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Do You Need A Raised Toilet Seat After An Anterior Hip Replacement ?

At the time of my Mom’s hip replacement I was rather overwhelmed by all the precautions that she, and I, would have to remember to follow, so she didn’t hurt her new hip, and my Mom was 88yrs old. This is a lot to handle for a lot of elderly adults who have posterior or lateral hip replacements.

Patients who have had an anterior approach hip replacement,  are not typically required to use a raised toilet seat, or to follow any of the many precautions for sitting down, standing up or bending down, which patients of a posterior, or lateral, approach hip replacement will have to observe for 6 to 12 weeks.

The reason for this easier recovery from surgery, is the fact that anterior approach hip replacement surgery is performed at the front of the hip, and does not require the cutting of any large muscles, which is the case with the posterior and lateral approach surgeries.

Even so, the anterior approach hip replacement does necessitate some different precautions of its own, and we will look at those too.

Although the anterior approach hip replacement recovery has, apparently, a quicker and smoother passage to recovery  in the beginning, in the long term, all three types of hip replacements face the same issues.

 

Why so many precautions with the Posterior and lateral approach hip replacements ?

With anterior approach hip replacement surgery  the muscles at the front of the hip are separated for the surgery, not cut through, and as such the joint’s stability is not as affected, as it is with the two other approaches.

Because, with the posterior and lateral approaches, the large muscles, and some ligaments have been cut through, and the hip is not so supported from behind until these have healed.

For some time, until healed, the muscles around the hip, will be weakened with very little tone, which can cause the joint to be less stable.

With the weakness and instability there may, for a number of weeks, be a minor risk of dislocations if the hip is stressed at certain angles, such as when sitting down and standing up and bending over, which if done incorrectly, can lead to a hip dislocation.

Raised toilet seats, are among the measures taken, to avoid placing excess stress on the hip.

Raising the level of all the seats you are using, including the toilet, to a position where seats are higher than the level at which your knee bends at the back, will help to relieve the stress on the hip.

It is rarely necessary for a patient with an anterior hip replacement to do this, unless they have a very low seat, or are very tall, but in any cases like this the surgeon will advise the patient.

 

Raised toilet seats after hip replacements

For those who are advised to use a raised toilet seat after hip surgery, which ever type of hip replacement surgery they have had, the types of raised toilet seats are the same.

It is normal  to use a raised toilet seat after a posterior, or lateral, approach hip replacement for up to 6 to 10 weeks.

If you have had an anterior approach hip replacement, and have been told to use one, you will need to ask your surgeon for how long, as this is not a typical precaution.

If you have been told that you need to use a raised toilet seat, and you wish to know about the precautions and positions that you will need to observe, when sitting and bending, you should about them in my article – “Do You Need A Raised Toilet Seat After Hip Surgery”.

Should you want to know how to sit down on a raised toilet seat, and how to stand up again, with the aid of a walker, and without injuring yourself, you’ll find that in my illustrated guide “How To Sit On A Toilet After Hip Surgery: A Detailed Illustrated Guide”, with instructions for seats both with, and without, armrests.

 

How high should a raised toilet seat be after a hip replacement

To find the right height for your raised toilet seat, you need to- 

(a) measure from the floor to the back of your knee

(b) measure from the floor to your toilet seat

now subtract (b) from (a), and you have the height required for your raised toilet seat.

This isn’t the only measurement you will need though, as toilets come in two shapes – standard and elongated

You will need to know which type of toilet you have, as well, before you buy a raised toilet seat, as not all raised toilet seats fit all toilet shapes.

You can read my article explaining how to check and measure the toilet to see if you have an elongated, or a standard toilet bowl here – “How To Measure For A Raised Toilet Seat”.

 

Best raised toilet seats after a hip replacement

Below is a list of what I think are the best models of raised toilet seats, depending on the age and weight of the user.

The full article, in which I explain all my choices that you are going to find below, is here – “Best Raised Toilet Seats After A Hip Replacement”

 

Best raised toilet seat for the elderly after a hip replacement

 

1) OasisSpace Stand Alone Safety Frame and Raised Toilet Seat – with a hard seat

2) OasisSpace Stand Alone Safety Frame and Raised Toilet Seat – with a padded seat

3) PlatinumHealth Ultimate Raised Toilet Seat (safety frames with raised toilet seat)

4) Medline – basic 3-in-1 Bedside Commode

5) Nova Drop-Arm Padded Commode

6) PlatinumHealth GentleBoost Uplift 3-in-1 Commode and Shower Chair

 

Best raised toilet seat for larger elderly seniors (over 350 lb) –

 

1) Nova Heavy Duty Drop-Arm Commode 8583

2) Drive Deluxe Bariatric Drop-Arm Commode 11135-1

Best raised toilet seat after a hip replacement for a younger senior in good shape

