hip replacement travel restrictions

Traveling Within Two Days After Hip Replacement: Is It Safe?

• Last updated Jun 11, 2024
• Difficulty Beginner

• Category Travel

Hip replacement surgery is a common procedure that provides relief for people suffering from chronic hip pain and mobility issues. However, the recovery process can be lengthy and require a significant amount of rest. As travel plans often arise, it is natural to wonder whether it is safe to travel within two days after hip replacement surgery. In this article, we will explore the potential risks and benefits of traveling shortly after surgery and provide some guidelines to help you make an informed decision about post-operative travel.

What You'll Learn

Preparing for travel: two days after hip replacement surgery, transportation options for traveling post-hip replacement surgery, tips for comfortable travel following hip replacement surgery, considerations and risks of traveling shortly after hip replacement surgery.

Hip replacement surgery can be a life-changing procedure for individuals suffering from severe hip pain and limited mobility. However, recovery after surgery is crucial to ensure the success and longevity of the new hip joint. While it is generally recommended to limit physical activity and avoid long trips during the initial recovery period, some individuals may have circumstances that require travel soon after surgery. If you find yourself in this situation, here are a few important factors to consider when preparing for travel just two days after hip replacement surgery.

• Consult with your surgeon: Before making any travel plans, it is essential to consult with your surgeon to ensure it is safe for you to travel so soon after surgery. Your surgeon will consider factors such as your overall health, the complexity of your surgery, and any specific risks associated with your condition. They will provide specific instructions based on your unique circumstances.
• Timing: Two days after hip replacement surgery is a very early stage in the recovery process. During this time, your body will still be healing, and you may experience pain, discomfort, and limited mobility. It is crucial to understand that traveling at this stage may not be ideal, but in certain situations, with your surgeon's approval, it may be necessary. Ideally, it is recommended to postpone travel plans until you have reached a more stable stage in your recovery.
• Mode of travel: The mode of travel you choose can significantly impact your comfort and safety during the journey. If possible, opt for a mode of transportation that allows you to minimize movement and stress on your hip joint. For example, traveling by car or train may be more comfortable than flying, as it allows you to have more control over your positioning and take regular breaks to stretch your legs.
• Preparation for the journey: If you receive clearance from your surgeon to travel, there are several preparations you can make to ensure a smooth and comfortable journey. Firstly, pack essential items such as pain medication, any necessary medical supplies, and comfortable clothing. It is also recommended to bring a pillow or cushion to provide support during the journey. Additionally, plan your travel schedule carefully to allow for sufficient rest breaks and avoid rushing or excessive activity.
• Accommodations: When making travel arrangements, consider booking accommodations that are conveniently located and offer suitable accessibility. Look for hotels or rental properties that have elevators or ground-floor rooms to minimize the need to navigate stairs. Request room modifications, such as grab bars in the bathroom or a shower chair, to ensure your comfort and safety.
• Supportive aids: Depending on your needs and mobility limitations, consider using supportive aids such as crutches, a walker, or a cane during your journey. These aids can provide stability and help reduce stress on your hip joint. Discuss with your surgeon or physical therapist which aids are most appropriate for your specific situation.
• Hydration and nutrition: Staying hydrated and maintaining a nutritious diet is essential for promoting healing and preventing complications after surgery. Make sure to drink plenty of water during your journey and have healthy snacks readily available. Avoid consuming excessive amounts of caffeine or alcohol, as they can dehydrate your body.
• Assistance and companionship: Traveling alone may be challenging and even risky during the early stages of hip replacement recovery. If possible, arrange for a friend or family member to accompany you on your journey. Having someone nearby can provide assistance with carrying luggage, navigating the airport or train station, and providing emotional support during this vulnerable time.

Remember, it is always best to follow the guidance of your surgeon and healthcare team regarding travel after hip replacement surgery. While it may be possible to travel two days after surgery in certain situations, it is crucial to prioritize your recovery and listen to your body's needs. Your health, comfort, and safety should remain the top priorities as you plan your journey.

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After undergoing hip replacement surgery, it's natural to have concerns about traveling and transportation. It's important to take proper care of your new hip and ensure a smooth and comfortable journey to your destination. In this article, we will discuss various transportation options that are suitable for individuals who have recently had a hip replacement surgery.

Public Transportation:

Using public transportation such as buses, trains, and trams can be a convenient and cost-effective option for post-hip replacement patients. However, it's important to keep the following considerations in mind:

• Accessibility: Check if the public transportation system you intend to use is fully accessible for individuals with mobility limitations. Look for wheelchair ramps, elevators, and designated seating areas.
• Timing: Plan your journey according to the schedule of the public transportation system. Avoid peak hours to minimize the risk of overcrowding and potential injuries.
• Supportive seating: Ensure that the seating on public transportation is comfortable and supportive for your post-surgery needs. Look for seats with adequate cushioning and back support.

Private Car or Taxi:

Taking a private car or taxi can offer more comfort and convenience compared to public transportation. Here are some considerations for traveling in a private vehicle:

• Arrange for Assistance: If you are not able to drive yourself, arrange for someone to drive you or consider using a taxi service. Having someone accompany you can provide additional support and help you navigate any challenges that may arise during the journey.
• Comfortable Seating: Ensure that the vehicle you choose has comfortable and supportive seating. Consider using pillows or cushions to provide extra comfort and support for your hip.
• Avoid Bumpy Roads: Choose routes that have well-maintained and smooth roads to minimize jarring movements that can cause discomfort. Avoid potholes and rough terrain as much as possible.

Air Travel:

If you plan on taking a flight post-hip replacement surgery, there are a few considerations to keep in mind:

• Consult Your Surgeon: Before booking a flight, consult with your surgeon to ensure that you are fit to fly. They will provide guidance based on your specific condition and recommend the best time to travel.
• Request Assistance: Inform the airline about your condition and request assistance if needed. Many airlines offer wheelchair services and priority boarding for individuals with mobility limitations.
• Choose an Aisle Seat: Opt for an aisle seat to make it easier to move around during the flight. This will allow you to stretch your legs and reduce the risk of developing blood clots.
• Pack Essentials: Pack any necessary medications, medical documents, and comfortable clothing for the flight. Consider wearing compression stockings to improve blood circulation and reduce swelling.

Remember to always consult with your medical team before making any travel plans. They will provide personalized advice based on your specific situation and guide you on the best options for transportation post-hip replacement surgery. Taking proper care and following these transportation tips will help you have a safe and comfortable journey, allowing you to focus on your recovery.

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Hip replacement surgery is a major procedure that requires time for recovery and rehabilitation. Traveling after hip replacement surgery can be challenging, but with proper planning and preparation, it can be made more comfortable. Whether you need to travel two days after hip replacement or at a later date, here are some tips to help you have a smoother journey:

