Hip Replacement Recovery: Safely Using a Pillow Between Your Legs

How Do You Put a Pillow Between Your Legs After Hip Replacement?

Safely positioning a pillow between your legs after hip replacement surgery is crucial to prevent dislocation, maintain proper joint alignment, and adhere to post-operative hip precautions. The primary goal is to keep the operated leg in abduction (away from the midline) and neutral rotation, especially when lying down or during transfers.

The Critical Role of Abduction Pillows After Hip Replacement

Following a total hip replacement (THR), protecting the newly implanted joint is paramount to ensure proper healing and prevent complications, most notably dislocation. The soft tissues surrounding the hip joint – including the joint capsule, muscles, and tendons – undergo significant trauma during surgery and require time to heal and regain stability.

• Preventing Dislocation: The most critical function of a pillow between the legs is to prevent excessive hip adduction (moving the leg across the body's midline) and internal rotation (turning the toes inward). These movements, particularly when combined with hip flexion (bending the hip), are common mechanisms for posterior hip dislocation, especially following a posterior surgical approach.
• Maintaining Abduction: The pillow physically keeps the knees and ankles separated, thus maintaining the hip in a position of abduction. This reduces stress on the healing tissues and provides a stable environment for the prosthetic components to integrate.
• Promoting Comfort and Alignment: Beyond preventing dislocation, the pillow helps maintain a neutral spinal and pelvic alignment, which can significantly improve comfort during rest and sleep, reducing strain on the lower back and unaffected hip.

Understanding Hip Precautions

The specific hip precautions you must follow depend on the surgical approach your surgeon used. While anterior approaches often have fewer restrictions, the use of an abduction pillow remains a common and beneficial recommendation across most rehabilitation protocols.

• Posterior Approach Precautions: These are typically more stringent and include avoiding:
  • Hip flexion beyond 90 degrees.
  • Hip adduction past the midline (crossing your legs).
  • Hip internal rotation (toes turning inward).
  • The pillow directly addresses the adduction and internal rotation precautions.
• Anterior Approach Precautions: While often less restrictive, common advice includes avoiding:
  • Hip hyperextension (leg moving too far backward).
  • Hip external rotation (toes turning outward).
  • Combining these with abduction can still be beneficial for comfort and alignment, even if dislocation risk is lower.

Always adhere strictly to the specific precautions provided by your surgeon and physical therapist.

Step-by-Step Guide: Safely Positioning Your Pillow

Whether you are lying on your back (supine) or side (lateral), careful technique is essential to avoid violating hip precautions.

For Supine (Lying on Back) Position:

1. Preparation: Ensure you have one or two firm pillows, or a specialized abduction pillow, within easy reach.
2. Slide, Don't Lift: The key is to avoid lifting your operative leg or crossing it over your midline.
3. Assisted Placement (Recommended Initially):
   • Have a caregiver or physical therapist gently slide the pillow lengthwise between your knees and calves.
   • They should ensure your knees and ankles remain separated, and your toes point upward or slightly outward, preventing internal rotation.
4. Self-Placement (When Approved and Safe):
   • Bend your unaffected knee, keeping your foot flat on the bed. This allows your pelvis to tilt slightly, creating space.
   • Using your hands, carefully slide the pillow between your knees. You may need to use your unaffected leg to help guide the pillow into place.
   • Ensure the pillow extends from at least your knees to your ankles to provide uniform support and prevent your ankles from touching or crossing.
   • Crucially, do not lift your operated leg or allow it to cross the midline during this process. Maintain a slight abduction of both legs.

For Side-Lying Position (Only if Approved by Your Surgeon/Therapist):

Side-lying often provides more comfort for sleep but requires extreme caution to prevent dislocation.

1. Log Rolling: You must turn as a single unit, like a log. Never twist your torso relative to your hips or legs.
   • Start by lying on your back with the pillow already between your legs.
   • Bend your unaffected knee, keeping your foot flat.
   • Use your arms to push yourself over, rolling your entire body simultaneously onto your unaffected side. Your hips and shoulders should turn at the same time.
   • The pillow must remain firmly between your legs throughout the roll.
2. Pillow Adjustment:
   • Once on your side, ensure the pillow is thick enough to keep your knees and ankles well separated.
   • It should maintain a straight line from your hip to your ankle, preventing the top leg from falling forward or backward, which could induce internal or external rotation.
   • A pillow that extends from the groin to the ankles is ideal for full support.

Choosing the Right Pillow

The type of pillow you use can significantly impact its effectiveness.

• Specialized Abduction Pillow: These are often provided by the hospital. They are typically triangular or hourglass-shaped, made of firm foam, and may have straps to secure them to your legs. They are designed specifically to maintain optimal abduction and neutral rotation.
• Standard Pillows: If a specialized pillow isn't available, use two to three firm standard pillows stacked together.
  • Firmness: Soft pillows will compress too much and won't provide adequate support.
  • Thickness: The stack should be thick enough to keep your knees and ankles at least 6-8 inches apart (or as instructed by your therapist).
  • Length: The pillows should be long enough to support your leg from the knee down to the ankles, preventing your ankles from touching.

Common Mistakes to Avoid

• Crossing Your Legs: This is the most common and dangerous mistake, directly violating adduction precautions.
• Pillow Too Thin or Soft: If the pillow doesn't maintain adequate separation, it's ineffective.
• Allowing Internal Rotation: Even with a pillow, ensure your toes don't turn inward when lying down.
• Forgetting the Pillow During Transfers: Be mindful when moving from bed to chair, or getting out of bed; maintain hip precautions throughout.
• Ignoring Discomfort or Pain: If the pillow causes pain or feels incorrect, adjust it or consult your healthcare provider.

When to Use a Pillow

The use of an abduction pillow is typically recommended for:

• Sleeping: This is the most critical time, as you are not consciously controlling your leg movements.
• Resting in Bed: Any prolonged period of lying down, whether on your back or side.
• During Transfers (Occasionally): Your physical therapist may advise using it during certain transfers for added stability.

The duration for which you need to use an abduction pillow varies but is often recommended for the first 6-12 weeks post-surgery, or until your surgeon or physical therapist advises otherwise.

Important Considerations and When to Consult Your Healthcare Provider

Your recovery journey is unique, and adherence to individualized advice from your medical team is crucial.

• Follow Professional Guidance: Always prioritize the specific instructions given by your orthopedic surgeon and physical therapist. They know your surgical details and recovery plan best.
• Listen to Your Body: While the pillow is a protective measure, if it causes new or increased pain, reassess its position or consult your therapist.
• Report Concerns: Contact your healthcare provider immediately if you experience any signs of potential complications, such as:
  • Sudden, severe hip pain.
  • A popping or clicking sensation in the hip.
  • Inability to bear weight on the operated leg.
  • Significant limb length discrepancy.
  • Signs of infection (fever, redness, warmth, swelling, drainage from the incision).

Proper use of an abduction pillow is a simple yet profoundly effective strategy in safeguarding your new hip and contributing to a successful recovery.