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Over the many years that I, as a physical therapist, have seen patients with a total hip replacement, the instruction the patient typically does not understand is the instruction: “Don’t cross your legs”.
This article is written for your edification of why or why not your surgeon may restrict “crossing the legs” and what that restriction means. It has been a point of a common misunderstanding of the total hip replacement patients I have seen with the restriction of “no leg crossing”.
There are three ways to cross the legs:
- “Tight-Leg” cross
- “Ankle-Lock” cross
- “Figure-4” cross
These instructions can be very different from surgeon to surgeon, depending on which surgical approach the surgeon has used:
- The posterior approach.
- The lateral approach.
- The anterior approach.
Can I cross my legs after total hip replacement?
|Can I Cross My Legs After Total Hip Replacement?||“Tight-Leg” crossing||“Ankle Lock” Crossing||“Figure-4” Crossing|
Always clarify the “don’t cross your legs” instruction with your surgeon.
The surgeon knows exactly where the joint capsule was cut to receive the hip implant, and they also know exactly what Range of Motion Restrictions they want their patients to follow.
What is the “Tight-leg” leg crossing position?
The “Tight-leg” crossed leg sitting position is when one leg is brought over the top of the other legs and the knees “stack” on top of each other.
What is the “Ankle-lock” leg crossing position?
The “Ankle-lock” crossed leg sitting position is when one leg is brought over the top of the other leg and the ankles are “stacked” on top of each other.
The “Ankle-lock” leg crossing is what people tend to do in a recliner chair position.
The ankle-lock position may apply in the upright seated position as well and may be one of the restrictions for the total hip replacement patient that has had a posterior or lateral surgical approach to hip replacement.
What is the “Figure-4” leg crossing position?
The “Figure-4” crossed leg sitting position is when one ankle is brought over the top of the other knee and the “stack” looks like the number 4.
The Figure-4 leg crossing is perfectly fine to do if the hip has been replaced using the anterior surgical approach.
In fact, I have one surgeon who’s home exercise protocol includes this position as a position of recommended stretches.
While the figure-4 leg crossing is fine for an anterior hip replacement patient it may not be allowed by the surgeon using a posterior or lateral approach to surgery.
Modified Figure-4 Leg-Crossing For Posterior & Lateral hip replacement approaches:
The Modified Figure-4 leg crossing technique is considered acceptable by some surgeons using the posterior or lateral total hip replacement approach.
Be sure to get approval from the surgeon before crossing the legs in this fashion if your hip replacement was done using the posterior or lateral surgical approach.
Only the surgeon knows EXACTLY where the surgical incision is for your specific surgery, and preventing the femoral head & neck from pushing into, and stretching out, the hip capsule surgical incision is the entire reason for the precautions.
A tight hip joint capsule rather than one stretched out is a primary restraint preventing hip dislocation.
Modifications of the Figure-4 leg cross to Consider
A modification consideration to a Figure-4 leg crossing is to prevent hip flex past 90 degrees when crossing the legs in this fashion (if 90 degrees of hip flexion is a restriction).
Below is a patient seated crossing the legs with a “Figure-4” that has greater than 90 degrees of hip flexion:
It is hard to cross the ankle at the knee without flexing the hip past 90 degrees in a soft seated chair or sofa, or even a hard-back chair such as a dining room chair (if no hip flexion past 90 degrees is one of your restrictions).
A good modification would be reclined a little in a recliner chair and crossing the legs using a Figure-4 technique.
In a recliner chair, the patient can be in the seated position with the chair back slightly reclined, and will be able to cross the legs Figure-4 style without flexing the hip more than 90 degrees flexion (if 90 degree flexion is a restriction).
Notice the use of the recliner chair arm rest to support the weight of the leg.
Another good modification would be reclined a little in a recliner chair and crossing the legs using a Figure-4 technique.
How could I accidentally cross my legs after total hip replacement without realizing they were crossed?
- By side-lying on the unoperated side and allowing the operated leg to drop off to the mattress.
- By pivoting on the operated leg toward the side of the operated leg while standing.
Side-lying on the unoperated side and allowing the operated leg to drop off to the mattress:
Most of my patients start off by sleeping on their backs.
Many elevate the head and torso a little, some even sleep in their recliner chair.
But sooner or later they will want to lie on their side.
Since the operated side is still too tender to lie on comfortably, they sleep on the unoperated side and will allow the upper leg (the operated leg) to fall off toward the bed and rest on the mattress.
This breaks the “no leg crossing” restriction if there is that restriction from the surgeon.
The patient can safely sleep on the unoperated side without breaking the “no crossing the legs” restriction, but the operated leg must be supported from groin to ankle to prevent the operated leg from crossing the mid-line of the body.
Pivoting on the operated leg toward the side of the operated leg while standing:
Another common way I see patients cross their legs (allow the leg to go past the mid-line of the body) is by turning toward the operated side.
They tend to pivot on the operated leg when turning toward the operated leg, stepping ACROSS the operated stationary leg with the unoperated leg.
This can be prevented by starting a turn toward the operated leg by lifting the operated leg and setting the foot about 45 degrees toward the direction of the turn before pivoting on the operated leg.
- This article is not written as a prescription of your range of motion restrictions regarding crossing the legs after a total hip replacement surgery. That prescription must be a specific range of motion restriction protocols developed by the surgeon and the physical therapists, based on their knowledge of you personally.
- This article is written for the three primary surgical approaches to hip replacement, the posterior, lateral, and anterior approaches.
- Please be aware there are several other specific approaches, identified by more modifiers of these three approaches, but they are based on these three primary concepts.
- The “no crossing legs” rule may be applied differently with each variation, but in general, this restriction rule will apply as described above.
Wishing you a safe and speedy recovery.
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Read my article How To Generate Retirement Income: Cash In On Your Knowledge.
See My Other Total Hip Replacement Articles:
How To Choose A Surgeon For Hip Replacement
Speed Up Recovery After Total Hip Replacement
Total Hip Precautions: Anterior, Posterior & Lateral Approaches
Can I Sit In A Recliner After Hip Replacement
Stairs After Total Hip Replacement: A Physical Therapy Guide
Ice After Total Knee Replacement: A PT’s Complete Guide
Paying It Forward
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