• Consult with Your Surgeon: Before making any travel plans, it's important to consult with your surgeon. They will be able to assess your specific situation and give you personalized advice on when it's safe for you to travel. They can also provide you with any necessary documentation or medical clearance for your journey.
• Plan Ahead: If you know in advance that you will be traveling after hip replacement surgery, it's essential to plan ahead. This includes booking your flights or any other mode of transportation, as well as arranging for any necessary assistance or accommodations, such as wheelchair assistance or an aisle seat.
• Pack Essentials: When packing for your trip, be sure to include any necessary medications, mobility aids, and comfortable clothing. You may also want to bring a travel pillow or cushion to provide extra support and comfort during the journey.
• Use Assistive Devices: Depending on your level of mobility, you may need to use assistive devices such as crutches, a walker, or a cane. Make sure you are familiar with how to use these devices properly and practice using them before your trip.
• Take Regular Breaks: It's important to take regular breaks and avoid sitting or standing for prolonged periods of time. If you're traveling by car, make frequent stops to stretch your legs and walk around. If you're flying, take advantage of opportunities to get up and move around the cabin.
• Request Special Assistance: When booking your travel arrangements, don't hesitate to request any special assistance that you may require. Airlines and other transportation providers are often willing to accommodate passengers with medical conditions or disabilities. This can include pre-boarding, wheelchair assistance, or extra legroom.
• Stay Hydrated: It's important to stay hydrated during your trip, as proper hydration can aid in the healing process. Drink plenty of water and avoid alcohol and caffeine, as they can contribute to dehydration.
• Follow Rehabilitation Guidelines: Your surgeon or physical therapist will provide you with specific exercises and guidelines for post-surgery rehabilitation. It's important to continue following these guidelines even when traveling. This may include performing exercises, wearing compression stockings, or taking precautions to avoid falls.
• Plan for Assistance at Your Destination: If you're traveling to a destination where you won't have access to the same support system you have at home, it's important to plan for assistance. This can include arranging for a rental wheelchair or scooter, hiring a personal caregiver, or staying at a hotel that is accessible and equipped to handle your needs.
• Stay Positive and Patient: Lastly, it's important to stay positive and patient throughout your journey. Traveling after hip replacement surgery can be physically and emotionally taxing, but having a positive mindset and being patient with yourself can make a significant difference.

In conclusion, traveling after hip replacement surgery requires careful planning and preparation. By following these tips, you can make your journey more comfortable and ensure a smoother recovery. Remember to always consult with your surgeon before making any travel plans and to prioritize your health and well-being throughout the process.

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If you are considering traveling shortly after hip replacement surgery, it is important to understand the considerations and risks involved. While it is possible to travel two days after the procedure, it is not recommended for everyone and should only be done with proper medical guidance. Here are a few key points to keep in mind:

• Consult with your surgeon: The first step before planning any travel post-surgery is to consult with your surgeon. They will be able to assess your specific case and advise you on whether it is safe for you to travel. They can evaluate your overall health, the type of surgery you had, and any potential complications that may arise from traveling.
• Pain management: Two days after hip replacement surgery, it is common to experience pain and discomfort. Managing your pain properly is crucial during the initial recovery period. It is important to discuss pain management strategies with your surgeon so that you can have an effective plan in place while traveling.
• Mobility and activity limitations: In the early stages of recovery, you will have limited mobility and range of motion. It may be challenging to move around, stand, or sit for long periods. Traveling by car or plane may not be ideal, as you may have difficulties with sitting for an extended duration or taking necessary precautions such as walking and stretching.
• Blood clot risk: After surgery, there is an increased risk of developing blood clots, also known as deep vein thrombosis (DVT). Traveling long distances, especially by air, can further increase this risk. It is important to discuss preventive measures with your surgeon, such as the use of compression stockings, frequent leg exercises, and medication to prevent blood clot formation.
• Infection risk: Traveling shortly after surgery can increase the risk of infection. Public transportation, crowded areas, and exposure to different environments may expose you to infectious agents. Your immune system is already compromised during the initial healing process, so it is essential to take extra precautions like practicing good hygiene and avoiding exposure to potential pathogens.
• Follow-up care: Immediately after surgery, you will require regular follow-up appointments with your surgeon to monitor your progress and ensure proper healing. Traveling may make it challenging to attend these important post-surgery appointments, which can affect your recovery.

If your surgeon determines that it is safe for you to travel two days after hip replacement surgery, here are some tips to make it more comfortable:

• Opt for a direct flight or car travel rather than long layovers or transfers.
• Request for any necessary assistance at the airport or train station, such as wheelchairs or assistance with luggage.
• Take frequent breaks during your journey to walk, stretch, and promote blood circulation.
• Pack essential medications, pain relievers, and any necessary medical supplies.
• Maintain proper hygiene by carrying hand sanitizers and cleaning wipes to reduce the risk of infection.

In conclusion, traveling two days after hip replacement surgery is possible in certain cases, but it should only be done under medical guidance and consideration of the potential risks and limitations. Consult your surgeon before making any travel plans and follow their recommendations for a safe and successful recovery.

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Frequently asked questions.

Most surgeons recommend that patients do not travel within the first two weeks after hip replacement surgery. It is important to allow your body time to heal and avoid putting unnecessary stress on the surgical area.

It is generally recommended to wait at least two weeks before traveling after hip replacement surgery. This allows enough time for the initial healing process and reduces the risk of complications.

Flying two days after hip replacement surgery is not recommended. The changes in air pressure during flight can increase the risk of blood clots and other complications. It is best to wait until your surgeon clears you for travel.

If you must travel two days after hip replacement surgery, it is important to take proper precautions. These may include wearing compression stockings to improve circulation, staying hydrated, and moving around regularly to prevent blood clots. It is best to consult with your surgeon for specific guidelines and advice.

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• What are the dos and don'ts after a hip replacement?

You have an important role in caring for your “new” hip:

• Do use crutches or a walker to assist with walking; be safe, falls can be disastrous
• Do use pillows between your legs or under your knee on the side of your new hip replacement in bed to keep your operated leg out to the side
• Do continue to wear your TED stockings. A second pair can be provided for you at the time of your discharge so you have a pair to wear while washing the other pair
• Do continue the exercises that you have been instructed in by the physical therapist
• Do use assistive devices to put on shoes and socks
• Do use an elevated toilet seat or bedside commode.You may purchase one from a local medical supply store or possibly borrow one through your local community organizations
• Do avoid constipation. While you are taking narcotics, you may need to take a stool softener and a laxative

There are certain movements that place stress on your new hip and should be avoided until you are instructed to do otherwise by your doctor:

• Do not overdo it; plan your activities with frequent rest periods.
• Do not bend your hip more than ninety degrees; do not sit in low or overstuffed sofas and chairs; do not sit in bucket seats in cars; do not pick up items from the floor – use a grabbing device.
• Do not cross your legs
• Do not drive a car until authorized by your doctor
• Do not lift heavy objects
• Do not have sexual intercourse until after your six-week follow-up visit and your doctor has given you permission; intercourse will be uncomfortable the first weeks after surgery
• Do not bathe in a bathtub or hot tub, swim in a pool, lake, or ocean until your physician gives you permission
• Do not play tennis, downhill ski, water ski, run, jog, or do other demanding physical activities that require quick starts and stops without first consulting your physician 
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How Soon Can I Travel After Hip Replacement?

People frequently ask when they can travel after their hip replacement. The thing to remember is that it is typically not the hip that’s going to get in the way of the travel. The issue is that you are at a unique risk for things like blood clots or complications from surgery during the first six or eight weeks.

That’s why those first six or eight weeks are golden time. You should make sure that you’re dedicating that time to your recovery. Listen to your physical therapist and make sure that you are dealing with any other medical issues that might arise.

After six weeks, people can typically travel. We might recommend blood thinners for travel, for example, if you are planning to take intercontinental or transcontinental flights. This might be as simple as taking an aspirin, or we might suggest something more robust if you have a known history of blood clots.

We highly recommend that you discuss any travel plans with your surgeon prior to scheduling surgery.

(415) 530-5330

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Nicholas Mast MD is a board-certified orthopedic surgeon specializing in conditions of the hip and pelvis.

Trained in pelvic and acetabular trauma and reconstruction by some of the best in the field, his treatments range from non-replacement options for the management of hip osteoarthritis to complex revision surgeries and hip preservation techniques including periacetabular osteotomy.

He is the most experienced surgeon in the region in the use of the anterior approach for hip replacement and regularly uses this minimally invasive, fast recovery anterior approach to treat a wide variety of hip conditions.

