After Total Hip Arthroplasty: Hip Precautions, Clot Prevention, and Dislocation Warning Signs
For the posterior approach, teach the precautions the surgeon orders: no hip flexion past 90 degrees, no crossing the legs, and no turning the foot inward. Teach use of a raised toilet seat, a reacher, a sock aid, a pillow between the knees, and anticoagulant prophylaxis for the prescribed duration. Sudden severe hip pain with a shortened or rotated leg indicates dislocation and requires emergency care.
Who needs this teaching
Clients after total hip arthroplasty and the caregiver who helps at home. After the posterior approach, hip flexion, adduction, and internal rotation cause posterior dislocation. Orthopedic hip surgery carries a high risk of venous thromboembolism. Precautions continue for the period the surgeon orders.
The priority teaching points
- Hip precautions. For the posterior approach, do not flex the hip past 90 degrees. Do not adduct the leg past the midline, including crossing the legs or ankles. Do not internally rotate the hip (turn the foot or knee inward). Precautions differ after the anterior approach; follow the surgeon's orders.
- Daily activities. Use a raised toilet seat and a firm chair with armrests that keeps the hips higher than the knees. Avoid low, soft chairs. Do not bend forward to reach the feet or the floor. Use a reacher, sock aid, and long-handled shoehorn. To sit, back up until the chair touches the legs, slide the operative leg forward, and lower the body with the armrests.
- Positioning. Keep a pillow or abduction wedge between the knees in bed and when turning.
- Walker use and fall prevention. Move the walker forward first. Step forward with the operative leg, then bring the unaffected leg forward. Bear weight as prescribed. On stairs, go up with the unaffected leg first and down with the operative leg first. Remove throw rugs, use night-lights, and keep pathways clear.
- Venous thromboembolism prevention. Take the prescribed prophylaxis, such as enoxaparin, apixaban, rivaroxaban, or aspirin, for the full duration, often up to 35 days. Wear compression stockings as prescribed. Perform ankle pumps every hour while awake, and walk several times daily. Report bleeding.
- Incision care. Keep the incision clean and dry. Follow the surgeon's showering instructions. Do not soak in a bathtub, pool, or hot tub until the surgeon gives clearance. Tell every provider and dentist about the joint replacement.
- Physical therapy exercises. Perform the prescribed exercises daily: ankle pumps, quadriceps sets, gluteal sets, heel slides within the precautions, and hip abduction as instructed. Take prescribed analgesics before exercise. Resume driving only after surgeon clearance.
- Complications. Dislocation signs are sudden severe hip pain, a popping sensation, shortening or rotation of the leg, and inability to bear weight; dislocation is an emergency. Infection signs are fever, increasing redness, warmth, swelling, drainage, and pain at the incision. DVT signs are unilateral leg edema, warmth, and pain. Pulmonary embolism signs are sudden dyspnea, chest pain, tachycardia, and hemoptysis; call 911.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Fever over 100.4 F (38 C) or chills | Sudden severe hip pain with a shortened or rotated leg, or inability to bear weight |
| Increasing redness, warmth, swelling, drainage, or pain at the incision | Sudden shortness of breath |
| Swelling, warmth, or pain in one calf or thigh | Chest pain or coughing up blood |
| Bleeding gums, nosebleeds, or new bruising during anticoagulant therapy | Rapid heart rate with lightheadedness or syncope |
Teach-back questions
- "Show me how you will sit down in a chair."
- "Which three hip movements will you avoid?"
- "How will you put on your socks?"
- "Show me how you walk with your walker."
- "What will you do if your leg suddenly looks shorter?"
Teaching tips
- Observe a return demonstration of transfers, walker use, and each device.
- Ask about toilet and chair heights at home before discharge.
- Write the anticoagulant name, dose, and end date on the handout.
- Include the caregiver in precautions teaching.
Read more on NCLEXPace
- Bones and Muscles Map: Fractures, Casts, Traction, and Joint Replacement
- Immobility and VTE: Prevent the Clot Before It Travels
- Perioperative Nursing: Safety Across the Surgical Journey
Sources
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Musculoskeletal Trauma and Orthopedic Surgery.
- Anderson DR, et al. American Society of Hematology 2019 Guidelines for Management of Venous Thromboembolism: Prevention of Venous Thromboembolism in Surgical Hospitalized Patients. Blood Adv. 2019;3(23):3898-3944.
- Falck-Ytter Y, et al. Prevention of VTE in Orthopedic Surgery Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e278S-e325S.
Why this matters for the NCLEX
Teaching is effective when the client states, "I keep a pillow between my knees when I turn in bed," and "I use my reacher to pick things up from the floor." Statements requiring further teaching include, "I will rest in my low recliner," "I can cross my legs at the ankles," and "I will bend down to tie my shoes."
Frequently asked questions
Why does a client after a posterior approach avoid low chairs?
Low seats flex the hip past 90 degrees. Hip flexion with adduction and internal rotation causes posterior dislocation.
Why does anticoagulant prophylaxis continue after the client walks well?
The risk of venous thromboembolism stays elevated for weeks after hip arthroplasty. The client completes the full prescribed course.
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