Appropriate Goal for Patient 5 Days After Total Hip Replacement
The most appropriate goal at 5 days post-total hip replacement is to maintain hip abduction without dislocation (Option A), as this represents the fundamental safety priority during the early postoperative period when dislocation risk is highest.
Rationale for Hip Abduction as Primary Goal
At 5 days post-operatively, the patient remains in the acute recovery phase where preventing dislocation is the paramount concern:
- Dislocation timing: The mean time to dislocation in the early postoperative period is approximately 5 days (range 3-12 days), making this timeframe particularly high-risk 1
- Hip abduction reduces impingement risk: Studies demonstrate that 20° of hip abduction can decrease the absolute risk of impingement by 0-16.3% in various positions, particularly when combined with modern surgical techniques 2
- Primary safety measure: Even in protocols that eliminate traditional restrictions, maintaining hip abduction remains a core protective strategy to prevent dislocation 2, 1
Why Other Options Are Inappropriate at This Stage
Option B (Rest with legs elevated while sitting)
- This is not a standard hip precaution and does not address dislocation prevention
- No evidence supports leg elevation as a specific goal after hip replacement 1, 3
Option C (Tie shoes and put on undergarments without assistive devices)
- This is explicitly contraindicated at 5 days post-op
- These activities require excessive hip flexion (>90°) and internal rotation, which are high-risk movements for dislocation 3
- Patients should maintain hip flexion <90° and rotation <45° for the first 6 weeks postoperatively 3
- Assistive devices (reachers, sock aids) are specifically designed to avoid these dangerous positions
Option D (Perform scissors-like leg exercise daily)
- Scissors exercises involve hip adduction, which directly opposes the protective abduction position
- This would increase dislocation risk rather than prevent it 2
Clinical Context and Common Pitfalls
Critical timing consideration: At 5 days post-op, the patient is still within the highest-risk window for dislocation. The surgical soft tissues have not yet healed sufficiently to provide stability 1, 3.
Avoid premature advancement: While some evidence suggests that extensive restrictions may not be necessary with anterior/anterolateral approaches and modern implants, the basic principle of maintaining hip abduction remains protective even in unrestricted protocols 1, 3.
Modern evidence nuance: Recent studies show that many traditional restrictions (elevated toilet seats, abduction pillows, driving restrictions) may not be necessary and can impede recovery 3. However, these studies still maintained basic range-of-motion limits (flexion <90°, rotation <45°) and emphasized avoiding adduction 3. Hip abduction as a protective position remains valid even when other restrictions are liberalized 2, 1.