The operative report for a patient who had a total hip arthroplasty includes reattachment of the greater trochanter with wire. Which of the following exercises is CONTRAINDICATED for the operative extremity during the acute phase of healing?

The operative report for a patient who had a total hip arthroplasty includes reattachment of the greater trochanter with wire. Which of the following exercises is CONTRAINDICATED for the operative extremity during the acute phase of healing?

• A. Active Hip Flexion to 80 degrees in Supine Position With the Knee Flexed
• B. Active Hip Abduction to 40 degrees in Sidelying With the Knee Extended
• C. Active Assisted Hip Extension to Neutral in Sidelying With the Knee Flexed
• D. Active Assisted Hip Adduction to Neutral in Supine With the Knee Extended

Answer: (B)

The key idea here is protecting the repair at the greater trochanter that was reattached with wires during the hip replacement. In the acute healing phase, movements that place a lot of tensile stress on that area are avoided. Active hip abduction in sidelying with the knee extended directly loads the gluteus medius, pulling on the greater trochanter where the wires are tied. That creates traction on the repair and can disrupt fixation or delay healing, so it’s contraindicated early on. The other options involve motions that place less traction on the repaired region (for example, controlled hip flexion in the supine position, active-assisted extension in sidelying, or adduction in a neutral position). These can be progressed with precautions as healing advances, but the abduction maneuver in this specific position is the one to avoid in the acute phase.

The key idea here is protecting the repair at the greater trochanter that was reattached with wires during the hip replacement. In the acute healing phase, movements that place a lot of tensile stress on that area are avoided. Active hip abduction in sidelying with the knee extended directly loads the gluteus medius, pulling on the greater trochanter where the wires are tied. That creates traction on the repair and can disrupt fixation or delay healing, so it’s contraindicated early on.

The other options involve motions that place less traction on the repaired region (for example, controlled hip flexion in the supine position, active-assisted extension in sidelying, or adduction in a neutral position). These can be progressed with precautions as healing advances, but the abduction maneuver in this specific position is the one to avoid in the acute phase.