An initial physical therapy evaluation 1 day post total hip arthroplasty via a posterolateral approach includes several goals. Which activity is NOT appropriate in the first week?

An initial physical therapy evaluation 1 day post total hip arthroplasty via a posterolateral approach includes several goals. Which activity is NOT appropriate in the first week?

• A. Independent bed mobility with use of a trapeze
• B. Active left hip abduction in right sidelying
• C. Active-assistive positioning of the left hip to 60 degrees of flexion
• D. Walking with moderate assistance with a standard walker to 25 feet

Answer: (B)

After a posterolateral total hip arthroplasty, the safety focus in the first week is to protect the joint from positions that can lead to dislocation, especially those involving adduction and internal rotation combined with flexion. Movements that push the operated hip toward the midline or rotate inward are avoided, while neutral or externally rotated positions and ROM within safe limits are encouraged. Abducting the operated hip while the patient is lying on the opposite side can place the hip in a position where the pelvis and thigh align unfavorably, and small deviations due to gravity or patient effort can shift the joint toward adduction and internal rotation. Because this combination is riskier for dislocation during the early healing phase, actively moving the left hip into abduction in that sidelying position is not appropriate in the first week. In contrast, bed mobility with a trapeze uses the upper body to reposition without stressing the hip, positioning the hip to about 60 degrees of flexion is within safe limits, and walking with a walker to a short distance is commonly started early with proper precautions.

After a posterolateral total hip arthroplasty, the safety focus in the first week is to protect the joint from positions that can lead to dislocation, especially those involving adduction and internal rotation combined with flexion. Movements that push the operated hip toward the midline or rotate inward are avoided, while neutral or externally rotated positions and ROM within safe limits are encouraged.

Abducting the operated hip while the patient is lying on the opposite side can place the hip in a position where the pelvis and thigh align unfavorably, and small deviations due to gravity or patient effort can shift the joint toward adduction and internal rotation. Because this combination is riskier for dislocation during the early healing phase, actively moving the left hip into abduction in that sidelying position is not appropriate in the first week.

In contrast, bed mobility with a trapeze uses the upper body to reposition without stressing the hip, positioning the hip to about 60 degrees of flexion is within safe limits, and walking with a walker to a short distance is commonly started early with proper precautions.