Post-Surgical Mobility

Post-surgical clients represent one of the most common and most complex mobility challenges in home care. Surgical restrictions, pain, and the recovery process all require adapted mobility approaches that protect healing while maintaining function.

Section 01

Why Post-Surgical Mobility Is Different

Weight-bearing restrictions: Many surgeries involve specific weight-bearing restrictions — non-weight-bearing (NWB), toe-touch weight-bearing (TTWB), partial weight-bearing (PWB), or weight-bearing as tolerated (WBAT). These are physician orders, not guidelines — they must be followed exactly.
Activity restrictions: Hip replacement patients have specific movement restrictions. Spinal surgery patients have bending, lifting, and twisting restrictions. Know your client's specific restrictions from the discharge summary.
Pain: Post-surgical pain changes mobility — it alters gait, reduces confidence, and can cause guarding that creates new movement problems.
Anticoagulation: Many post-surgical clients are on blood thinners — any fall requires medical evaluation regardless of apparent injury.

Section 02

Hip Replacement Precautions

🚨 Hip precautions are not optional

Total hip replacement patients typically have three precautions that must be followed until cleared by the surgeon (usually 6–12 weeks):

1. No hip flexion beyond 90 degrees — The hip must not bend past a right angle. Implications: no low chairs (seat must allow 90+ degree hip angle), no reaching to the floor, no bending to put on socks/shoes.

2. No internal rotation — The operated leg must not turn inward. When turning, the toes stay neutral or turned out — never in.

3. No adduction across midline — The operated leg must not cross the body's center line. An abduction pillow between the legs when in bed prevents this.

Violating any of these precautions risks dislocating the new hip joint.

Section 03

Knee Replacement Mobility

Quad strength is critical: The quadriceps are typically very weak after knee replacement. Rising from chairs and stairs require quad strength — allow more time and more assistance than you might expect.
CPM (Continuous Passive Motion) device: Some clients have a CPM device that passively bends and straightens the knee for prescribed periods. Follow the prescribed schedule exactly — do not skip or modify CPM sessions.
Swelling management: Elevation and ice (as ordered) reduce swelling that limits knee flexion. Follow the care plan protocol for timing and duration.
Stair capability: Stair use post-knee replacement is typically delayed and requires PT clearance. Do not assist with stairs unless the care plan specifically permits it.

Section 04

Spinal Surgery Restrictions

⚠ BLT restrictions after spinal surgery

Most spinal surgery patients have BLT restrictions:

No Bending: At the waist — use hip hinge technique for all low-level tasks
No Lifting: Nothing heavier than typically 5–10 pounds (specifics vary — check the discharge summary)
No Twisting: Of the spine in any direction — log roll technique required for all in-bed movements

These restrictions may last weeks to months depending on the surgery type. Never assume they have expired — always confirm with the care plan.

Section 05

Recognizing Post-Surgical Complications

✓ When to call the nurse for post-surgical clients

Report immediately for:

Increasing pain, warmth, or redness at the surgical site
Fever above 101°F (or per care plan threshold)
Significant increase in swelling at the surgical site or extremity
Wound drainage change: increasing, discolored, or foul-smelling
Sudden severe pain with movement — possible dislocation (hip) or hardware failure
Numbness or weakness that is new or significantly worsening
Any fall — post-surgical clients on anticoagulants require medical evaluation after any fall