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San Francisco Location 2250 Hayes Street, Suite 208 San Francisco, CA 94117

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Phone: (415)530-5330 Fax: (415)-530-5333

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• Artificial hip

Hip prostheses are designed to mimic the ball-and-socket action of your hip joint. During hip replacement surgery, your surgeon removes the diseased or damaged parts of your hip joint and inserts the artificial joint.

During hip replacement, a surgeon removes the damaged sections of the hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.

Also called total hip arthroplasty, hip replacement surgery might be an option if hip pain interferes with daily activities and nonsurgical treatments haven't helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement.

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Why it's done

Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:

• Osteoarthritis. Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.
• Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.
• Osteonecrosis. If there isn't enough blood supplied to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone might collapse and deform.

Hip replacement may be an option if hip pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from a seated position

Risks associated with hip replacement surgery can include:

• Blood clots. Clots can form in the leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. Blood-thinning medications can reduce this risk.
• Infection. Infections can occur at the site of the incision and in the deeper tissue near the new hip. Most infections are treated with antibiotics, but a major infection near the new hip might require surgery to remove and replace the artificial parts.
• Fracture. During surgery, healthy portions of the hip joint might fracture. Sometimes the fractures are small enough to heal on their own, but larger fractures might need to be stabilized with wires, screws, and possibly a metal plate or bone grafts.
• Dislocation. Certain positions can cause the ball of the new joint to come out of the socket, particularly in the first few months after surgery. If the hip dislocates, a brace can help keep the hip in the correct position. If the hip keeps dislocating, surgery may be needed to stabilize it.
• Change in leg length. Surgeons take steps to avoid the problem, but occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contracture of muscles around the hip. In these cases, progressively strengthening and stretching those muscles might help. Small differences in leg length usually aren't noticeable after a few months.
• Loosening. Although this complication is rare with newer implants, the new joint might not become solidly fixed to the bone or might loosen over time, causing pain in the hip. Surgery might be needed to fix the problem.
• Nerve damage. Rarely, nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.

Need for second hip replacement

The artificial hip parts might wear out eventually, especially for people who have hip replacement surgery when they're relatively young and active. If this happens, you might need a second hip replacement. However, new materials are making implants last longer.

How you prepare

Before the operation, you'll have an exam with the orthopedic surgeon. The surgeon may:

• Ask about your medical history and current medications
• Examine your hip, paying attention to the range of motion in your joint and the strength of the surrounding muscles
• Order blood tests and an X-ray. An MRI is rarely needed

During this appointment, ask any questions you have about the procedure. Be sure to find out which medications you should avoid or continue to take in the week before surgery.

Because tobacco use can interfere with healing, it's best to stop using tobacco products. If you need help to quit, talk to your doctor.

What you can expect

When you check in for your surgery, you'll be asked to remove your clothes and put on a hospital gown. You'll be given either a spinal block, which numbs the lower half of your body, or a general anesthetic, which puts you into a sleep-like state.

Your surgeon might also inject a numbing medicine around nerves or in and around the joint to help block pain after your surgery.

During the procedure

The surgical procedure can be completed within two hours. To perform a hip replacement, the surgeon:

• Makes an incision over the hip, through the layers of tissue
• Removes diseased and damaged bone and cartilage, leaving healthy bone intact
• Implants the replacement socket into the pelvic bone
• Inserts a metal stem into the top of the thighbone, which is then topped with a replacement ball

After the procedure

After surgery, you'll be moved to a recovery area for a few hours while your anesthesia wears off. Medical staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.

You'll be asked to breathe deeply, cough or blow into a device to help keep fluid out of your lungs. How long you stay after surgery depends on your individual needs. Many people can go home that same day.

More information

• Outpatient joint replacement: Is it a safe option?

Blood clot prevention

After hip replacement surgery, you'll temporarily be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:

• Moving early. You'll be encouraged to sit up and walk with crutches or a walker soon after surgery.
• Applying pressure. Both during and after surgery, you might wear elastic compression stockings or inflatable air sleeves on your lower legs. The air sleeves squeeze and release your legs. That helps keep blood from pooling in the leg veins, reducing the chance that clots will form.
• Blood-thinning medications. Your surgeon might prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you might need blood thinners for several weeks after surgery.

Physical therapy

Daily activity and exercise can help you regain the use of your joint and muscles. A physical therapist can recommend strengthening and mobility exercises and can help you learn how to use a walking aid, such as a walker, a cane or crutches. As therapy progresses, you'll gradually increase the amount of weight you put on your leg until you're able to walk without assistance.

Home recovery

Before you leave the hospital, you and your caregivers will get tips on caring for your new hip. For a smooth transition:

• Arrange to have a friend or relative prepare some meals in advance
• Place everyday items at waist level, so you won't have to bend down or reach up
• Consider getting a raised toilet seat and a shower chair for your recovery at home
• Put your phone, tissues, TV remote, medicine and books near the area where you'll be spending most of your time during recovery

Full recovery from a hip replacement varies from person to person, but most people are doing well three months after the surgery. Improvements typically continue during the first year after surgery.

The new hip joint can reduce pain and increase the hip's range of motion. But don't expect to do everything you could do before the hip became painful.

High-impact activities, such as running or playing basketball, might be too stressful on the artificial joint. But in time, most people can participate in lower-impact activities — such as swimming, golfing and bicycle riding.

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Hip replacement care at Mayo Clinic

• Hip replacement. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/hip-replacement-surgery/advanced. Accessed Nov. 2, 2021.
• Erens GA, et al. Total hip arthroplasty. https://www.uptodate.com/contents/search. Accessed Nov. 2, 2021.
• Total hip replacement. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/total-hip-replacement. Accessed Nov. 2, 2021.
• Goldman L, et al., eds. Surgical treatment of joint diseases. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 2, 2021.
• Erens GA, et al. Complications of total hip arthroplasty. https://www.uptodate.com/contents/search. Accessed Nov. 2, 2021.
• Azar FM, et al. Arthroplasty of the hip. In: Campbell's Operative Orthopaedics. 14th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Nov. 2, 2021.
• Office of Patient Education. Total hip replacement surgery. Mayo Clinic; 2018.
• Sierra RJ (expert opinion). Mayo Clinic. Dec. 8, 2021.
• Jensen NA. Allscripts EPSi. Mayo Clinic. Dec. 10, 2021.
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News from Mayo Clinic

• Mayo Clinic expert: Warm climates offer mobility options for snowbirds after surgery Jan. 29, 2024, 10:07 p.m. CDT
• Mayo Clinic Minute: What to know about aging and joint replacements Oct. 31, 2023, 03:49 p.m. CDT
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• Mayo Clinic in Florida awarded top national certification for advanced total hip, knee replacement Oct. 28, 2022, 03:00 p.m. CDT
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Exercises and Activities to Avoid After Hip Replacement

Recovery can take from three months to over a year

If you have had a total hip replacement surgery , there are certain precautions you need to take while you are recovering. This is especially true if your surgery was done via a posterior approach (at the back of the hip, near the buttocks).

These precautions are important in order to avoid a hip replacement dislocation . When this happens, the artificial ball of the upper leg (femur) slips out of the artificial hip socket.

This article will explain the three precautions you need to take after your surgery and for how long.

According to research from the University Hospital of Cologne, around 2% of people with a total hip replacement will experience a dislocation within a year, while 28% of those with a second hip replacement will experience the same.

Click Play to Learn More About Hip Replacement Exercises to Avoid

This video has been medically reviewed by Oluseun Olufade, MD .

Precautions After Hip Replacement

For at least the six weeks after surgery, and sometimes up to six months, you'll need to take extra precautions as your mobility returns. For example:

• Avoid bending your hip past 90 degrees
• Don't cross your leg on the side with the new hip over your other leg
• Keep your toes straight when you walk

Recommendations

After a total hip replacement with a posterior incision, three movements should be avoided to prevent the dislocation of your artificial hip. Until you are fully recovered and your mobility and range of motion have been fully evaluated by your orthopedic surgeon, you should avoid:

• Hip flexion past 90 degrees : This means that you should not bend your hip up too far or lift your knee too high. When you are sitting in a chair, for example, your thigh should be parallel to the floor. Sitting in a low chair or bending your knee and hip up to put on a sock may break this 90-degree rule and put you at risk for hip dislocation.
• Crossing your operated leg over the other one : You should not cross your leg with the new hip over the other one. You may be required to use a special wedge called an abduction pillow when sleeping to help keep your legs separated.
• Walking pigeon-toed (internal rotation of the hip) : After a posterior approach total hip replacement, you should not rotate your hip inward. This means that your toes should be kept straight ahead or slightly rotated outwards when walking, sitting, standing, or lying down.

Sometimes the very exercises you may do as part of a physical therapy program after hip surgery can be risky. Your physical therapist can show you how to do them so they don't result in a dislocation.

When to Call Your Healthcare Provider

Call your healthcare provider if you experience signs of hip replacement dislocation, including:

• Intense pain in the hip and groin
• A popping sound when you move
• Difficulty walking or an inability to walk
• Feeling like the hip joint "catches" with movement
• Inability to move the hip joint
• Noticing that the leg with the prosthetic hip is suddenly shorter than the other

Duration of Precautions

Most people need to follow the precautions for approximately 90 days after surgery. Some healthcare providers may want you to follow the precautions for about six months. Others may only have you follow them for 60 days. It all depends on your health and mobility level before the surgery and how complex the surgery was. It will also depend on the intensity of your post-operative rehabilitation and recovery.

Your healthcare provider will tell you when you no longer need to follow your total hip precautions.

A 2011 study in the Journal of Orthopaedic & Sports Physical Therapy reported that most people experience rapid recovery in the first three to four months following a total hip replacement. After that, improvements continue at a slower rate for up to a year.

Lifetime Precautions

Depending on your age and physical condition, you may also need to adopt some lifetime precautions after hip surgery, including:

• Avoid bending the hip too far: Older adults in particular should continue to avoid flexing the hip past 90 degrees or lifting the knee above hip level. Don't sit in deep or low chairs if they will result in a high knee position.
• Avoid twisting motions: Certain movements can increase the risk of dislocation. Examples include crossing your legs, pivoting, or walking with your toes turned in.
• Sleep with a pillow between your legs: If you are a side sleeper, it's a good idea to keep a pillow between your legs to help your hip and leg stay aligned.
• Avoid high-impact, repetitive activities: Running, jumping, and high-impact sports that involve a lot of twisting like basketball and racquetball may cause wear and increase the risk of dislocation.

Talk to your healthcare provider about whether these precautions are necessary in your situation.

After a total hip replacement surgery, you will do rehab with a physical therapist. You will also need to avoid certain movements in your everyday life to avoid the possibility of dislocating your new hip ball and socket.

Remember that each person heals differently after total hip replacement surgery. Working with your physical therapist is the best way to ensure a safe and rapid recovery.

Frequently Asked Questions

Many of the risk factors are beyond your control. Underlying neuromuscular disorders, for instance, play a role. Surgical mistakes such as the protheses being placed incorrectly can also lead to displacement. However, you can lower the risk by not pushing your range of motion: Don’t bend far forward from a standing position and avoid making an internal rotation of the flexed hip.

Yes. The hip should be treated with a technique called reduction within 6 hours of the displacement to avoid permanent complications or the need for additional surgeries or invasive procedures.

Ärzteblatt DÄG Redaktion Deutsches. Dislocation following total hip replacement . Deutsches Arzteblatt . 2014;111(51-52):884-890. doi:10.3238%2Farztebl.2014.0884

Dawson-Amoah K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the hip: a review of types, causes, and treatment . TOJ . 2018;18(3):242-252. doi:10.31486/toj.17.0079

Zahar A, Rastogi A, Kendoff D. Dislocation after total hip arthroplasty .  Curr Rev Musculoskelet Med . 2013;6(4):350–356. doi:10.1007/s12178-013-9187-6

Peters A, Tijink M, Veldhuijzen A, Huis in 't Veld R. Reduced patient restrictions following total hip arthroplasty: study protocol for a randomized controlled trial .  Trials . 2015;16:360. doi:10.1186/s13063-015-0901-0

Barnsley L, Barnsley L, Page R. Are hip precautions necessary post total hip arthroplasty? A systematic review .  Geriatr Orthop Surg Rehabil . 2015;6(3):230–235. doi:10.1177/2151458515584640

Eannucci EF, Barlow BT, Carroll KM, Sculco PK, Jerabek SA, Mayman DJ. A Protocol of Pose Avoidance in Place of Hip Precautions After Posterior-Approach Total Hip Arthroplasty May Not Increase Risk of Post-operative Dislocation .  HSS J . 2019;15(3):247–253. doi:10.1007/s11420-019-09708-9

Madara KC, Marmon A, Aljehani M, Hunter-Giordano A, Zeni J Jr, Raisis L. PROGRESSIVE REHABILITATION AFTER TOTAL HIP ARTHROPLASTY: A PILOT AND FEASIBILITY STUDY .  Int J Sports Phys Ther . 2019;14(4):564–581.

Teyhen DS, Robertson J. Total hip replacement: how long does it take to recover? . J Orthop Sports Phys Ther . 2011;41(4):240. doi:10.2519/jospt.2011.0502

By Laura Inverarity, DO  Laura Inverarity, PT, DO, is a current board-certified anesthesiologist and former physical therapist.

• Anterior Hip Replacement Do’s and Don’ts

By: Saurabh Dang, MD, Interventional Pain Physician

Peer-Reviewed

Immediately after hip replacement surgery , a patient is given a list of precautions—certain movements and activities that should be avoided in order to protect the new hip’s ball and socket from injury, particularly dislocation. Unlike other types of hip replacements, anterior hip replacements require few, if any, precautions.

See Post-Surgical Hip Replacement Precautions and Tips

Show Transcript

For example, people who have traditional hip replacements are told not to bend at the hip more than 90 degrees for about 6 weeks. This precaution makes it challenging to sit on low chairs, sofas, or toilets. Anterior hip replacement patients do not have to follow this precaution.

See Total Hip Replacement Surgery Recovery

In This Article:

• Anterior Hip Replacement Exercises

Why Anterior Hip Patients Have Fewer Precautions

During anterior hip replacement surgery , the surgeon makes an incision at the front of the hip and does not need to cut any nearby muscles or other soft tissues. These soft tissues naturally support the hip joint, so keeping them intact reduces the risk of the new hip dislocating.

See Advantages and Disadvantages of Anterior Hip Replacement

Other types of hip replacements (including anterior-lateral hip replacement) involve incisions at the side or back of the hip. The surgeon must cut soft tissue to access the hip joint and perform the hip replacement. After surgery, the cut soft tissue needs several weeks to heal. During this time the risk of dislocating the new hip is significantly increased.

See Anterior vs. Posterior Hip Replacement Surgeries

Postsurgical Precautions Can Vary for Anterior Patients

Many surgeons believe the risk of dislocation after anterior hip replacement is so low that precautions are not necessary. 1 Restrepo C, Mortazavi SMJ, Brothers J, Parvizi J, Rothman RH. Hip Dislocation: Are Hip Precautions Necessary in Anterior Approaches? Clinical Orthopaedics and Related Research. 2011;469(2):417-422. These surgeons may tell patients to do whatever is comfortable. Other surgeons recommend a few precautions to their anterior hip patients, or recommend precautions on a case-by-case basis.

