🔒 Hip Precautions: Based on Surgical Approach
Posterior Approach
- No bending hip beyond 90°
- No crossing legs (adduction)
- No turning foot inward (internal rotation)
- Never combine these movements
Anterior Approach
- No stretching hip backwards (extension beyond neutral)
- No turning foot outward excessively
- No bridging or lying face down
- Keep hip slightly bent when lying
Anterolateral / MIS
- Usually limited precautions only
- Avoid extremes of movement
- Confirm with Dr. Satish Reddy
All Approaches
- No floor sitting: permanently avoid
- No cross-legged sitting: permanently avoid
- No squatting below 90° hip bend
- Precautions apply until surgeon clears you
Phase 1
Hospital Phase: Immediate Recovery
Day 0 – Day 3🎯 Goals
- Sit up and transfer out of bed safely
- Walk with walker for at least 15 metres
- Understand and follow hip precautions
- Control pain and swelling
- Manage stairs if needed for discharge home
⚠️ Precautions
- Follow your specific approach precautions (see above)
- Full weight bearing allowed with walker unless told otherwise
- No twisting or pivoting on the operated leg
- No exercises with weights or resistance
- Watch for signs of dislocation and DVT (see alerts below)
- Keep wound clean and dry
🚨
Hip Dislocation Warning: Tell Your Doctor Immediately If:
Sudden severe pain in the hip · Operated leg looks shorter or rotated compared to the other leg · Feeling or sound of the hip "popping out" · Unable to move the leg · These require urgent attention: do not try to walk.
🩺
DVT Warning: Tell Your Doctor Immediately If:
Calf becomes painful, red or unusually swollen · Sudden chest pain or breathlessness · Operated leg becomes cold or pale · These are warning signs of a blood clot and require urgent attention.
Exercises (Start Day 1 in Hospital)
- Ankle pumps: move foot up and down, 20 reps every hour
- Thigh squeeze: press back of knee into bed, hold 5 sec
- Buttock squeeze: tighten buttocks, hold 5 sec, 10 reps
- Heel slides: bend and straighten operated leg slowly
- Straight leg raise: tighten thigh, lift leg 30cm, lower slowly
- Hip abduction: slide leg out to side and back (if allowed)
- Sitting hip flexion: sit at edge of bed, lift knee gently
- Sit-to-stand: slide to edge, push up using arms, do not bend hip past 90°
- Walking with walker: short walks 3–4 times a day
🧊 Ice / Swelling Control
- Apply ice pack (wrapped in cloth) for 15–20 minutes
- Use 4–5 times per day, especially after exercise
- Never apply ice directly to skin
- Elevate the leg when resting
🚶 Discharge Readiness Checklist
- Can get in/out of bed independently with walker
- Can walk 50–100 metres with walker safely
- Understands and following hip precautions
- Can manage 2–3 steps if home has stairs
- Pain under control with oral medications
Pain Management: What to Expect
Painkiller (Basic)
Paracetamol (500–1000 mg)
Every 6–8 hrs as needed. Safe to use regularly for 4–6 weeks.
Anti-inflammatory
Etoricoxib / Celecoxib
Take with food. Avoid if kidney or heart issues. As prescribed.
Nerve Pain
Pregabalin / Gabapentin
For burning/tingling pain. Can cause drowsiness: take at night.
Short-term (Stronger)
Tramadol / Tapentadol
Only if severe pain. Avoid driving. Wean off by Week 2.
Blood Clot Prevention
Rivaroxaban / Aspirin
As prescribed (usually 2–6 weeks). Do not skip doses.
Injection (In Hospital)
Pericapsular Block
Given during surgery. Provides 12–24 hrs of good pain relief.
