Guide — Musculoskeletal
Hip & Knee Arthroplasty Nursing Care
Joint replacement is one of the most common surgeries a med-surg nurse will see, and the care bundle is remarkably consistent: protect the new joint from dislocation, prevent clots and infection, and get the patient moving the same day. The details — especially hip precautions — are where exams and real patients both test you.
9 min read · Musculoskeletal
Educational use only. Precautions vary with surgical approach, and weight-bearing status, VTE prophylaxis, and therapy progression are surgeon-directed — always confirm the specific orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) replace joints destroyed by osteoarthritis, rheumatoid disease, avascular necrosis, or fracture. Most patients are older adults with comorbidities, which makes the perioperative course as much a medical-management problem as a surgical one.
Modern programs move fast: mobilization the day of surgery, discharge in one to two days (or same-day for selected patients), and a heavy reliance on the patient executing precautions and exercises at home. That shifts the weight of safety onto nursing assessment and teaching.
Key Concepts
Posterior hip precautions — the classic triad
After a posterior-approach THA: no hip flexion beyond 90 degrees, no crossing the legs or adduction past midline, no internal rotation of the operative leg. An abduction pillow or pillows between the knees enforces this in bed; raised toilet seats and high chairs enforce it everywhere else.
Approach changes the rules
Anterior-approach THA patients avoid hip extension and external rotation instead, and many programs use minimal or no formal precautions. Never recite precautions from memory without checking which approach the surgeon used.
Knees want motion, hips want position
TKA care emphasizes early flexion and extension exercises — quad sets, ankle pumps, progressive range of motion — because a stiff knee is the failure mode. The hip’s failure mode is dislocation; the knee’s is arthrofibrosis.
The prosthetic joint is forever an infection risk
Periprosthetic joint infection is a devastating complication. Strict perioperative asepsis, surveillance of the wound, and lifelong patient awareness (report fever plus new joint pain promptly) all matter.
Assessment Findings
Postoperative assessment is the standard post-surgical bundle plus joint-specific items: neurovascular checks of the operative limb (peroneal nerve function after TKA — dorsiflexion and great-toe sensation), wound and drain output, and pain trended against activity.
Hip dislocation looks like this: sudden sharp pain with a pop, the operative leg shortened and rotated, inability to bear weight or move the hip. It is an emergency — keep the patient still and notify the surgeon immediately. Suspect VTE with unilateral calf swelling or warmth; suspect infection with fever, spreading erythema, or purulent drainage.
Nursing Priorities
Enforce precautions in every transfer
The dangerous moments are getting out of bed, onto the toilet, and into a car. Cue the patient before each move, keep the abduction pillow in place in bed after posterior THA, and never let the operative hip pass 90 degrees of flexion during a boost or transfer.
VTE prevention as a bundle
Pharmacologic prophylaxis per orders, sequential compression devices on, ankle pumps hourly while awake, and ambulation on schedule. Joint replacement is among the highest-risk elective surgeries for DVT.
Mobilize on schedule, medicate ahead of therapy
Pre-medicate before physical therapy so pain doesn’t cancel the session. Day-of-surgery ambulation reduces VTE, ileus, and length of stay.
Watch the hemoglobin
Arthroplasty can bleed meaningfully. Trend hemoglobin, watch for orthostasis and tachycardia on first ambulation, and report per parameters.
Therapeutic Communication Considerations
Most arthroplasty patients chose this surgery to get their lives back, and they arrive motivated but often surprised by how hard the first days are. Normalize the early struggle and anchor to the trajectory: function at six weeks, not day two, is the measure.
Precaution teaching lands better as collaboration than command. Walk the patient’s actual day — their bathroom, their car, their favorite chair — and problem-solve each one against the precautions. A rule mapped to a real chair is a rule that survives discharge.
Patient Education
Send the patient home able to recite: their precautions and how long they last, the dislocation emergency picture (sudden pain, leg looks wrong, can’t bear weight — call 911, don’t try to walk it off), VTE warning signs, wound care, and their anticoagulant plan including follow-up labs if applicable.
Home setup: raised toilet seat and shower chair after posterior THA, no low or reclining chairs, clear walking paths, assistive device used exactly as therapy taught. For TKA, the home exercise program is the implant’s warranty — missed exercises are how good knees go stiff.
NCLEX Pearls
- ✦Posterior THA precautions: no flexion past 90°, no adduction past midline, no internal rotation. Abduction pillow in bed.
- ✦Sudden pain + shortened, rotated leg + unable to move the hip after THA = dislocation. Immobilize and notify the surgeon stat.
- ✦Raised toilet seats and high firm chairs are correct answers; low recliners and crossing the legs are traps.
- ✦Joint replacement is high VTE risk — prophylaxis, SCDs, ankle pumps, early ambulation all together, not either-or.
- ✦After TKA, check peroneal nerve function: dorsiflexion and sensation between the great and second toes.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Orthopaedic Surgeons (AAOS) · National Association of Orthopaedic Nurses (NAON). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →