Hip and knee replacement: dislocation precautions, VTE prevention, mobilisation and going home
- Safe practice
After a hip or knee replacement the patient gets up early, prevents clots, protects the new joint and learns the warning signs before going home.
What it is
Most patients stay one or two days after a hip or knee replacement, and some go home the same day. Nursing gets the patient out of bed on the day of surgery when possible, controls pain so that exercise is possible, prevents blood clots and chest infection, and checks the leg's circulation and nerves, especially after a nerve block. After hip replacement the patient learns the movements that can dislocate the new joint; after knee replacement, how to keep the knee straight at rest. Before discharge the patient should move in and out of bed and on and off the toilet safely, walk with the walking aid and know the signs of infection and of a clot.
What it requires
- Early mobilisation with physiotherapy and occupational therapy.
- Pain relief planned so the patient can exercise.
- Clot and chest-infection prevention from the day of surgery.
- Discharge criteria: safe transfers, walking with the aid, a few steps with help, and for the knee bending to almost a right angle.
How it is applied (and why)
- Check the dressing, any drain, and the colour, warmth, pulses, feeling and movement of the leg per protocol — bleeding and nerve or vessel problems show early.
- Assess pain and give the ordered relief before exercise — pain that limits movement delays recovery.
- Help the patient to the chair and to walk with the aid as early as the order allows — early movement prevents most post-operative problems.
- Teach and check hip precautions at every transfer, or keep a replaced knee straight with support under the heel — this protects the joint and its movement.
- Apply stockings or compression devices as ordered and teach ankle pumps — they improve venous return and lower the clot risk.
- Coach deep breathing, coughing and the incentive spirometer — this helps prevent pneumonia.
- Watch the bladder after the catheter is removed and ask about fullness — it can be hard to pass urine at first.
- Check that the patient can transfer, use the toilet and walk safely with the aid, with the home set up — discharge depends on safe function.
- Teach wound care, no soaking the wound, the walking aid, fall prevention at home and the warning signs — the risks continue at home.
In nursing practice
- Sudden pain, trouble moving the hip, or a feeling that the hip has slipped out of place after a fall or a movement can mean dislocation.
- Calf swelling or pain, or chest pain and shortness of breath, suggest a clot.
- Redness, drainage, rising pain or fever suggest wound infection.
- A cool or darker foot or toes need urgent review.
- Bruising and mild redness around the wound are expected.
Common mistakes
- Teaching precautions once and never checking that the patient follows them.
- Putting a pillow under the knee after a knee replacement.
- Letting the patient sit for long periods without moving.
- Assuming numbness is just the nerve block and not checking that it resolves.
- Discharging without checking the home for loose rugs, low chairs and stairs.
Test yourself
Think of the answer, then tap the question to see it.
Which two movements should a patient avoid after a hip replacement with dislocation precautions?
Bending the hip past a right angle and crossing the legs; also sitting with the knees higher than the hips.
Where does the pillow go after a knee replacement?
Under the heel or ankle, not under the knee, so that the knee stays straight.
Which measures prevent blood clots after joint replacement?
Compression stockings or devices, ankle pumps, early walking and the anticoagulant ordered.
Which signs should make the patient call the surgeon after discharge?
Calf pain or swelling, chest pain or breathlessness, wound redness or drainage, fever, uncontrolled pain, or a cool or darker foot.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Hip or knee replacement - in the hospital after, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Taking care of your new hip joint, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Knee joint replacement - discharge, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Hip replacement - discharge, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.