When precautions are recommended, they may be different, and sometimes even contrary, to the precautions for other types of hip replacements. 2 Disario, A. Anterior Hip Replacement: An Overview. Hospital for Special Surgery. https://www.hss.edu/conditions_anterior-hip-replacement-overview.asp. Posted January 18, 2012. Accessed July 11, 2016.

Because there are no standard, universally agreed-upon precautions for anterior hip replacement, patients are advised to follow their surgeons’ and physical therapists’ instructions. These medical professionals are able to tailor post-surgical instructions to an individual patient’s needs.

• 1 Restrepo C, Mortazavi SMJ, Brothers J, Parvizi J, Rothman RH. Hip Dislocation: Are Hip Precautions Necessary in Anterior Approaches? Clinical Orthopaedics and Related Research. 2011;469(2):417-422.
• 2 Disario, A. Anterior Hip Replacement: An Overview. Hospital for Special Surgery. https://www.hss.edu/conditions_anterior-hip-replacement-overview.asp . Posted January 18, 2012. Accessed July 11, 2016.

Dr. Saurabh Dang is an interventional pain physician at Garden State Pain Control. Dr. Dang specializes in various methods of treating chronic back pain, including interventional pain injections, spinal cord stimulation, neuromodulation, and intrathecal drug delivery systems.

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What Are Permanent Restrictions After Hip Replacement?

To ensure the longevity and proper functioning of the artificial hip joint, which replaced the damaged hip joint, certain permanent restrictions, precautions and lifestyle changes are absolutely necessary after hip replacement. These are not just critical in the initial recovery stage, but also play a significant role in maintaining the stability of the joint in the long run.

The restrictions imposed post-hip replacement are designed to prevent complications such as dislocation, wear, and tear of the prosthetic components, and to maximize the implant’s lifespan. Physical therapy is a crucial part of the recovery process. This rehab program is very important for regaining strength, flexibility, and mobility.

Remember, these are general guidelines, and individual recommendations can vary depending on your specific circumstances and also the type of implant used. Do talk to your doctor or physical therapist to avoid complications.

Permanent Restrictions After Hip Replacement

As already noted, while these limitations might require some adjustments to one’s lifestyle and daily activities, they are essential for safeguarding the hip joint and ensuring that the benefits of the surgery are long-lasting. Adhering to these guidelines not only helps in a smoother recovery but also contributes to a more active and pain-free life after your surgery.

The restrictions after hip replacement are:

Certain movements and positions

Some movements can increase the risk of limiting the internal rotation , dislocation or harm to the soft tissue surrounding the new joint. The hip joint’s stability is partly dependent on the muscles and ligaments around it, which are still healing and adapting after surgery. These are:

• Deep squats
• Leg crossing
• Extreme stretching movements.
• Movements that twist the hip or turn the foot excessively inward should also be avoided.

Also, there are quite a few positions to avoid as they can put the hip at an unnatural angle, increasing the risk of dislocation, especially in the first few months after surgery when the tissues are healing. However, it is highly recommended that these positions and restrictions are avoided after hip replacement in the long run too.

• Bending forward past 90 degrees,
• Twisting the hip while sitting
• Crossing the legs at the knees,
• Avoid raising your knee beyond the level of your hip.
• Refrain from leaning forward either when seated or during the process of sitting down.
• Do not ever attempt to retrieve items from the floor while in a seated position.

High-impact activities and quick turns and twists

These activities can put excessive stress on the artificial joint, which can cause wear and tear of the prosthetic components. This can lead to loosening or even failure of the implant.

Besides running and jumping, this also includes activities like heavy lifting, intense aerobics, or sports that involve quick turns and twist. Avoiding permanent restrictions after hip replacement is necessary to promote a successful and effective recovery process.

Long-term care

Long-term care and permanent restrictions and precautions are necessary to avoid complications after hip replacement. It’s often recommended to continue with specific exercises or physical therapy routines to strengthen the hip and maintain a range of motion that supports the joint’s stability.

Also consider using some assistive devices like a raised toilet seat, shower chair, or tools to help with dressing to reduce the need to bend or twist. Long-term mindfulness about how to sit, lie down, and bend over is important for protecting the hip.

This article is for educational and informational purpose only and does not substitute for professional medical advice. For any questions about your own health condition, speak to a qualified physician or healthcare provider.

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Will I Have Lifetime Precautions After Hip Replacement?

Table of Contents

Permanent Restrictions After Hip Replacement —

You likely understand the hip precautions you will have after your upcoming total hip replacement surgery.  Included in these precautions are don’t cross your legs, don’t bend over 90 degrees at the waist and don’t twist on that leg.

So does this mean you can never ever do these motions again?   You will get varying opinions on what you will be able to do again in the future.  Luckily, most of your early precautions will get lifted again at some point.

After hip replacement you will have permanent lifetime precautions but they include only specific activities.  You will never be able to position the hip in extreme rotation or bending positions like those in advanced yoga poses.  You will not be able to participate in contact, jumping or plyometric activities including football, basketball, hockey, volleyball and soccer.  Prolonged bending and kneeling should be avoided permanently as well.

Can You Ever Bend Over After Hip Replacement?

As you know initially you will not be allowed to bend at the waist greater than 90 degrees for the first 8-12 weeks after surgery.  This will affect basic activities such as tying your shoes, picking objects off the floor and getting dressed.

If you had an anterior hip replacement approach you will likely be able to bend over at the waist immediately after surgery.  Please check with your surgeon regarding this.

For standard posterior approach surgeries, you will likely be able to freely bend forward at the waist again after 3 months.  To be safe you may want to avoid this motion for an extra 2-3 months and avoid the extreme bending positions like the yoga pose in the picture shown.   Please check with your surgeon on their specific rules.

Will I Ever Be Able to Twist On My Leg After Hip Replacement?

For the first 8-12 weeks after hip replacement you will not be able to twist or pivot on your surgery leg to avoid possible dislocation.  This twisting hip precaution is the most important of all to maintain as twisting places a lot of strain on the new hip.

Luckily you will be able to twist and pivot on your new hip leg after a period of 3 months.  Again, you may want to avoid this motion for an extra month or two just to be safe and make sure your new hip is solidly in place.   Check with your surgeon on this precaution and the rules associated with it.

Can You Ever Cross Your Legs After Hip Replacement?

We all take crossing our legs for granted when we are sitting comfortably. After hip replacement you are not allowed to do so. This will limit the chances of hip dislocation for the first 8-12 weeks.

Good news for you is that crossing your legs is not a lifetime precaution .  You will be allowed to cross your legs once again roughly in the range of 3-4 months after surgery depending on your symptoms.

Crossing your legs involves hip internal rotation which is a movement that is forbidden in the early rehab phase.  I recommend to my patients to continue and avoid these types of motions for quite some time, 4-5 months to be safe.  

Rotational motions of the hip place the new artificial joint in the most vulnerable positions where a dislocation can happen the easiest.  Because of this, I advise extreme caution when attempting to return to these activities.

Can I Ever Sit in My Favorite Old Sofa Again After My Hip Is Replaced?

There’s a difference between can and should when it comes to sitting in a low soft unsupportive sofa after surgery.  Clearly you cannot sit in any low surface for the first few months after getting a new hip.

Let’s discuss what is best for you in the longer term as far as the proper sitting surfaces for the best outcomes.  I would highly recommend not sitting in that same old sofa that likely caused your hip issues in the first place.

Sure, you might miss that old couch because that’s what you’ve been used to sitting in for many years.  However, you need to be smart in terms of maximizing your future and keeping your new hip in shape.

Bottom line:  Its probably time to get a new sofa with better support and a higher sitting surface for your hip.  Sitting hours and hours in your old beat up sofa is not a good idea and something I would strongly recommend getting rid of.

PRO PT TIP : If you have other ailments such as knee or back arthritis you should consider purchasing a recliner lift chair . It makes for easier sleeping and allows for easy leg elevation to help with swelling. Consider it an investment in you health.

