hip replacement

[morwenna]

One of the reasons for range limitation the joint itself can not get more than 90 degrees flexion .

I don't really understand that sentence. Do you mean to say that all joints will not flex to more than 90??

I am doing post op checks for patients one year or more after their surgery, and some will flex to 120 plus quite easily. Some don't though.

Some have restricted movement from soft tissue tightness, and sometimes there is impingement at the end of available range. Often that is dependent on the orientation of the implants, or maybe heterotrophic bone.

Some of our surgeons advise their patients that they will never be able to flex "much more than 90".

... which brings me to the questions of "Hip Precautions".

Is everyone advising on the usual hip precautions these days? ... there is evidence that a stable hip is stable, and instability often is a result of inadequate placement of the implants. How long do you tell patients not to flex beyond 90 or adduct past mid-line?

It is really quite limiting for a patient if they are strictly to observe those rules for ever!

Here's another thing: In the UK we'd tell our patients that supine with a pillow between their legs was safest sleep position. If they really could not sleep supine we'd advise them to lie on their OPERATED side, with a pillow between their knees. Obviosuly this would be uncomfortable for most people until the immediate post-op swelling/pain had subsided.

Here in Calgary they are advised to lie on their GOOD side with pillows supporting their operated leg. This, I always thought, is the least safe position as the leg can "fall into flex/add". Indeed I found one of my Home Care patients had subluxed her hip sleeping in this position. I told her to stop doing it!! (and reduce flexion to max of 70 until seen again by the surgeon)

I'd be interested to know other people's experiences/views?

[nadja66]

hmm..at the place where i work we also tell the patients that they can sleep on the good side with a pillow between the leg. to lie on the operated leg mostly really hurts them and is not possible during the first week..
but of course if they lie on the good side the chance that the leg goes in to adduction is much bigger..
most patients by us anyway prefer to sleep supine, even if they didnt befor surgery..

[morwenna]

hmm..at the place where i work we also tell the patients that they can sleep on the good side with a pillow between the leg. to lie on the operated leg mostly really hurts them and is not possible during the first week..
but of course if they lie on the good side the chance that the leg goes in to adduction is much bigger..
most patients by us anyway prefer to sleep supine, even if they didnt befor surgery..

Heh .... well, I used to find in the UK that patients just about got used to sleeping supine by about six weeks ... ie the time we told them they no longer had to!

[emad]

Hi Mawr :

I meant it preaucation .Unfortunately ,I have seen implants long time ago during my undergraduate study ,so that I can not remember how much range does it allow ,however it may be different from producation to another , just preacuation for dislocation . As for timing of keeping not flexing beoyend 90 degrees ,usually I tell them that but have not thought of long term .I do think mobility is central here .
Just interesting to me ,in your practice do they recommend hip protector fallowing hip replacment for prevention of hip fracture ?

cheers
Emad

[morwenna]

.
Just interesting to me ,in your practice do they recommend hip protector fallowing hip replacment for prevention of hip fracture ?

No. We recommend our patients try not to fall over though!

The hip would not fracture following a total hip replacement anyway, though I have seen periprosthetic fractures (femoral shaft), usually later down the line.

[emad]

Well , I began a hip-fracture prevention program however seems the prevention program is complex needs cooperation from all society and health professionals .
There is eveidence that people who experienced hip fracture are more liable to have hip fracture on sound side and be ridden patient or sidentry .Of course, I am talking about elder people .

cheers
Emad

[morwenna]

Well our patients are virtually all having cold joint replacement surgery for OA so most are not especially at risk of falls.

People who have fallen and undergone a hemiarthroplasty (or occasionally a THA) to fix a fractured hip are a different case of course.