From old prohibitions to modern hip replacement surgery

Anyone who has had a hip replacement knows the typical phrases that patients used to hear on the first day after surgery:
"Do not bend over 90 degrees, do not lift heavy objects, do not cross your legs, no jerky movements."

these prohibitions were an integral part of every rehabilitation plan following hip surgery . The reason: fear of dislocation (dislocation of the artificial joint) and premature wear or loosening of the prosthesis.

But times have changed. Thanks to minimally invasive surgical techniques , improved implant designs, modern bearing surfaces, and a deeper understanding of the load-bearing capacity of prostheses, much of what was once considered normal is now simply obsolete. Even lifting heavy objects is possible again – under certain conditions.

In this article you will learn:

• Where the strict prohibitions after hip surgery originally came from
• How modern implants and surgical techniques have minimized the risk
• What to consider lifting in the first few weeks after hip replacement surgery
• How much weight can realistically and safely be lifted today
• Practical tips for everyday life and the protection of hips and back

1. Historical rules after hip replacement – ​​and their background

Well into the late 20th century, patients were discharged after hip surgery with a long list of behavioral guidelines. The most important were:

1. Do not lift heavy objects – the advice was often: maximum 2–5 kg, for life.
2. Do not bend over more than 90 degrees – for example, do not sit low or tie your shoes while sitting.
3. Do not cross your legs – to avoid twisting in the hip joint.
4. sudden twisting movements – e.g., during sports or when turning around while standing.

The reason for these strict prohibitions lay primarily in the medical conditions at the time:

• Large, open surgical incisions : Muscles and tendons were partially detached to access the hip. This led to a longer healing time and reduced stability in the first few months.
• Smaller prosthetic heads : Older implants had significantly smaller joint heads (e.g., 22 mm or 28 mm in diameter) than today's. This resulted in a shorter lever arm and a significantly higher risk of dislocation.
• Simpler sliding pairings : Polyethylene with low cross-linking wore out faster, so overloading should be avoided as much as possible.
• Less experience with early exposure : At that time, very long recovery periods were used, as the long-term effects of exposure were hardly researched.

2. Modern hip replacement surgery – why many things are different today

Hip replacement surgery has changed dramatically in the last two decades . Today, many of the old prohibitions are obsolete. The main reasons for this are:

2.1 Minimally invasive approaches

• Muscle-sparing surgical techniques such as the anterolateral or direct anterior approach largely avoid the detachment of important muscles.
• This means: greater stability immediately after surgery and a significantly lower risk of dislocation.

2.2 Short stem prostheses

• Shorter anchorage in the femur, anatomically shaped.
• Reduced leverage and more physiological power transmission.
• Especially suitable for younger, active patients.

2.3 Modern sliding pairings and materials

• Ceramic-ceramic , ceramic-polyethylene or metal-ceramic combinations with highly cross-linked polyethylene have extremely low abrasion rates.
• Oxidation-resistant surfaces ensure that there is hardly any abrasion even under higher loads.

2.4 Larger prosthetic heads

• Today, they are usually 32 mm, 36 mm or even 40 mm in diameter.
• This significantly increases the safety of preventing dislocations.

Conclusion: Thanks to these developments, patients can now become active again much earlier and more safely – including when it lifting .

3. How many kg am I allowed to lift after hip replacement surgery?

Previously, lifting heavy loads after hip surgery strictly forbidden . Today, the rule is: Yes, heavy lifting is possible – but gradually and depending on the individual's recovery.

3.1 The critical healing phase (first 6–8 weeks)

• Most modern hip replacements are implanted without cement.
• During the first few weeks, the implant must grow (osseointegration).
• loosening during this phase .

Recommendation for the first few weeks:

• 0–4 weeks: Maximum 5 kg per hand (e.g. a full case of water is too much).
• 4–8 weeks: Up to 10 kg is usually possible, provided there is no pain and the ability to walk is secure.

3.2 From week 8 – increasing the workload

• In uncomplicated cases, loads of 15–20 kg can often be lifted without problems.
• After 3 months, many patients are again able to move heavier loads professionally or athletically – always depending on individual fitness.

4. Correct lifting technique – protection for hips and back

Even though the artificial joint can withstand a lot, the lifting technique correct:

1. from your knees , not your back.
2. Keep the load close to the body.
3. Do not twist abruptly when standing up from a squatting position.
4. Even weight distribution on both legs.
5. For very heavy loads: Use aids or support.

5. Why old prohibitions after hip replacement play almost no role today

The fear of dislocation after hip surgery was justified – in the past. Today it is unfounded:

• muscle-sparing approaches,
• larger prosthetic heads,
• modern implant materials
  have been almost completely eliminated.

permanent lifting bans no longer necessary in the vast majority of cases for healthy patients with modern hip prostheses

6. Individual factors remain crucial

Despite modern technology, every patient is different. Factors such as:

• General fitness
• Bone quality
• Comorbidities
• Muscle power
• Coordination
  affects how quickly and how heavy lifting can be done after surgery.

7. Conclusion – you can lift things even with a hip replacement!

• In most cases, old prohibitions
• During the first 6–8 weeks, the weight should be limited a maximum of 5–10 kg
• After that – assuming no complications – heavy lifting possible again.
• The correct technique protects not only the hip prosthesis , but also the back.

If you hip surgery or already have a hip replacement and are unsure how much you are allowed to lift in everyday life, you should seek advice from real specialists.

At the ENDOPROTHETICUM Rhein-Main, under the direction of Prof. Dr. Karl Philipp Kutzner, you will receive modern, individual and scientifically sound advice on the load-bearing capacity of your hip.

📍 More information & appointment booking:
www.endoprotheticum.de