I always recommend Infinite Position Lift Chairs to my patients. Why? It allows you to elevate your legs above heart level for maximum swelling prevention. Yes it might cost more but its worth the extra investment.

[** Note: As an Amazon Associate I earn from qualifying purchases.]

Can You Kneel After Hip Replacement?

Hip replacements are not designed to be knelt on for prolonged periods of time. You can kneel for short timeframes however this is not a recommended activity.

Final Thoughts on Lifetime Precautions After Hip Replacement

• Lifetime Precautions Are Only for Jumping and High Impact Activities
• Activities You Should Never Do Again Include Competitive Basketball, Football, Soccer, Volleyball and Hockey
• You Can Return to Yoga However Avoid Extreme End-Range Positions Forever
• Consider Purchasing a Recliner Lift Chair if Other Ailments Are Involved

Many people are concerned that once they get their new hip they will no longer be able to do many things.  For the most part you will be able to return to most of those activities with no long term limitations.

If you are expecting to return to the extreme sports such as football, basketball or jumping activities you need to reevaluate your expectations.   Getting a new hip does not mean getting a fresh new leg but rather providing relief in that joint itself.

Don’t forget, the muscles and tissues around your new hip joint are still the same age as you.  You are not finding the fountain of youth and should be realistic in your goals after surgery.

About Jeffrey Roth MPT

Owner and operator of Roth Therapy Services in Pittsburgh, PA focusing on in home rehabilitation physical therapy services.

How Long Does it Take to Walk Normally After Hip Replacement Surgery?

Driving after hip replacement.

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What are the procedures if I have an internal or external medical device, such as a pacemaker or metal implant?

Advanced Imaging Technology (AIT) can facilitate your screening and reduces the likelihood of a pat-down. Inform the TSA officer that you have an artificial knee, hip, other metal implant or a pacemaker, defibrillator or other internal medical device. You should not be screened by a walk-through metal detector if you have an internal medical device such as a pacemaker. Consult with your physician prior to flying.

If you choose to not be screened through the  Advanced Imaging Technology (AIT), or a walk-through metal detector (WTMD), you will undergo a pat-down screening.

Total Hip Replacement (Direct Anterior Approach)

• • A minimally invasive surgery to replace a damaged hip while avoiding nearby muscles and tendons
• • For eligible patients who want less pain and a quicker recovery from surgery
• • Not all hip surgeons perform the anterior approach, which is more technically demanding
• • Involves joint reconstruction, trauma & fracture care
• Direct Anterior Approach Hip Replacement

What is the direct anterior hip approach and how is it different?

What will my experience be like with direct anterior hip replacement, what are the benefits of the direct anterior hip approach, what are the risks of direct anterior hip replacement, why should you go to yale medicine for a direct anterior hip replacement.

If you need a hip replacement, you may be worried about what lies ahead. That’s natural and understandable—but you will be pleased to learn that, in terms of outcome, a hip replacement is one of the most successful operations you can have. Though they sound dramatic and off-putting, hip replacements can be counted upon to reliably deliver pain relief and restore quality of life.

A type of hip replacement surgery called the direct anterior hip approach can make the early recovery after surgery even better. This is a minimally invasive technique. With anterior hip replacement, the surgeon makes a small incision near the front of the hip to allow for removal of damaged bone and cartilage, and implantation of an artificial hip without damaging surrounding muscle and tendons. Patients leave the hospital sooner than they would with some other approaches.  

Lee Rubin, MD , an orthopedic surgeon and chief of the Yale Medicine Joint Replacement Program, is a leading expert in the direct anterior approach. He is one of the few surgeons in the U.S to have learned the approach directly from Kristaps J. Keggi, MD, a Yale Medicine orthopedic surgeon who was among the first to recognize the benefits of the direct anterior approach.  

Since Dr. Keggi started performing direct anterior hip surgeries in the 1970s, the technique has sparked the evolution of minimally invasive hip surgery, according to Dr. Rubin. “As a result of this innovation, hip surgery has become a positively transformative experience for my patients,” he says.

A total hip replacement is exactly what it sounds like—a surgery to replace a natural hip joint that has worn out or been damaged with an artificial one. There are several surgical approaches that generally follow the same path: Your surgeon makes an incision near the hip joint, carefully extracts the diseased or damaged bone and cartilage, then inserts an artificial hip and secures it in place. (Your new hip might be made out of metal, plastic, or ceramic—or some combination of those materials.)

The direct anterior approach is a minimally invasive way to perform hip replacement surgery, and surgeons who perform it say it has advantages over traditional approaches. For example, the incision for the direct anterior approach is only three or four inches, compared to up to 12 inches with the traditional approach. Also, recovery after surgery is generally quicker. Patients typically go home sooner than with other approaches, have less pain, and can reach therapy milestones more rapidly after the procedure.

Why is this? The key difference is in how the surgery is done. The direct anterior method is considered “muscle sparing” because it does not involve cutting into (and later repairing) muscles and tendons to reach the damaged bone and tendon. Instead, the surgeon gently pushes the groups of muscle and ligaments aside, inserts the implants, and then moves them back to their proper position.

Because the anterior approach is more technically demanding, some surgeons use a minimally invasive posterior approach. This involves making an incision of about four to five inches on the back of the hip, while the patient lies on their side on the operating table. The posterior approach involves detaching some muscles and tissues to reach the hip joint. However, the surgeon avoids cutting into abductor muscles, which are the major walking muscles.

There has been much debate about which minimally invasive approach is better. While some surgeons may continue to prefer the posterior approach, the anterior approach may become more popular as more surgeons learn the technique.

You and your doctor will decide whether you should have general or regional anesthesia. An example of regional anesthesia is a spinal anesthetic, which injects anesthesia into the spinal canal to reduce pain without loss of consciousness. You can expect the surgery to take up to several hours. Your care team will monitor your heart rate and other vital signs throughout the procedure.

You should be able to start moving around within hours after your surgery. You may even be able to go home the same day. 

Because the surgeon does not cut through muscle and soft tissue areas, you will typically have less pain and better mobility after the surgery. You'll generally go home from the hospital sooner, use less pain medicine, and be able to heal well without extensive physical therapy.

Studies have shown patients who have the anterior hip approach walk on their own as much as six days earlier than those who have traditional surgery.  

A hip replacement is one of the safest, most effective operations you can have, but all surgical procedures carry some risks. One risk of hip surgery is hip dislocation, especially in the weeks after the operation. However, because the muscles and soft tissues are preserved and play a role in preventing hip dislocation, you are less likely to dislocate your hip after hip surgery using the anterior approach.

One risk of surgery unique to the direct anterior hip approach is a numbness of the skin in the front of your thigh. This can occur because of stretching in the skin nerves. It typically resolves after a few months.

With most hip replacements—and many surgeries—the risks have less to do with the surgical approach than with the patient’s general health. As with any surgery, it’s important to talk to both your anesthesiologist and your surgeon about your age, your weight, any medications you may be taking and your general health, and let them know if you are a smoker. All of these things can impact your risks.

Yale Medicine Orthopedics & Rehabilitation is a leader in all types of total hip replacement surgeries. Our surgeons are skilled in providing minimally invasive approaches that may not be easy to find elsewhere. These are approaches that can mean smoother surgical experiences and quicker recoveries.

Yale Medicine has special expertise in anterior hip replacement surgery. In 2016, Dr. Keggi and Dr. Rubin published the first comprehensive textbook for surgeons on the direct anterior approach, summarizing more than 40 years worth of expert knowledge on the topic. In addition, Dr. Rubin continues to research, author papers, and teach on the subject, helping to advance the field into the future for surgeons across the country and around the world.

