Hip Replacement Safety

Are contraindications after hip replacement helpful or harmful? Are they seen as providing comfort and guidance or do they cause fear?  Are they realistic or just restrictive? 

I recently shared a video titled “Hip Replacement Safety Made Simple” which you can find on my YouTube channel here.

The intention of the video is to provide general guidance for instructors who are teaching group classes, and for people who have hip replacements.  These post-surgical contraindications can become our guidelines for teaching movement as we help people return to their normal activities.   

Contributing Factors

Some factors that may contribute to THR dislocation include hip joint structure, type and size of the prosthesis, including the stem type, cup size, and head type, whether the surgeon relied on the Lewinnek Safe Zone classification (7) or customized the angle and inclination of the prosthesis for the patient, whether the person had / has hip dysplasia or other comorbidities such as inflammatory arthritis.

A small retrospective study reinforces the “multifactorial nature of dislocation risk” and points to patient non-compliance as one of the causes of early THR dislocation “followed by trauma and excessive range of motion.” (6)

What these studies tell us is THR dislocation is multi-factorial, and while true that most occur within the first year, there are THR dislocations that occur much later.  Therefore, what is really needed are holistically-minded professionals who can take all of the factors into consideration and guide patients in their post-rehab to achieving their movement wellness and fitness goals.

When a practitioner is working in any other environment besides one to one, they may not have the opportunity to interview participants about the type and age of the hip replacement. 

We also may not know what their hip joint structure was prior to hip replacement or what it is now. 

Hormonal changes can create an environment that leads to bone density loss and this can make a hip replacement less stable over time due to medullary expansion.

 Motion And Functional Movement

Most people with whom I work that have hip replacements, regardless of the approach, do very well with range of motion and functional movement.

There is, however, a sub set who do not do as well. Multiple factors may influence hip replacements including scoliosis, osteoporosis, hypermobility, arthritis, very little body awareness, and pain; those are people for whom using the contraindications as a safe starting point for movement may be our wisest choice. 

In my own lived experience, I know a person with bilateral anterior approach hip replacements who dislocated their own hip in a yoga class doing a quadruped version of dancer. Another person who dislocated a posterior approach hip replacement while twisting and bending, seated in their car, putting on golf shoes – the hip joint was in medial rotation under the pelvis.  Another who was still holding on to their post-surgical contraindications 6 years after surgery and had become sadly deconditioned as a result.

 If someone is holding on to contraindications given by their Dr., I suggest they go back to their Dr. and ask clarifying questions.  I work with 2 people who have contraindications that are forever, and these are because of their particular joint structure and the type of surgery. 

Focus On The CAN Instead Of The CAN’T

As practitioners our role is to guide the person back to movement, at the same time teaching them to listen to their body – which is a new body! The art is to combine what we know from science and studies with our hearts and to affirm the person’s autonomy and agency in their own movement practice. 

I believe it is important to focus on what people CAN do instead of CAN’T; by teaching these basic ideas as a starting point for replaced hips, I have found that the fear of movement is addressed with a positive result.

The best outcome for hip replacements are for those people who exercise, so let’s help instructors and their layperson clients using simple, common sense, global cueing strategies for groups, while for individuals, we can explore more nuanced health information.  In both cases, group or individual appointments, using guidelines can help us design programs that have successful outcomes. 

I offer a simple common-sense-based way to look at working with hip replacements. With the hip replacements available now, especially when we are working with people in an environment where we may not know the person’s full history; the length of time since their THR, and other factors that may be part of the multifactorial risk environment for that person, we can use these guidelines to cue in a way that brings mindfulness into that person’s practice.  

The client can then use that as a basis to explore how the movement feels in their body.

Peace and love,
-Gwen

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