Are Postoperative Hip Precautions Necessary After Primary Total Hip Arthroplasty Using a Posterior Approach? Preliminary Results of a Prospective Randomized Trial

Tetreault, Matthew W.; Akram, Faisal; Li, Jefferson; Nam, Denis; Gerlinger, Tad L.; Valle, Craig J. Della; Levine, Brett R.

doi:10.1016/j.arth.2020.02.019

Cited by 27 publications

(45 citation statements)

References 29 publications

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“…In terms of post-operative orders or restrictions, variations still exist. For example, despite mounting evidence suggesting that removal of routine hip precautions after primary THA via posterior or anterolateral approach is safe (Dietz et al, 2019;Tetreault et al, 2020), 88% of respondents reported either standard or modified hip precautions as routine for this population. For sites where THA via an anterior approach was completed (62.4%), there was no consensus regarding use of routine precautions or restrictions.…”

Section: Discussionmentioning

confidence: 96%

Benchmarking physiotherapists’ usual care for total hip and knee joint arthroplasty in Australia and New Zealand

Hart¹,

Tarrant²,

Liew³

et al. 2023

NZJP

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This study presents findings from a benchmarking survey describing reported practice in Australia and New Zealand for pre-and post-operative total joint arthroplasty management. The aim of this study was to identify differences in service delivery between both public and private healthcare sectors and geographical regions. Surveys were sent to senior physiotherapists and undertaken online. Responses were received from 125 institutions. Predicted length of stay (LOS) varied across regions with most therapists reporting an agreed LOS of ≥ 3 days (83% total hip arthroplasty; 89% total knee arthroplasty). Significantly longer LOS was reported in the private healthcare sector (p = 0.001). Patients in New Zealand and Western Australia were reported as more likely to be discharged directly home following total hip arthroplasty (p = 0.001) and total knee arthroplasty (p < 0.001) compared with other regions. The majority of physiotherapists suggested they would mobilise patients on post-operative day 0 (total hip arthroplasty 53%; total knee arthroplasty 55%), with both hospital and patient factors cited as barriers to early mobility. Heterogeneity of care across both healthcare sector and region is prevalent following elective total joint arthroplasty in Australia and New Zealand. Research opportunities regarding optimal management remain, particularly in regard to discharge destination, length of stay, and timing of first mobility.

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Section: Discussionmentioning

confidence: 96%

Benchmarking physiotherapists’ usual care for total hip and knee joint arthroplasty in Australia and New Zealand

Hart¹,

Tarrant²,

Liew³

et al. 2023

NZJP

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“…Activity restrictions after HA and KA have been common [ 12 ], and restrictions following HA for at least 3 months have been widely practiced [ 13 ]. There are reports showing that departments with recommendations for activity restrictions have fewer dislocations than departments without restrictions [ 14 ], but other studies find that fewer lifestyle restrictions and precautions following HA seem to lead not to worse dislocation rates but to earlier and better resumption of activities and greater patient satisfaction, and these results appear to hold up for various surgical approaches [ 15 – 17 ]. Hip precautions may unnecessarily exacerbate patient anxiety and fear of dislocation following HA [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions

Paulsen

Djuv

Ludvigsen

et al. 2022

BMC Musculoskelet Disord

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Background Fast-track hip and knee arthroplasty (HA and KA) has been increasingly common over the last decade. In the same time period, there was a strong trend toward less restrictive mobilization. However, few reports have been published on combining these novel programs while measuring the postoperative results by patient-reported outcome measures (PROMs). Descriptions of fast-track surgery programs and their results are warranted. Methods The aim of this retrospective cohort study was to examine if it is possible to achieve excellent PROM results for hip and knee arthroplasty patients in a fast-track pathway without postoperative restrictions. During 2014–2017, the stepwise introduction of a PROM program was implemented at Stavanger University Hospital for all scheduled HA and KA patients, with preoperative assessments and postoperative follow-ups at the outpatient clinic. Standardized information with a focus on early mobilization and no postoperative restrictions was also initiated for the same patients. The generic EuroQol questionnaire (EQ-5D) and either the Hip or Knee disability/injury and Osteoarthritis Outcome Score (HOOS or KOOS) were used. Results PROM response rates varied from 80 to 99%. The median (interquartile range) change from preoperative to one-year postoperative results were as follows for HA and KA patients, respectively: pain, 55 (43–68) and 47 (31–61); other symptoms, 50 (40–65) and 36 (19–50); function in daily living, 54 (41–65) and 44 (31–55); function in sports and recreation, 56 (38–75) and 40 (15–64); joint-related quality of life, 69 (50–81) and 56 (38–75). The length of stay (LOS) was reduced by 1.9 days (mean), corresponding to a 40% reduction for HA patients and a 37% reduction for KA patients. Conclusions We found excellent PROM results after fast-track HA and KA with no postoperative restrictions. We believe that a fast-track program focusing on mobilization without any postoperative restrictions is superior for most patients, but further comparative studies are warranted.

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“…In OT for HA patients, improving the performance of activities of daily living (ADL) is a central goal of the IRP [12]. Achieving this goal is essential for increasing individual independence, thereby improving the quality of life (QOL) for HA patients [13].…”

Section: Introductionmentioning

confidence: 99%

Benefits of Combining Physical Therapy with Occupational Therapy in Hip Arthroplasty

Marcu

Negruț

Uivaraseanu

et al. 2021

JPM

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(1) Background: Hip arthroplasty (HA) is a surgery that replaces the damaged hip joint with an artificial implant called a hip prosthesis. The increase in life expectancy correlated with the population aging level, to which the increase in the number of prosthetic interventions among the young population is added, translates to the imperative need to analyze the quality of life beyond the immediate postoperative period. Strict adherence to an individualized rehabilitation program (IRP), and adapted to each patient, is followed by an improved quality of life. The main goal is the recovery of the patient with HA. This study was aimed to demonstrate that an IRP, represented by physical therapy associated with occupational therapy, improves the quality of life of patients with HA; (2) Methods: In this study, conducted between 2019 and 2021, 50 patients with HA were divided into two groups: study group—group A (25 subjects compliant with the IRP) and control group—group B (25 subjects, non-compliance with the IRP). To evaluate the two study groups, we monitored the evolution of the modified Harris hip score (mHHS) in both hips (arthroplasty hip (AH), contra lateral hip (CH)), for four months, respectively 30 days before the surgery (T0) and at 90 days after the surgery (T1); (3) Results: We notice significant differences in mHHS values at 90 days-T1 after surgery, both on AH in favor of subjects from group A vs. group B (p = 0.030) and on CH, where mHHS values were statistically higher in group A compared to group B (p < 0.001). The results of our study outline at T1 moment, both on the AH (p = 0.030) and on the CH (p < 0.001), the fact that mHHS values were statistically higher in patients included in group A compared to group B. In terms of the results for mHHS, comparing AH with CH, it is noted that the number of subjects who had a good or excellent mHHS result in group A versus group B is statistically significant in the case of CH (group A: 23 (92%) vs. group B: 11 (44%), p = 0.039); (4) Conclusions: The study reveals clear advantages of HA in both hips, both in subjects who complied with the IRP and those who did not comply; the higher therapeutic benefits of IRP are outlined at the level of CH compared to AH; in patients who comply with the IRP, the mHHS parameters that have improved in both CH and AH are pain, leaning, and shoes and socks activities; in addition, limping was reduced in CH.

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Are Postoperative Hip Precautions Necessary After Primary Total Hip Arthroplasty Using a Posterior Approach? Preliminary Results of a Prospective Randomized Trial

Cited by 27 publications

References 29 publications

Benchmarking physiotherapists’ usual care for total hip and knee joint arthroplasty in Australia and New Zealand

Benchmarking physiotherapists’ usual care for total hip and knee joint arthroplasty in Australia and New Zealand

Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions

Benefits of Combining Physical Therapy with Occupational Therapy in Hip Arthroplasty

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