Navigating life after hip replacement surgery requires careful attention to daily movements, particularly the transition into and out of bed. Following specific procedures is important to protect the new joint during the initial recovery phase. During this period of healing, the joint and surrounding tissues are vulnerable to movements that could cause dislocation. Using specific techniques ensures a safe transition and promotes better recovery.
Understanding Post-Operative Hip Precautions
The primary concern after hip replacement is preventing the new joint from dislocating, so movement restrictions (hip precautions) are put in place. The most common rule is to avoid bending the hip past 90 degrees, known as excessive hip flexion. This means the knee should never be higher than the hip when sitting or leaning forward.
Patients must also avoid crossing the legs or ankles (adduction), as this movement can place stress on the hip capsule. Twisting the operative leg inward (internal rotation) should also be prevented to maintain proper joint alignment. While some surgical approaches, such as the anterior approach, may have fewer restrictions, avoiding these three movements remains a standard safety measure, especially for those who underwent the posterior approach.
Preparing the Bedroom and Bed Height
The environment must be configured to support safe movement before attempting to enter the bed. Bed height is a factor in maintaining the 90-degree hip precaution. Ideally, the mattress surface should be high enough so that when sitting on the edge, the knee is level with or slightly below the hip joint. The bed should be at least two inches higher than the patient’s knee height when standing.
A firm mattress provides stable support and prevents the body from sinking too deeply, which could increase hip flexion. Assistive tools (a walker or crutches) should be placed within easy reach of the bed. A long-handled grabber can also help retrieve items or pull up blankets without bending or twisting.
Step-by-Step Guide for Getting Into Bed
Getting into bed must be slow and deliberate, ensuring the new hip remains protected. First, approach the bed backward, using a walker for stability, until the back of the non-operative knee touches the edge of the mattress. The operative leg should be kept slightly extended forward to prevent excessive hip flexion.
Next, use the arms to slowly lower the body onto the bed, sliding the hips backward toward the pillow as the arms take the weight. Sit far enough back to support the operative leg, which must remain extended. Once seated, pivot the body so the head moves toward the headboard, keeping the torso and legs moving as one unit to avoid twisting the hip.
The legs are brought up onto the bed one at a time, always leading with the operative leg. The non-operative leg can be bent and used to push the body further back into the desired sleeping position. During this final maneuver, the knees should be kept slightly separated to prevent crossing, and the kneecaps should face the ceiling.
Safe Movement: Getting Out of Bed and Sleeping Positions
Getting out of bed is essentially the reverse procedure, still requiring careful attention to hip alignment. The patient uses their arms and the bent non-operative leg to push the body toward the edge of the bed. Once the hips are near the edge, the operative leg is carefully swung off the bed first, followed by the non-operative leg.
Push up to a standing position using the arms on the bed surface or a stable rail, keeping the operative leg extended forward until standing fully upright. For sleeping, lying flat on the back is the safest position to maintain proper hip alignment. If turning onto the side is necessary, it should only be done on the non-operative side.
When sleeping on the side, an abduction wedge or a stack of firm pillows must be placed between the knees and ankles. This support prevents the top leg from crossing the bottom leg and maintains the necessary separation. Place a pillow behind the back to prevent accidentally rolling onto the operative side.