Yale Medicine surgeons also have reported dramatic improvements among geriatric hip fracture patients who are been treated through the Fragility Hip Fracture Program at Yale New Haven Hospital. This program established processes in the emergency room for prioritizing patients who have had traumatic hip fractures, providing pain control and scheduling surgery as quickly as possible. 

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Is There a Consensus on Air Travel Following Hip and Knee Arthroplasty?

Tobenna j oputa.

1 Trauma and Orthopedics, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, GBR

Amogh Patil

Joe b amissah-arthur.

2 Trauma and Orthopedics, Royal Blackburn Hospital - East Lancashire Hospitals NHS Trust, Blackburn, GBR

Kathryn McLoughin

Qaisar choudry, ethan caruana, fayez almari, andrew sloan, introduction.

"When can I fly after my hip or knee replacement?" is a question frequently encountered by surgeons. Both air travel and arthroplasty increase the risk of venous thromboembolism (VTE); however, few studies examine the risk of air travel following arthroplasty. This study aimed to review the advice given to patients by surgeons, airlines, and insurance providers about flying after arthroplasty. We also review the current literature and available guidelines.

Materials and methods

A survey was sent to consultants with a special interest in hip or knee arthroplasty at 14 hospital trusts in the United Kingdom (UK) asking how long they would advise patients to avoid flying after surgery. We contacted all UK commercial airlines asking if they imposed any limitations on flying after arthroplasty. We contacted 15 UK insurance providers to determine whether they would provide insurance coverage following arthroplasty.

A total of 110 knee surgeons and 105 hip surgeons were contacted. The response rate was 42% for hip surgeons and 44% for knee surgeons. Advised time to avoid flying varied widely from 14 to 180 days. A total of 22 airlines were contacted, and the response rate was 63% (n=14). Five airlines would not allow passengers to fly following arthroplasty and seven airlines required certification from a doctor. Fifteen insurance providers were contacted and the response rate was 73% (n=11). Seven insurance providers had restrictions on providing cover to passengers after arthroplasty.

Advice given to patients by surgeons, airlines, and insurance providers about flying following arthroplasty varies greatly. There is an absence of evidence-based guidelines to inform such advice. Further study is required to provide the evidence on which to base such advice. Therefore, we recommend that surgeons exercise caution when providing advice to patients.

“How soon can I fly after my hip or knee replacement?" this is a question frequently posed to hip and knee arthroplasty surgeons. Both flying and lower limb arthroplasty have been shown to increase a patient's risk of suffering a venous thromboembolic event. The risk of suffering from symptomatic venous thromboembolism (VTE) after prolonged air travel has been estimated to be around 1.9-5.2 per million person-days [ 1 ]. Similarly, it is estimated that around 3-4% of patients undergoing total hip arthroplasty will develop a symptomatic VTE within the first three months following surgery [ 2 ]. Patients with both of these risk factors are classed as being at an even greater risk [ 1 - 3 ].

Many arthroplasty surgeons advise patients to avoid flying for a brief period of time following surgery. However, there is an absence of any clear evidence in the literature to show that this is the case and this risk is in fact summative. Additionally, there are no strong evidence-based guidelines as to how long this time period should be. Patients are often advised to check with their airlines and travel insurance providers to see if they are permitted to fly and if their travel insurance is valid following surgery.

The aim of this study was to examine the advice given to patients undergoing hip or knee arthroplasty about air travel from surgeons, airline companies, and travel insurance providers. We also review the current guidelines and evidence base that may inform such advice, while considering the legal implications for surgeons.

All consultant orthopedic surgeons with a sub-specialist interest in hip or knee arthroplasty practicing at 14 hospital trusts in the United Kingdom (UK) were invited to complete an online survey. Consultants were asked how long they would advise patients, both with and without risk factors for VTE, to avoid taking long- and short-haul flights following both hip and knee arthroplasty. Long-haul flights were determined as any flight lasting longer than four hours. The 14 hospital trusts consisted of 21 hospitals, four of which were teaching hospitals, one was a national center for orthopedics and the remainder were district general hospitals. Among them, 7422 joint replacements were performed in the previous year (4068 hips and 3354 knees).

All UK commercial passenger airlines with type A licenses (airlines licensed to carry 20 or more passengers) were contacted by email or telephone. Airlines were asked if they had any restrictions on passengers flying following hip or knee arthroplasty and if passengers required any medical certification prior to flying.

We contacted 15 UK-based travel insurance providers by email or telephone. Insurance providers were asked if they had any restrictions on providing insurance cover to customers who had recently undergone hip or knee arthroplasty, and if an insurance claim would be valid should a customer traveling by air were to suffer from a VTE following hip or knee replacement surgery.

A total of 105 consultants with a sub-specialist interest in hip arthroplasty were invited to complete the survey. Forty-four surveys were completed (response rate: 42%). A total of 110 consultants with a sub-specialist interest in knee arthroplasty were invited to complete the survey. Forty-eight surveys were completed (response rate: 44%). Advice from surgeons varied widely both for patients with and without risk factors for VTE and for patients traveling on short and long-haul flights.

For patients with no risk factors for VTE, the advised time to avoid flying following both hip and knee arthroplasty ranged from 14 to 180 days for short-haul flights and 35 to 180 days for long-haul flights. The median time for short-haul flights was 45 days and 90 days for long-haul flights. For patients with one or more risk factors for VTE, advised time to avoid flying following both hip and knee arthroplasty ranged from 14 to 180 days for short-haul flights and 42 to 180 days for long-haul flights. The median time was 90 days for both long- and short-haul flights (Figure ​ (Figure1 1 ).

VTE: venous thromboembolism

Time is given as number of days after surgery.

A total of 22 airlines were contacted and 14 replies were received (response rate: 63%). Five (36%) of the airlines informed us that they had restrictions on passengers flying after hip or knee arthroplasty, while the other nine airlines had no restrictions. Three of these five airlines did not permit patients to fly for seven days following surgery. The fourth airline did not permit patients to fly for 10 days following surgery and the fifth required patients to wait 14 days after surgery before flying. Seven (50%) of the contacted airlines required medical certification for patients who wished to fly in a defined period after surgery. This was seven days for one airline, 10 days for three airlines, and 14 days for another airline. Also, two airlines did not specify what this time period was (Table ​ (Table1 1 ).

Insurance providers

A total of 15 insurance providers were contacted and 11 replies were received (response rate: 73%). Seven (64%) of these insurance providers informed us that they had restrictions on providing insurance coverage for patients traveling by air after hip or knee arthroplasty. Two of the insurance providers required certification from a doctor or surgeon that the patient was fit to fly. One company told us that coverage would be dependent on patient screening. The four remaining companies had time restrictions on when insurance coverage could be provided following surgery ranging from six weeks to two years (Table ​ (Table2). 2 ). When asked if a submitted claim would be valid for a patient suffering from VTE who has traveled by air following hip or knee arthroplasty, nine (82%) companies said they would accept the claim provided adequate information had been disclosed when cover was arranged.

Our results demonstrate that there is a great disparity in the advice given to patients by surgeons about flying following hip or knee arthroplasty ranging from 14 to 180 days. There are also disparities between the rules and regulations of different airlines as to when patients are permitted to fly following hip or knee arthroplasty ranging from zero to 14 days. Similarly, there is a disparity among travel insurance providers as to whether insurance can be provided to customers who have recently undergone hip or knee arthroplasty ranging from zero days to two years.

Guidance from the National Institute of Health and Care Excellence (NICE) in the United Kingdom on deep vein thrombosis (DVT) prevention for travelers stratifies patients who have recently undergone major surgery into a group of patients at high risk. In such patients, NICE recommends that specialist advice should be sought and clinicians should recommend delaying or canceling trips. Where travel is unavoidable, patients should be given general advice on DVT prevention and advised to use graduated compression stockings or low molecular weight heparin when indicated [ 4 ].

