Total Joint Replacement — Total Hip Arthroplasty (Posterior Approach)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

WBAT with assistive device unless otherwise specified; transition to 1 crutch/cane possible wks 3-6, D/C device once gait normal/pain-free

Key Restrictions

Traditional posterior THA precautions: flexion <90 deg, no IR or adduction past midline; abduction pillow between legs in bed x6 wks; limit passive extension and ER; no yoga x6 wks; avoid passive forced stretching/joint mobs (dislocation/subluxation risk); no impact activities (running/jumping discouraged) through Phase III

Timeline & Phases

Phase I (surgery-6 wks): protect hip via WBAT gait and posterior-approach ROM precautions (flexion <90 deg, no IR/adduction past midline), abduction pillow between legs in bed x6 wks, normalize gait with AD progressing to no device by wks 3-6, restore leg control (standing hip abduction) while respecting dislocation precautions, transition off narcotics to NSAIDs, DVT prevention (TED hose, anticoagulation), AAROM/gentle PROM hip all planes within restrictions, isometric hip flexion/extension/abduction/adduction/IR/ER, weight shifting to balance exercises, hip AROM without resistance (short arc to full arc, gravity-minimized to anti-gravity), bridging, supine hip dangle, grade 1-2 hip mobilizations, UBE/treadmill/elliptical; Phase II (6-8 wks): regain muscular strength (focus abduction), progress off assistive device, single leg stance control, functional movements (step up/down, sit-to-stand, squat) pain-free, don socks/garments independently, traditional THA precautions typically lifted at 6 wks, stationary bike 10-20 min, transfer training to/from ground, hip AROM with progressive resistance, non-impact LE/core strengthening, non-impact balance/proprioception, progressive hip abduction strengthening (standing/side-lying abduction, functional closed chain), aquatic pool exercises if Trendelenburg persists, low-impact endurance training; Phase III (9-12 wks): improve strength/endurance, pain-free with ADLs and work-specific movements, walk 1 mile without limp, sensible hip positioning, strength/balance progressing double-to-single leg and single-to-multi-plane, dynamic control low-to-high velocity, ROM/stretching toward and above 90 deg flexion with ER for shoe/sock donning, advance aerobic training (walking, swimming, golf, hiking, Stairmaster, weight training, elliptical, cross-country skiing, doubles tennis, cycling, downhill skiing), lifelong exercise commitment encouraged

Notes

OSMS Rehabilitation Guidelines; posterior-approach companion to OSMS's Anterior THA protocol — same references and phase structure but with posterior-specific dislocation precautions (flexion <90 deg, no IR/adduction past midline, abduction pillow) in place of the anterior approach's extension/ER limits; antibiotic prophylaxis for dental procedures recommended; references Lahey Hospital THA protocol (Argillo, Barerera, Dynan 2015) and UW Health STAR Team outpatient THA guidelines (2014)