Hip Surgery: Safe Rolling Techniques and Precautions

How do you roll over after hip surgery?

Rolling over after hip surgery requires careful adherence to surgeon-prescribed precautions to prevent dislocation, typically involving a controlled "log roll" technique to maintain hip alignment and avoid excessive flexion, adduction, or internal rotation.

Understanding Hip Precautions Post-Surgery

Following hip surgery, particularly total hip arthroplasty (THA), specific movement precautions are critical to prevent dislocation of the newly implanted joint. These precautions are dictated by the surgical approach used:

• Posterior Approach Precautions: This is the most common approach and typically involves avoiding hip flexion beyond 90 degrees, adduction (crossing the midline), and internal rotation of the operated leg. These movements put the hip at risk of posterior dislocation.
• Anterior Approach Precautions: While often considered less restrictive, some surgeons may still advise avoiding excessive hip extension, external rotation, and combined movements that could lead to anterior dislocation, especially in the early stages.
• Lateral Approach Precautions: Similar to posterior, but often with less emphasis on internal rotation restriction.

It is paramount to receive and strictly follow your surgeon's and physical therapist's specific instructions, as protocols can vary based on individual patient factors, surgical technique, and implant type.

Preparing to Roll Over Safely

Before attempting to roll over, ensure you have the necessary environment and mental preparation:

• Consult Your Healthcare Team: Always confirm the appropriate rolling technique with your surgeon or physical therapist. They will provide personalized instructions based on your specific surgery and recovery stage.
• Pain Management: Time your rolling attempts with your pain medication schedule, if applicable, to ensure you are as comfortable as possible.
• Bed Height and Firmness: A firm mattress and a bed at an appropriate height (allowing your feet to touch the floor when seated) can make movements easier.
• Necessary Equipment:
  • Pillow or Abduction Wedge: This is crucial for maintaining hip alignment, especially if rolling to the non-operated side after a posterior approach. It prevents adduction of the operated leg.
  • Overhead Trapeze Bar (if available): Can assist with upper body leverage.
  • Bed Rails: Offer a stable handhold for support.

The Log Roll Technique: Step-by-Step

The "log roll" is the safest method for turning in bed after hip surgery, as it keeps your spine and hips aligned, minimizing twisting or excessive movement at the hip joint.

1. Start on Your Back: Lie flat on your back, centered in the bed.
2. Position the Pillow/Wedge: If instructed, place a pillow or an abduction wedge between your knees. This is particularly important for posterior approach patients to prevent the operated leg from crossing the midline. Ensure your legs remain parallel and slightly apart, maintaining the pillow's position throughout the movement.
3. Bend Non-Operated Knee (Optional, for leverage): If it helps, gently bend your non-operated knee, keeping your foot flat on the bed. This can provide leverage. Do not bend your operated knee excessively.
4. Arm Positioning:
   • To Roll Towards the Operated Side: Place your non-operated arm across your chest. Use your operated arm to push off the bed or hold onto a bed rail.
   • To Roll Towards the Non-Operated Side: Place your operated arm across your chest. Use your non-operated arm to push off the bed or hold onto a bed rail.
5. Engage Core and Initiate Roll: Gently engage your abdominal muscles. Simultaneously, use your arms for leverage and push through your heels (or the non-operated foot if bent) to initiate the roll.
6. Move as One Unit: The key is to move your head, shoulders, trunk, and hips as one solid unit, like a log. Keep your spine straight and your hips in line with your shoulders. Avoid twisting at your waist or letting your operated leg swing independently.
7. Controlled Movement: Roll slowly and deliberately. Do not rush. Stop if you feel any sharp pain.
8. Stabilize Once Turned: Once on your side, ensure you are stable and comfortable. Readjust the pillow between your knees if necessary to maintain proper alignment. Keep your operated leg supported and avoid letting it fall forward or backward.

Common Challenges and Solutions

• Pain: If you experience sharp pain, stop immediately. Reassess your technique or consult your therapist. Dull, manageable discomfort is normal, but sharp pain is a warning sign.
• Weakness or Fatigue: Rolling can be tiring initially. Take breaks, and don't push yourself if you feel too weak. Enlist assistance from a caregiver if needed.
• Fear of Movement: It's natural to be apprehensive. Practice the movements with your physical therapist first. Trust in the precautions and the proper technique. Gradually, your confidence will grow.
• Getting Stuck: If you feel unable to complete the roll, use your arms and core strength to gently roll back to your starting position and try again, perhaps with more assistance.

When to Seek Professional Guidance

Contact your surgeon or physical therapist immediately if you experience any of the following:

• Sudden, severe pain in your hip.
• A "pop" or "clunk" sensation in your hip.
• Inability to bear weight on the operated leg.
• Increased swelling, redness, or warmth around the incision site.
• Fever or chills.
• Numbness or tingling in your leg.
• Any signs that your hip may have dislocated (e.g., leg appears shortened, rotated, or you cannot move it).

The Role of Rehabilitation

Safe rolling is just one component of your post-surgical recovery. Your physical therapist will guide you through a progressive rehabilitation program designed to:

• Restore Range of Motion: Gradually and safely increase hip mobility within your surgeon's guidelines.
• Strengthen Surrounding Muscles: Build strength in the hip abductors, adductors, extensors, and flexors, as well as core muscles, to provide stability and support for the new joint.
• Improve Balance and Proprioception: Enhance your body's awareness in space, reducing fall risk.
• Facilitate Functional Movement: Progress you from basic bed mobility to walking, stair climbing, and resuming daily activities safely and effectively.

Adhering to your rehabilitation plan and consistently practicing safe movement patterns are crucial for a successful recovery and long-term joint health.