Evidence guide
Hip precautions: do you still need them?
For decades, people were told not to bend, cross their legs or twist after hip replacement. Newer research suggests many patients may not need these rules. Here's what it shows.
The short answer
- Hip precautions are movement limits, like not bending the hip past 90 degrees, meant to prevent dislocation.17
- Recent reviews of trials after posterior-approach surgery found no clear difference in dislocation with or without precautions.18,19
- Patients without precautions stopped using walking aids sooner in one analysis.19
- Follow your own surgeon's instructions. Some patients, such as those at high risk of dislocation, may still be told to use them.
What hip precautions are
After hip replacement, especially through the posterior (back) approach, patients have traditionally been told to avoid:
- Bending the hip past 90 degrees, such as sitting in low chairs or reaching for your feet
- Crossing the operated leg past the middle of the body
- Turning the operated leg inward
They were often paired with equipment such as raised toilet seats and reachers.17
What the research shows
- A Cochrane review in 2016 found only three small trials and could not say whether precautions and equipment helped, because the evidence was of very low quality.17
- A 2023 review of four randomized trials and five other studies (8,835 patients) found little or no difference in early dislocation and concluded the evidence does not support routinely prescribing precautions.18
- A 2024 meta-analysis of three randomized trials (1,215 patients) found no difference in dislocation, and patients without precautions reported better function and stopped using walking aids sooner.19
Dislocation is more strongly linked to things like implant position and patient risk factors than to everyday movements. Dual mobility implants are one option for higher-risk patients.20
What this means for you
Many surgeons have dropped or relaxed precautions, while others still use them, particularly for people at higher risk. Ask your surgeon whether you'll have precautions, what they are and when they end. If you have them, follow them.
- Korfitsen 2023: early dislocation RR 1.8 (95% CI 0.6 to 5.2) in RCTs and RR 0.9 (0.3 to 2.5) in non-randomized studies; low and very low certainty.18
Sources
- Smith TO, et al. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev. 2016;7(7):CD010815. doi:10.1002/14651858.CD010815.pub2
- Korfitsen CB, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthop. 2023;94:141-151. doi:10.2340/17453674.2023.11958
- Guo J, et al. No need for hip precautions after total hip arthroplasty with posterior approach: a systematic review and meta-analysis. Medicine (Baltimore). 2024;103(50):e40348. doi:10.1097/MD.0000000000040348
- Manohar M, et al. Dual mobility versus fixed bearings in complex primary total hip arthroplasty: a systematic review and meta-analysis. J Clin Orthop Trauma. 2026;80:103538. doi:10.1016/j.jcot.2026.103538