Hip Replacement: Safely Entering, Sitting In, and Exiting a Car

How to sit in a car after hip replacement?

Safely entering, sitting, and exiting a car after hip replacement surgery requires adherence to specific hip precautions to prevent dislocation and promote healing. This involves maintaining a neutral hip position, avoiding extreme flexion, adduction, and internal rotation, and using proper body mechanics and assistive devices.

Understanding Hip Precautions Post-Surgery

Following hip replacement surgery, your orthopedic surgeon and physical therapist will provide specific hip precautions. These are critical guidelines designed to protect the healing joint, prevent dislocation, and ensure a successful recovery. Ignoring these precautions can lead to serious complications.

Common hip precautions typically include:

• Avoid excessive hip flexion: Do not bend your hip beyond 90 degrees (e.g., squatting low, bringing your knee too high towards your chest).
• Avoid hip adduction: Do not cross your legs or bring your operated leg across the midline of your body.
• Avoid hip internal rotation: Do not twist your leg inward.
• Avoid hip external rotation (for certain approaches): Some posterior approaches may also caution against excessive external rotation.
• Avoid twisting at the waist: Move your entire body as a unit, especially when turning.

These precautions are crucial because the soft tissues around the new hip joint need time to heal and strengthen, providing stability. Violating these limits can put undue stress on the joint, potentially leading to dislocation.

Preparing for Car Travel

Before you even attempt to get into a car, some preparation can make the process significantly safer and easier.

• Choose the right vehicle: A car with higher seating (like an SUV or truck) often makes entry and exit easier than a low-slung sedan, as it minimizes the degree of hip flexion required.
• Driver vs. Passenger: Initially, it is safer to be a passenger. If driving, ensure you can safely operate the pedals and turn to check blind spots without violating precautions. Consult your surgeon or therapist before driving.
• Adjust the seat: If possible, slide the passenger seat as far back as it can go to maximize legroom. Recline the seatback slightly to further reduce hip flexion.
• Gather assistive devices:
  • Firm cushion or wedge: A firm cushion (e.g., a wedge cushion) can elevate your seating height, making it easier to maintain the 90-degree hip flexion limit.
  • Plastic bag: A plastic grocery bag or a small towel placed on the seat can help your bottom slide more easily, reducing the need for twisting.
  • Grab bar/strap: A portable grab bar that fits into the door latch or a strong strap secured to the car can provide a stable handhold for support.

The Step-by-Step Guide to Entering a Car

This technique prioritizes maintaining hip precautions and minimizing strain.

1. Position the car: Have the car parked on a level surface. Open the car door fully. If you are entering the passenger side, ensure the seat is pushed all the way back and slightly reclined.
2. Approach the car: Back up slowly towards the car seat, ensuring your operated leg is slightly forward. Your back should be facing the car seat.
3. Use support: Place one hand on the car's dashboard or door frame and the other on the back of the seat or an assistive grab bar for stability.
4. Lower yourself gently: Slowly lower your bottom onto the edge of the seat, keeping your operated leg extended slightly forward. Use your arms to control your descent. Avoid plopping down.
5. Slide backward: Once your bottom is on the seat, use your arms to push yourself gently backward into the seat.
6. Pivot your legs: Keeping your knees together and your torso relatively straight, pivot your entire body as a single unit. Use your hands to help lift and swing both legs into the car simultaneously. Avoid twisting at your waist or letting your operated leg cross the midline. The plastic bag on the seat can facilitate this slide and pivot.
7. Adjust your position: Once both legs are inside, adjust your seating for comfort. Ensure your hips are not flexed beyond 90 degrees. If needed, use your cushion. Fasten your seatbelt.

Proper Seating Posture During Travel

Maintaining an optimal posture during your car journey is as important as the entry and exit.

• Maintain hip angle: Keep your hips at a slightly open angle (greater than 90 degrees) by slightly reclining the seatback and/or using a wedge cushion.
• Avoid crossing legs: Never cross your legs or ankles, as this violates the adduction precaution.
• Keep knees apart: If possible, keep a small pillow or rolled towel between your knees to prevent adduction, especially if you tend to sleep or shift position.
• Regular breaks: For longer journeys, plan frequent stops (every 1-2 hours) to get out, walk a short distance, and stretch gently. This helps prevent stiffness and promotes circulation.
• Adjust seatbelt: Ensure the seatbelt is comfortable and not digging into your hip or abdomen.

The Step-by-Step Guide to Exiting a Car

Exiting the car mirrors the entry process, but in reverse, always prioritizing hip precautions.

1. Prepare to exit: Unfasten your seatbelt. Ensure the car door is open fully.
2. Slide forward: Use your arms to push yourself gently forward to the edge of the seat. The plastic bag can again be helpful here.
3. Pivot legs out: Keeping your knees together and your torso relatively straight, pivot your entire body as a single unit. Use your hands to help lift and swing both legs out of the car simultaneously, extending your operated leg slightly forward.
4. Plant feet firmly: Once your feet are firmly on the ground, ensure your operated leg is slightly forward.
5. Use support to stand: Place one hand on the dashboard or door frame and the other on the seat or grab bar. Push up slowly, using your legs and arms, keeping your back straight. Avoid bending forward at the waist.
6. Stand tall: Once standing, take a moment to regain your balance before moving away from the car.

Important Considerations and Troubleshooting

• Pain as a guide: Listen to your body. If any movement causes sharp or increasing pain, stop immediately and re-evaluate your technique.
• Long trips: For extended travel, discuss strategies with your physical therapist. They might recommend specific exercises or a schedule for breaks.
• Driving post-surgery: Your surgeon will advise you on when it is safe to resume driving, typically after 4-6 weeks, and once you are off strong pain medication and can react quickly. Ensure you can safely operate pedals and turn to check blind spots without violating hip precautions.
• Seek professional guidance: Your physical therapist is your primary resource for personalized advice and modifications based on your specific surgical approach and recovery progress. Do not hesitate to ask them for demonstrations and practice sessions.
• Emergency situations: In an emergency, maintaining perfect form might not be possible. Focus on minimizing extreme movements as much as you can.

Reintegration and Long-Term Mobility

As your recovery progresses, you will gradually regain strength and flexibility. Your physical therapist will guide you through exercises to strengthen the muscles supporting your new hip, which will enhance stability and confidence in daily activities, including car travel. While initial precautions are strict, the goal is to safely reintegrate you into a full and active lifestyle. Continue to practice good body mechanics, even after the initial recovery period, to protect your hip for years to come.