 

Risers with armrests –

 

1) Nova 3.5″ raised toilet seat riser with arms  (standard), Model No. 8344-R

2) Nova 3.5″ raised toilet seat riser with arms  (elongated), Model No. 8343-R

3) Vive 3.5″ toilet seat riser with handles  (standard), Model No. LVA1071S

4) Vive 3.5″toilet seat riser with handles  (elongated), Model No. LVA1071E

Front locking raised toilet seat with armrests

 

1) Vive raised toilet seat with detachable handles, Model No. LVA10011

2) Drive Medical Premium plastic raised toilet seat with armrests, Model No. 12013

3) Nova raised toilet seat with detachable arms, Model No. 8351-R
 

Best raised toilet seats after a hip replacement, for larger, younger seniors (over 300 lb)

 

1) Nova Heavy Duty Drop-Arm Commode, Model No. 8583 – 500 lb weight capacity

2) Drive Deluxe Bariatric Drop-Arm Commode, Model No. LVA1071S – 1000 lb weight capacity

Toilet hygiene after a hip replacement

These are the embarrassing questions that no one likes to ask, but they have to be addressed. So…

 

To wipe your bottom after a hip replacement if you are not allowed to bend forwards, you basically have two options  –

  • using an extendable wiping device
  • using a handheld bidet or a bidet seat

Just before I get into the options, I would like to note that not everyone who is observing the precautions for bending, will have difficulty wiping themselves without bending, and it is usually larger individuals who need assistive devices to help them do this.

 

Open Front Seats

With both the handheld wiping devices and the bidets, you may find that an open front seat is a big help with personal care.

Safety frames with raised toilet seats and bedside commodes have models which have open front seats, which allow more, and easier access for cleaning yourself.

 

Toilet Aids for wiping

Wiping devices come in the form of long-handled plastic devices, with a gripping mechanism at one end. You insert your toilet paper or wet wipes into the gripper, and then clean your self without bending more than your precautions allow –

  • “Freedom Wand” is one popular wiping device with a retractable gripping claw, which has a number of extensions, extending the device up to 30″ in length. You can make it  7″, 14″, 21″, 25″ or 30″ long.
  • “Comfort Wipe” is another wiping device, with a different gripping system, though not as long as the “Freedom Wand”, the length of the handle extends a person’s reach by 15 “, it should be good for most people.

These devices are used to wipe your private parts from the front, without making you lean forwards. You simply pass the device between your legs and clean yourself in an upright sitting position.

You can find these assistive wands at all large retailers such as Walmart or on Amazon.

 

Handheld bidet sprayer

A handheld bidet spray will wash you clean, and you know that you are spotless, and it is ultra hygienic – this is my preference.

Handheld bidet sprayers are attached to your toilet water inlet pipe via a T-valve, and once you have relieved yourself, you can take the handheld spray and clean yourself, passing it between your legs from the front.

There are many, many models to choose from, on Amazon and at large retailers like Walmart.

A toilet bidet unit

Should you like the idea of the bidet, and you want something which is even easier to use, you can also get units which –

  • are part of the toilet seat – they replace your existing seat, and you just set the water sprays to the right position once, and you only have to turn them on and off
  • can be fitted under your existing seat toilet seat, and again you set the water sprays to the right position, and you are done

 

More elaborate models exist, which are electric and offer a choice of water temperatures.

There is a model to suit pretty all budgets.

 

When can you use a regular toilet after hip surgery ?

 

Typically, after a posterior or lateral approach hip replacement, you will need to use a raised toilet seat for between 6 and 10 weeks, before you can use a regular toilet seat.

The exact length of time depends on the strength and age of the patient, so only your surgeon can answer this after you have had your post surgery assessments.

If you have been told to use a raised toilet seat after an anterior approach hip replacement, it is not that typical, so it may be due to a weakness or complication, which does not fall into typical post-operative guidelines.

Anterior hip replacement recovery week by week

This is a rough timeline, and only your surgeon can tell you when you can, and cannot, start to do the different activities.

 

1st Week

1-2 days

 

  • walking starts on the first day with a walker
  • basic exercises – not all doctors give exercises
  • showering regularly after 48 hrs
  • depending on stability, you may still need the walker indoors
  • still using a walker when outside in public areas

 

5-7 days

 

  • you may be having a follow-up with your surgeon
  • you may be allowed to start driving
  • your gait may be assessed
  • you can start using a recumbent stationary bicycle
  • typically coming off the walker in public areas

 

2nd Week

10-14 days

 

  • swimming can be done as soon as your wound is healed
  • you should no longer have stopped using the walker in public
  • most patients begin to up their activity levels
  • at the two-week mark, you may start physical therapy if it is needed (not all surgeons suggest physical therapy)
  • return to desk work