NICE recommends that following hip or knee arthroplasty, patients should be advised to avoid long-haul flights for three months but that it may be possible to undertake short-haul flights after six weeks [ 4 ]. However, on review of the references of these guidelines, these recommendations only appear to be based on level five evidence [ 5 ]. One of their key outcomes is that there is a lack of evidence to support any recommendations made for air travel following arthroplasty [ 4 ].

The American Association of Hip and Knee Surgeons state that patients with a low risk of blood clots can travel soon after their joint replacement if appropriate measures are taken, such as DVT prophylaxis medication, compression stockings, and staying well hydrated. Higher-risk patients are advised to discuss their travel plans with their primary care doctor as well as their surgeon [ 6 ]. However, in the United Kingdom, several National Health Services provide leaflets to patients which recommend not flying within three months of surgery [ 7 - 9 ].

The Civil Aviation Authority (CAA) in the United Kingdom provides guidance to passengers on flying after different surgical procedures, but this does not extend to hip or knee arthroplasty [ 10 ]. There is; however, guidance provided for healthcare professionals on assessing fitness to fly following surgery. This recommends avoiding air travel for three months after both hip and knee arthroplasty [ 5 ].

Existing knowledge 

In a review of the literature, only two studies were identified reporting on the incidence of VTE in patients flying after hip or knee arthroplasty [ 11 , 12 ]. Neither study demonstrated patients to be at an increased risk. Ball et al., reviewed 608 patients on VTE chemoprophylaxis who traveled an average of 1377 miles at an average of 6.5 days postoperatively following hip arthroplasty (462 by airplane, 143 by car, and 3 by train) [ 11 ]. There were no reported deaths, no symptomatic pulmonary embolisms, and only five reported symptomatic DVTs (0.82%). Four of these five were in patients who had other significant risk factors for VTE. This study concluded that with chemical VTE prophylaxis, travel within six weeks of hip arthroplasty surgery is associated with a low rate of symptomatic DVT [ 11 ].

In a retrospective review of 1465 consecutive patients undergoing total hip and knee replacement surgery, Cooper et al. compared a cohort of 220 patients who traveled by air at a mean of 2.9 days postoperatively, with 1245 patients who did not travel by air postoperatively [ 12 ]. There was no statistical difference in the incidence of symptomatic deep vein thrombosis or pulmonary embolus or VTE overall between the two cohorts. This study concluded that allowing air travel after total joint arthroplasty appears to be a safe practice [ 12 ].

Implications

Our results have demonstrated that there is no clear consensus among orthopedic surgeons as to when patients should be allowed to fly following hip and knee arthroplasty. Advice offered by orthopedic surgeons varied widely and was neither standardized nor evidence-based. This is in part due to a lack of any relevant, consistent, and evidence-based guidelines to assist when making recommendations in such circumstances.

Courts in the United States and Australia have previously recognized an airline's liability for failing to adequately warn patients of the risk of suffering a DVT following international flights [ 13 , 14 ] and despite previous contradictory judgments, this remains a contentious issue in the United Kingdom [ 15 ]. Without a strong evidence base or consensus, many surgeons may be exposing themselves to litigation when giving such advice. In some scenarios, over half of the surgeons surveyed advised patients that they could fly sooner than was recommended by the guidelines from the CAA and NICE. We question how this may affect the defense of a surgeon in court if a patient developed a DVT after advising a patient that they could fly.

Furthermore, half the airlines surveyed and two of the 15 insurance companies required certification from a doctor before flying. Surgeons may be exposed to potential further litigation if a scenario occurs where a patient develops DVT after receiving documentation stating they were "fit to fly." In their advice to general practitioners about certifying patients as fit to fly, The Medical Protection Society recommends careful consideration of the wording of statements for airlines, and where possible recommends simply offering factual information only [ 16 ].

Conclusions

We advise surgeons to be cautious when providing advice to patients about flying following hip and knee arthroplasty. We would recommend that it is stressed that there is currently no evidence as to when it is “safe” to fly, ensure that patients are aware of the potential risks, recommend necessary precautions, and also make this clear in any documentation provided for airlines and insurance companies. We would also echo advice from the Medical Protection Society that rather than certifying patients as “fit to fly” following surgery, surgeons should instead consider providing a factual letter outlining the above.

Due to the inherent difficulty and infeasibility of performing any randomized control trials, we recommend that a clinical consensus study is performed with the aim of producing guidelines to inform the advice given by surgeons.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.

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Travel after Joint Replacement Surgery

You may be worried about traveling in the first months following surgery. One concern is sitting in a car or airplane seat for long stretches of time and the risk of forming a blood clot in your leg – also known as deep vein thrombosis (DVT). Several studies have shown that, if appropriate measures are taken , it is safe to travel soon after your joint replacement without an increased risk of developing a blood clot for most patients.

If you have a higher than normal risk factors for blood clots, it is important to have a discussion about post-surgery travel plans with your primary care physician and surgeon prior to joint replacement because DVT is a serious condition that can be life threatening. This may potentially affect your surgeon’s choice of medication to prevent blood clots after surgery.

Most people will feel safe to travel within a few weeks of surgery; however, keep in mind that your comfort level may also play an important role in determining when you are ready to take a long trip. Anticipate that you may be more sore, stiff or swollen when traveling within a few weeks of surgery. This increase in discomfort will likely be short-lived, but you may experience a slight setback in recovery and should have a plan in place to address any increase in pain. Depending on the progress of your recovery, you may find it easier to use a cane, crutches or a walker (or at least have one available) when traveling even if you were not using them prior to the trip.

What precautions should I take when traveling with my joint replacement?

In general, there is an increased risk of developing a blood clot immediately after surgery whether or not you plan to travel long distance. If appropriate measures are followed, these risks can be minimized and make it possible to travel soon after surgery. These precautions include using compression stockings , and/or mobile compression devices and taking medication that can range from aspirin to prescription blood thinners to prevent a blood clot. We recommend continuing the use of these preventive methods when traveling. These are other precautions that can be beneficial and are recommended:

• Walk and move around frequently. This can consist of basic stretching and getting up to walk the aisle of the plane or stopping the car to walk every one to two hours.
• Do calf squeezes and ankle pumps to keep the circulation in your legs moving.
• Pull your knees to your chest to stretch your legs.
• Stay well hydrated by drinking plenty of fluids like water and juice. Avoid dehydrating beverages like coffee and alcohol.

If you are planning to travel after your joint replacement, please discuss this with your surgeon before your surgery so you can both work together in developing a customized plan for a safe journey.

More information concerning travel and the risk of blood clot along with the symptoms of DVT and pulmonary embolism can be found on the US Centers for Disease Control website .

See also “ Will my artificial joint set off airport security metal detectors? ”

• Ball ST, Pinsorsnak P, Amstutz HC, Schmalzried TP. Extended travel after hip arthroplasty surgery. Is it safe? J Arthroplasty 22(6 Suppl 2): 29, 2007
• Cooper HJ, Sanders SA, Berger RA. Risk of symptomatic venous thromboembolism associated with flying in the early postoperative period following elective total hip and knee arthroplasty. J Arthroplasty 29(6): 1119, 2014
• Nwachukwu BU, Dy CJ, Burket JC, Padgett DE, Lyman S. Risk for Complication after Total Joint Arthroplasty at a Center of Excellence: The Impact of Patient Travel Distance. J Arthroplasty 30(6): 1058, 2015

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This article has been written and peer reviewed by the AAHKS Patient and Public Relations Committee and the AAHKS Evidence Based Medicine Committee. Links to these pages or content used from the articles must be given proper citation to the American Association of Hip and Knee Surgeons.