Posterior/Posterolateral Approaches

ROM
• Avoid hip flexion > 80 to 90 and adduction and internal rotation beyond neutral.

ADL
• Transfer to the sound side from bed to chair or chair to bed.
• Do not cross the legs.
• Keep the knees slightly lower than the hips when sitting.
• Avoid sitting in low, soft chairs.
• If the bed at home is low, raise it on blocks.
• Use a raised toilet seat.
• Avoid bending the trunk over the legs when rising from or sitting down in a chair or dressing or undressing.
• For bathing, take showers or use a shower chair in the bathtub.
• When ascending stairs, lead with the sound leg. When descending, lead with the operated leg.
• Pivot on the sound lower extremity.
• Avoid standing activities that involve rotating the body toward the operated extremity.
• Sleep in supine position with an abduction pillow; avoid sleeping or resting in a side-lying position.

Anterior/Anterolateral and Direct Lateral Approaches With or Without Trochanteric Osteotomy

ROM
• Avoid flexion > 90.
• Avoid hip extension, adduction, and external rotation past neutral.
• Avoid the combined motion of flexion, abduction, and external rotation.
• If the gluteus medius was incised and repaired or a trochanteric osteotomy was done, do not perform active, antigravity hip abduction for at least 6 to 8 weeks or until approved by the surgeon.

ADL
• Do not cross the legs.
• During early ambulation, step to, rather than past, the operated hip to avoid hyperextension.
• Avoid activities that involve standing on the operated extremity and rotating away from the involved side.

These precautions apply to traditional total hip arthroplasty and may or may not be necessary after minimally invasive procedures, depending on the surgeon’s guidelines.

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