A review article: primary total hip arthroplasty precautions; are they still necessary?

Relevance:

Due to the potential risk of dislocating a prosthetic hip joint, patients have historically been advised to adhere to particular movement restrictions following primary total hip arthroplasty (THA) [1].  The surgical techniques and prosthesis used today have evolved to optimise function and longevity and have reduced the likelihood of dislocation.  It follows that the use of these precautions may no longer be necessary with current THA practice.

Purpose:

The aim of this paper was to establish the evidence that abandoning precautions after a primary THA using the anterolateral surgical approach does not increase the dislocation rate.

Methods:

A literature search was carried out using the databases AMED, BNI, Cinahl, Embase, Medline and PEDro.  The Cochrane Library and The Department of Health National Research Register were also checked.  Only English language papers from 2000 were included. Trials comparing patients following THA precautions and those that are not were incorporated.  Surveys looking at the dislocation rate after removing precautions were also considered. The relevant outcome was the dislocation rate after THA.

Results:

Four papers were identified that investigated the primary THA dislocation rate. Two randomised controlled trials and two cohort studies were analysed using the PEDro scale and CASP guidelines.  Results indicate that the rate of dislocation was no different in patients who did not follow restrictions compared to those that did.

Discussion and Conclusion:

The evidence from these papers demonstrates that the rate of dislocation is not increased in patients not following post operative precautions after a primary anterior approach THA.