanding this may start out at 60 degrees and progress to 90 degrees. Can you tell me how long these restrictions last? Or is it surgeon-dependent? The textbooks are not clear on this. Thanks.

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  2. 9 Comments...

  3. 0
    Depends on the patient's condition.
  4. 0
    All the surgeons I work with do not allow flexion past 70 degrees for I think at least the first 6 weeks maybe even longer.
    Last edit by PeachyOrthoRN on Jul 10, '05 : Reason: to correct information
  5. 1
    I went to the trouble of registering so I could reply to this post but I am not a nurse. My husband had a hip replacement a year ago and I am an active participant in 2 hip joint replacement support groups.

    Patients may be restricted to about 70 degrees for a couple of days but move to 90 degrees thereafter. Usually the 90 degree restriction lasts from 6 to 12 weeks; for my husband it was 12 weeks because he was older. There are 2 other restrictions as well. First, do not twist the body - move the whole body instead. Second, do not cross the operated leg over the center line of the body - no leg crossing at ankle or knee, even if you could. Also, if the femoral component is uncemented, there may be limited weight bearing for about 6 weeks although many surgeons are confident enough to allow immediate weight bearing. If it is cemented, usually weight bearing is allowed immediately, or as tolerated (code for "if it doesn't hurt too much").

    A personal comment. Many THJ replacement patients live alone or a alone for much of the day; too much limitation is impractical and will probably be ignored. And the restrictions get rather tattered toward the end of 12 weeks.
    vkotyay likes this.
  6. 0
    Quote from nursemomruns
    I'm not an ortho nurse, so I need your help. In patients who've had a total hip, there is a restriction on flexion. It is my understanding this may start out at 60 degrees and progress to 90 degrees. Can you tell me how long these restrictions last? Or is it surgeon-dependent? The textbooks are not clear on this. Thanks.
    Where I work, the surgeon decides... lots of times the patients are in a 45 degree wheelchair, but some of the surgeons are saying that their patients' hips are stable enough for 90 degrees... they are not to bend forward beyond that. Also, remember to place a pillow between legs when turning, to avoid internal rotation of the joint..
  7. 0
    Our docs say no more than 90 degrees of flexion, but when you sit in a chair it is better to recline than to sit in an upright position.
  8. 0
    Thank you all for your help. I appreciate all of the feedback you've given me!
  9. 0
    It is also dependent on the approach used. An anterior incision possibly dislocate if the person extends the hip excessively. Also the recline position usually doesn't include a reclining chair. The effort to pull yourself up in a recliner can sometimes cause the hip to flex too much.

    I haven't worked since the minimal incision procedures so my "hippy knowledge" is limited to the regular old kind. But I did do ortho 22 years and am certified ortho.....
  10. 0
    Quote from clichay
    I went to the trouble of registering so I could reply to this post but I am not a nurse. My husband had a hip replacement a year ago and I am an active participant in 2 hip joint replacement support groups.

    Patients may be restricted to about 70 degrees for a couple of days but move to 90 degrees thereafter. Usually the 90 degree restriction lasts from 6 to 12 weeks; for my husband it was 12 weeks because he was older. There are 2 other restrictions as well. First, do not twist the body - move the whole body instead. Second, do not cross the operated leg over the center line of the body - no leg crossing at ankle or knee, even if you could. Also, if the femoral component is uncemented, there may be limited weight bearing for about 6 weeks although many surgeons are confident enough to allow immediate weight bearing. If it is cemented, usually weight bearing is allowed immediately, or as tolerated (code for "if it doesn't hurt too much").

    A personal comment. Many THJ replacement patients live alone or a alone for much of the day; too much limitation is impractical and will probably be ignored. And the restrictions get rather tattered toward the end of 12 weeks.
    Hello clichay! Welcome to Allnurses!
    Thank you for signing on, and sharing with us the orders your husband received from his ortho doc when he had total hip replacement surgery. You are welcome to share whatever you like. I hope your husband is recovering successfully from his hip surgery.
    Last edit by live4today on Jul 14, '05
  11. 0
    One does not need to recline when sitting after a hip joint replacement, one needs to keep the knees lower than the hip. The easiest way to do that is to sit in a chair high enough that the knee naturally falls below the hip. The seats of chairs can be raised with padding and cushions, or the whole chair can be raised on a platform. And chairs should have arms to make it easier to stand up without bending forward which is how most of us get out of a chair. Recliners can be used quite safely if it is high enough or can be put on a platform AND if there is a mechanism for raising the back and lowering the leg rest without using the body; a few members of our support group have slept in their recliners because it was the only was they could get comfortable.

    It would be wonderful if you, or your hospitals, supplied the URLs of some useful web sites for those of your patients who use the Internet or who have relatives who do, and not only post-op but pre-op too. I have been appalled at the number of people who come to our support group without adequate information. I hope that I am not violating any rules in giving you the following URLs.

    http://groups.msn.com/hipuniversesup.../welcome1.msnw
    (This is the support group in which I participate. Anyone can read it
    but you have to join to post)
    http://www.totaljoints.info/total_joint_home_page.htm
    (This is a Swedish site in somewhat quirky English run by a retired
    orthopedist)
    http://hipuniverse.homestead.com/
    (This is the Mother Ship, as they put it, which is the permanent
    repository of helpful information for the support group)
    http://www.activejoints.com/
    (run by a hip joint replacement patient)
    http://members.tripod.com/totallyhip1/index1.htm
    (general information run by a "hippie" - also includes a support group
    component)

    There are also support groups for resurfacing patients and those who have developmental hip dysplasia but I don't know the URLs.

    And thank you, Cheerfuldoer, my husband had an uneventful recovery from his surgery after a somewhat rocky start (he had muscle spasms which restricted his walking for a couple of days). He also had restrictions for 12 weeks instead of 6 weeks which I confess got a little frayed toward the end but he was driving by 5 weeks.


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