Phase 2
Early Recovery at Home
Week 1 – Week 6🎯 Goals
- Walk comfortably without walker by Week 3
- Hip bending (flexion) to 110° by Week 6
- Climb stairs with one hand on railing
- Reduce swelling and pain significantly
- Build hip muscle strength (abductors and extensors)
⚠️ Precautions
- Continue hip precautions until surgeon clears you (usually Week 6)
- No floor sitting: permanently avoid
- No cross-legged sitting: permanently avoid
- No low chairs or sofas: sit on firm elevated surface
- Use raised commode seat: Western toilet only
- Wound must stay dry until fully healed (10–14 days)
Week 1–3 Exercises
- Continue all Phase 1 exercises
- Standing hip abduction: hold chair, lift leg out to side
- Standing hip extension: hold chair, kick leg gently backwards
- Mini squats: 0–45° only, holding chair/wall
- Side-stepping: step sideways holding support
- Weight shifting: shift weight side to side, holding frame
- Wean off walker to stick by Week 2–3
Week 3–6 Exercises
- Step-ups: one step height, use railing
- Sit-to-stand from normal height chair
- Stationary cycling: start from Week 3–4
- Walking outdoors: flat surfaces, increase distance gradually
- 4-way straight leg raises: front, back, side (as precautions allow)
- Balance: single-leg stand briefly, holding chair
🏠 Daily Life Adjustments
- Toilet: Use raised Western commode seat permanently: no Indian toilet
- Sitting: Always on firm chair with armrests; hip must not bend past 90°
- Car: Slide seat back fully; ease in legs first; short journeys from Week 2
- Driving: Wait 6 weeks minimum; must be off strong painkillers
- Two-wheeler: Not allowed for 3 months minimum
- Sleeping: Pillow between knees when lying on side (posterior approach)
✅ Ready for Phase 3 When:
- Hip flexion to 110°
- Walking community distances (500–800m) without stick
- Minimal swelling and pain
- Good hip muscle strength: no significant limp
- Surgeon has cleared hip precautions at 6-week review
Phase 3
Strengthening Phase
Week 7 – Week 12🎯 Goals
- Full hip strength (4+/5) in all directions
- Stairs with alternating legs: both directions
- Return to most daily activities and light work
- Walk long distances outdoors without limping
- Good balance and proprioception
Exercises
- Squats: progress to 60–70° depth
- Lunges: with support initially
- Step-ups/step-downs: higher step
- Sidestepping with resistance band
- Balance board or single-leg balance
- Walking on ramps and uneven ground
- Swimming: from Week 8 once wound healed
- Cycling: outdoors on flat terrain from Week 8+
🏠 Daily Life Adjustments
- Light housework / cooking: OK from Week 8
- Temple visits: walking with footwear OK; avoid steps and floor sitting
- Light field/farm work: defer to Week 12+
- Driving: Wait 6 weeks minimum; must be off strong painkillers
- Two-wheeler: minimum 3 months; confirm with surgeon
✅ Ready for Phase 4 When:
- Hip strength ≥4/5 all directions
- Stairs: one leg per step, both directions
- Walking all surfaces without significant limp
- Minimal to no pain
Phase 4
Return to Full Activity
Week 12 – Week 16🎯 Goals
- Full independence with all daily tasks
- Return to recreational activities
- Pain-free walking, stairs, and daily life
- Maintain hip strength and joint health long-term
Exercises
- Continue and progress all Phase 3 exercises
- Increase walking distance and pace
- Swimming: all strokes
- Cycling outdoors (flat terrain)
- Activity-specific training as needed
Activity Guide: When Can I Return to Normal Life?
| Activity | Allowed? | When | Notes |
|---|---|---|---|
| Walking (flat ground) | YES | Immediately | With walker in hospital; progress to stick, then unaided by Week 3 |
| Western commode | YES | Day 1 | Use raised seat; keep hip above knee level |
| Indian-style toilet | NEVER | Permanently avoid | Hip bends too far: risk of dislocation. Use Western commode only. |
| Floor sitting / cross-legged | NEVER | Permanently avoid | Puts hip in dangerous position: risk of dislocation. |
| Climbing stairs | YES | Before discharge | Good leg up first, operated leg down first; hold railing |
| Driving | CAUTION | Week 6 | Wait 6 weeks minimum; must be off strong painkillers |
| Two-wheeler | WAIT | 3 months minimum | Risk of fall; balance must be fully restored; confirm with surgeon |
| Swimming | YES | Week 6–8 | After wound fully healed; excellent rehabilitation activity |
| Stationary cycling | YES | Week 3–4 | Adjust seat height so hip does not bend past 90° |
| Road cycling | CAUTION | Week 12+ | Flat terrain only; avoid potholes and rough roads |
| Light housework / cooking | YES | Week 4–6 | Take breaks; avoid prolonged standing or bending forward |
| Office / desk work | YES | Week 3–4 | Take hourly walking breaks; ensure chair height keeps hip above knee |
| Field work / manual labour | CAUTION | Week 12–16 | Light only; no squatting, heavy lifting or prolonged bending |
| Walking / swimming / cycling | ENCOURAGED | Long-term | Best activities to maintain joint health lifelong |
| Cricket / football / badminton | DISCOURAGED | - | High-impact pivoting sports: not recommended after THR |
🚨 When to Call Dr. Satish Reddy / Come to Hospital Immediately
🔴 Emergency Signs
- Sudden severe hip pain with leg appearing shortened or rotated
- Feeling or sound of hip "popping out"
- Sudden severe calf pain, chest pain, or breathlessness
- High fever (>101°F / 38.5°C) with wound redness or pus
- Wound bleeding heavily or opening up
🟡 Call Clinic Within 24 Hours If:
- Hip swelling suddenly increases significantly
- Pain is not controlled despite medications
- Wound looks infected or is not healing
- Significant new limp appears after improving
- Operated leg feels significantly different in length
📅 Follow-up Schedule
🗓 Routine Follow-ups
- 2 weeks: Wound check, suture removal
- 6 weeks: ROM, gait, X-ray; precautions reviewed
- 3 months: Strength and function assessment
- 6 months: Full functional review
- 1 year: Annual X-ray + review
🏋 Long-term Exercise Advice
- Walk 30 min daily: lifelong
- Swimming or stationary cycling 3x/week
- Hip and core strengthening: continue forever
- Avoid weight gain: reduces implant stress
- Wear supportive footwear at all times
🏠 Long-term Lifestyle Tips
- Always sit on firm chairs with armrests
- Avoid low sofas, charpoy or floor seating
- Non-slip mat in bathroom: essential
- Handrails in bathroom strongly advised
- Firm mattress recommended