Hip Surgery: Safe Leg Movement, Exercises, and Recovery

How to Move Legs After Hip Surgery?

After hip surgery, leg movement must be carefully managed according to specific surgical precautions and your surgeon's and physical therapist's guidance to ensure proper healing, prevent dislocation, and facilitate a safe, effective recovery.

Understanding Hip Precautions: The Foundation of Safe Movement

Immediately following hip surgery, the primary concern is preventing dislocation of the new hip joint. This requires strict adherence to specific "hip precautions," which vary depending on the surgical approach:

• Posterior Approach Precautions (most common for total hip replacement):
  • No Hip Flexion Beyond 90 Degrees: Avoid bending your hip more than 90 degrees (e.g., don't bring your knee higher than your hip). This means no deep squats, bending over to pick things up, or sitting on low chairs.
  • No Hip Adduction Across Midline: Avoid crossing your operated leg over the midline of your body (e.g., don't cross your legs). A pillow or abduction wedge between the knees may be used in bed.
  • No Internal Rotation: Avoid turning your toes and knee inward towards your body's centerline.
• Anterior Approach Precautions (often fewer restrictions, but still important):
  • No Hip Extension: Avoid extending your leg backward beyond your body.
  • No External Rotation: Avoid turning your toes and knee outward.
  • No Combined Extension and External Rotation: This is a common position to avoid.
  • No Excessive Abduction: Some surgeons may caution against wide leg movements.

Always confirm your specific precautions with your surgical team and physical therapist. These precautions are typically in place for 6-12 weeks, but can vary.

Immediate Post-Operative Mobility: The Hospital Phase

The goal in the initial days is early, gentle mobilization to prevent complications like blood clots (DVT) and pneumonia, and to begin restoring basic function.

• Ankle Pumps: While lying down, repeatedly point your toes away from you and then pull them back towards your shins. This helps promote circulation in the lower legs.
• Quad Sets: Tighten the muscles on the front of your thigh (quadriceps) by pushing your knee down into the bed, holding for a few seconds, then relaxing.
• Gluteal Sets: Squeeze your buttocks together, hold, and relax.
• Gentle Heel Slides: While lying on your back, slowly slide your heel towards your buttocks, keeping your heel on the bed. Only go as far as comfortable and within your hip flexion precautions.
• Assisted Bed Mobility: Your physical therapist will teach you how to safely roll and get in and out of bed using proper body mechanics and assistive devices. This often involves using your non-operated leg for leverage and keeping your operated leg straight or slightly bent to avoid hip precautions.
• Weight-Bearing Status: Your surgeon will specify how much weight you can put on your operated leg:
  • Weight-Bearing As Tolerated (WBAT): You can put as much weight as you can comfortably bear.
  • Partial Weight-Bearing (PWB): Only a certain percentage of your body weight.
  • Touch-Down Weight-Bearing (TDWB): Foot can touch the ground for balance, but no weight.
  • Non-Weight-Bearing (NWB): No weight on the operated leg.
  • You will use crutches, a walker, or a cane as directed.

Essential Exercises for Early Recovery (Phase 1: 0-6 Weeks)

These exercises focus on maintaining range of motion, preventing muscle atrophy, and improving circulation within the limits of your hip precautions. Perform them gently and without pain.

• Ankle Pumps and Circles: Continue these regularly throughout the day.
• Quad Sets & Gluteal Sets: Perform multiple repetitions throughout the day.
• Heel Slides: Progressively increase the range as tolerated, always staying within the 90-degree hip flexion limit for posterior approach.
• Gentle Hip Abduction (Side Lying or Supine):
  • Supine: Lie on your back, keep your leg straight, and slide it slowly out to the side and back in. Use a slide board or towel under your heel if needed.
  • Side Lying (if permitted): Lie on your non-operated side with a pillow between your knees. Keep your operated leg straight and lift it slightly towards the ceiling, then slowly lower. Ensure no internal rotation.
• Knee Extension/Flexion (Seated): While sitting in a chair (ensuring your hip is not flexed beyond 90 degrees), extend your operated leg straight out, hold, and then bend your knee back.

Progressing Mobility and Strength (Phase 2: 6-12+ Weeks)

Once your surgeon clears you and your physical therapist deems it safe, you will begin to progress your exercises to rebuild strength, endurance, and balance.

• Standing Marches: Holding onto a stable surface for support, gently lift your operated knee towards your chest (staying within hip flexion limits if applicable).
• Standing Hip Abduction: Stand facing a counter or wall for support. Keep your operated leg straight and move it slowly out to the side, then return to the starting position.
• Standing Hip Extension: Stand facing a counter or wall for support. Keep your operated leg straight and move it slowly backward, squeezing your glutes, then return. Avoid arching your back.
• Mini-Squats (Partial): Stand with feet shoulder-width apart, holding onto support. Slowly bend your knees as if to sit, keeping your back straight and hips above 90 degrees of flexion.
• Heel Raises: Stand holding onto a support, lift up onto the balls of your feet, then slowly lower.
• Light Stationary Cycling: Once approved, a stationary bike can be an excellent low-impact way to improve hip and knee range of motion and endurance. Start with minimal resistance and ensure the seat height is adjusted so your hip does not flex beyond 90 degrees at the top of the pedal stroke.
• Balance Exercises: Single-leg standing (with support), tandem stance, and weight shifts are crucial for regaining stability.

Long-Term Considerations and Return to Activity

Recovery is a journey. Continued adherence to safe movement patterns and a progressive exercise program is vital for long-term success.

• Continued Strengthening: Maintain a regular exercise routine focusing on hip and core strength.
• Low-Impact Activities: Favor activities like walking, swimming, cycling, and elliptical training.
• Avoid High-Impact or Twisting Movements: Running, jumping, contact sports, and activities involving sudden pivots (e.g., tennis, golf swings initially) should be approached with extreme caution or avoided, as they can stress the new joint. Consult your surgeon for specific guidance on returning to sports.
• Listen to Your Body: Pain is a signal. Do not push through sharp or increasing pain.
• Warm-up and Cool-down: Always prepare your muscles before exercise and stretch gently afterward.

Important General Guidelines and Red Flags

• Follow Your Physical Therapist's Instructions: They are your primary guide for exercise progression and safety. Adherence to their prescribed program is paramount.
• Pain Management: Take prescribed pain medication as directed to allow for participation in therapy.
• Incision Care: Keep the incision clean and dry. Report any redness, swelling, or discharge to your medical team.
• Hydration and Nutrition: A balanced diet and adequate hydration support healing.
• Signs of Complications: Seek immediate medical attention if you experience:
  • Sudden, severe hip pain.
  • Inability to bear weight.
  • Leg length discrepancy that was not present before.
  • Sudden swelling, redness, or warmth in the calf.
  • Fever, chills, or increasing redness/drainage from the incision.

Moving your legs after hip surgery is a carefully orchestrated process. By understanding your specific precautions, diligently following your rehabilitation program, and communicating openly with your healthcare team, you can achieve a safe and successful recovery, restoring function and improving your quality of life.