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You will read about the major joints since they are the most common orthopaedic diagnoses you will
see in the acute, SNF, home health or inpatient rehab settings.
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Hip Replacement Surgery
 Following a total hip replacement/arthroplasty, or other hip surgery following a fracture,
your patient may have several precautions.
 These can include weight-bearing precautions and/or anterior/posterior hip precautions.
On the other hand, the individual may have no restrictions at all depending on the
surgeon. If there are precautions in place, these are the main ones you will see.
 Weight-Bearing Precautions
 Non-weightbearing: 0% of body weight
 Toe-touching weight-bearing: Up to 20% of body weight
 Partial weight-bearing: 20-50% of body weight
 Weight-bearing as tolerated: This one is literally “as tolerated,” so it can be up
to 100% if the patient is able to tolerate that.
 Full weight-bearing: 100% of body weight
 Anterior Hip Precautions
 No stepping backwards with surgical leg (lead with non-surgical leg when backing
up to toilet, chair, etc.)
 No hip extension
 No external rotation (turning outwards) of the surgical leg
 No crossing legs
 Sleep on surgical side when side lying
 Posterior Hip Precautions
 No bending the hips forward past a 90 angle (no forward flexion)
 No crossing the legs
 No twisting the hip or toes inward
 The hip kits generally include a reacher, long handled
shoehorn, long handled sponge, dressing stick and sock
aid to prevent the patient from breaking precautions
and making the task possible.
Knee Replacement Surgery
 Total knee replacements will typically have less precautions to follow but can be more
painful for the patient than hip replacements.
 These tips can help increase the patient’s function and mobility following a total knee
replacement.
 Always use the assistive device provided (usually rolling walker) until cleared by
the doctor or physical therapist.
 When ambulating, lead with the walker, then the surgical leg, followed by the nonsurgical leg, being sure to keep the walker close
 Keep the surgical leg elevated and extended with a towel roll under the heel when
sitting or lying down
 Avoid twisting the surgical leg
 Avoid sitting in low chairs or surfaces. For example, use a bedside commode over
the toilet or next to the bed as low toilets are more difficult to get up from
following a knee replacement. The patient can also purchase a raised toilet seat
with handles if a bedside commode is not covered.
 Lower body dressing is usually difficult for knee surgeries as well, so the hip
kit will also be invaluable for donning/doffing socks, shoes and threading pants.
Spinal Surgery
 Spinal surgeries, whether elective or not, may also be extremely painful for your patient
the first few days.
 The general precautions are as follows: Spinal Precautions (“The BLT’s”)
 No bending forward past 90
 No lifting over 5 or 10 pounds, depending on the doctor’s orders
 No twisting the trunk during any activities
 In addition to the BLT’s, instruct the patient to use the log rolling method during
bed mobility tasks to avoid twisting the spine. This may take some repetition as
patients forget this one more often than not and may end up twisting when getting
out of bed.
 If the patient is provided a brace, they must always wear it when out of bed until
the doctor states otherwise. A really great intervention following the surgery is
instructing them on putting it on without twisting.
Shoulder Surgery
 Shoulder replacements/arthroplasties are less commonly seen in the rehab setting since
many of these patients go home shortly after the surgery. Many of these surgeries are
seen only 1-2 times in acute care followed by outpatient OT or PT services depending on
the surgeon’s referral.
 The general precautions immediately following shoulder arthroplasty are as follows:
 Keep sling on affected arm for at least one week, including when sleeping. Some
resources state to wear the sling for 4-6 weeks while sleeping and while entering
the community, but this will depend on the surgeon’s orders.
 No pushing up from affected upper extremity
 The sling may be removed gradually over the course of the week to move the
elbow, wrist and hand several times a day, as well as during Pendulum
exercises (if prescribed)
 No lifting objects heavier than a coffee cup
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While lying supine, place a small pillow or towel roll behind the elbow to avoid
shoulder hyper-extension (Cleveland Shoulder Total Shoulder
Arthroplasty/Hemiarthroplasty Protocol)
No external rotation beyond 30 in scaption.
 ADL Education Following Shoulder Surgery
 No pushing up from chair, toilet, bed, etc. with the surgical arm for X number of
weeks (X = doctor’s recommendation)
 No hygiene tasks reaching back during toileting with operative arm until cleared
 Upper body dressing is generally the most challenging task after this surgery. The
best way to educate your patient in completing upper body dressing is to wear
button-up, loose fitting shirts and to not use operative arm during the task. To doff
the shirt, start with taking the shirt off the non-operative arm first, then gently
slide the shirt off of the non-operative arm.
 To don a shirt, start with the operative arm first by gently sliding the shirt onto it
with the non-surgical arm, then pull the unaffected arm in, buttoning with the nonsurgical arm. After the shirt is on, the sling can be applied.
 Use the non-surgical arm for all other basic ADLs until cleared (grooming, eating,
bathing, dressing, cooking, etc.)
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