 

3rd Week

  • return to driving, but it may take up to 6 weeks and cannot be done while you are still taking (narcotic/opioid pain medications)
  • normal daily activities should have been resumed
  • for golfers, you may start chipping and putting

 

4th – 6th Week

  • end of anterior hip precautions
  • stiffness and swelling begin to dissipate
  • some surgeons allow exercises like tennis and weight lifting can in some cases after 6 weeks
  • you may be able to return to heavy lifting and manual jobs

 

10th -12th Week

  • heavy lifting
  • some surgeons advise 3 – 6 months before sports activities

 

 

Sources –

https://www.edwinsu.com/anterior-hip-replacement-post-op-instructions.html

https://greaterphoenixorthopedics.com/blog/what-to-expect-after-anterior-hip-replacement/

https://www.newportcentersurgical.com/orthopedic-surgery/how-long-is-recovery-from-direct-anterior-hip-replacement/

https://scottsdalejointcenter.com/patient-education/anterior-hip-replacment-recovery-time/

Exercises to avoid after an anterior approach hip replacement

Typical exercises for after an anterior approach hip replacement include –

  • Ankle pumps
  • Bilateral knee rolling
  • Gluteal sets
  • The Hula
  • Thomas Test stretch: Stretching Hip Flexors on the operative leg
  • Hamstring Curls
  • Flexion while sitting
  • Standing Extension Stretching
  • Riding exercise bike

 

Here is a link to a very clearly laid out set of exercises on the Bronson Joint Replacement Program website here – https://www.bronsonhealth.com/app/files/public/7850/Anterior-Hip-Exercises.pdf

Lifetime Precautions after a hip replacement

The temporary precautions that hip replacements patients are advised to take, relate mainly to the surgical procedure that was used.

Once your hip replacement recovery period is over, the muscles and other soft tissues have been given the time to heal, and you have done your strengthening work, you will then be able to return to activities such as exercise and sports

Most surgeons recommend that patients could return to sports activities 3 to 6 months after surgery.

The lifetime precautions that patients will follow after a hip replacement, are more related to materials that make up your hip replacement.

Depending on the type of materials in your implant – metal, ceramic, polyurethane – you will be advised on which activities and sports, you can take part in.

Typically, you will be advised that swimming, bowling, stationary biking, dancing and walking are allowed, being referred to as low-impact activities.

Those patients with “experience”, will be told that they can do downhill skiing, cross-country skiing, weightlifting, ice-skating and Pilates.

What are called “high-Impact sports”, such as racquet ball, squash, football, soccer, rugby, baseball, softball, jogging and sprinting, are totally advised against.

The above recommendations are all based on the results of a study from 2005, in which data from 614 surgeons were collected, to find out what activities and sports were (a) “allowed”, (b) “allowed with experience” and (c) “not allowed”, after a hip replacement.

“The current recommendations of allowable or recommended activities are derived from surveys of hip and knee surgeons based on clinical experience and preference, not prospective and retrospective analyses.”

These results are not based on actual statistics of accidents from taking parts in activities, but are derived from what surgeons thought was good for their patients. This may be just as good, but I though that was interesting to note.

Depending on which type of material your hip replacement is made of, you will be advised to on which activities you can take part in safely.

“Polyethylene wear and the associated prosthetic loosening are the most common causes of post‐operative failure and the need for revision surgery. Therefore, activities that potentially expedite the wear through increased frequency or magnitude of loading (such as high impact sports) is a primary concern. To date there is limited information on the specific relationship between wear and sporting activities.”

The particular quotes above, and much of the information, come from the –  IJSPT – International Of Sports Journal Physical Therapy – Nov 2014 –

“Sports Participation Following Total Hip Arthroplasty”

 – by Erik P. Meira, PT, DPT, SCS, CSCS and Joseph Zeni Jr, PT PhD

You can read the article on the US National Library of Medicine National Institutes of Health website here –

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223292/

 

If you read the article I have linked to above, you will also see that there are also risks from wear down different parts of the hip replacement, and that small particulates can be ground off the implant, getting into the soft tissues, leading to pain and other complications

There is also an assumption that less vigorous, and a more low-impact activities may lead to fewer particulates coming off the implant and into the soft tissues, but there is no clear evidence, yet.

Finally, there is the life expectancy of your hip replacement – (according to webmd.com)

“95% of hip replacements last at least 10 years, about 75% last 15 to 20 years, and just over half last 25 years or more.”

It seems, for now, that the best strategy is to take part in regular activities to maintain good muscle strength around the hip, and to do low-impact sports and exercises, so as not to damage the implant.

I’m Gareth and I’m the owner of Looking After Mom and Dad.com

I have been a caregiver for over 10 yrs and share all my tips here.

Gareth Williams

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