Recall and patient perceptions of hip precautions 6 weeks after total hip arthroplasty

Abstract

Background and purposeThere is a lack of evidence to support the role of hip precautions in preventing dislocation following total hip arthroplasty (THA). We report an exploratory study which assesses recall, adherence, and the impact of precautions on activities of daily living in the first 6 weeks postoperatively.Patients and methodsWe designed a new questionnaire based on the education patients receive and refined by professionals within our multidisciplinary team. 129 patients underwent primary elective THA during the study period and received the questionnaire at 6 weeks postoperatively.Results97 (75%) patients responded before the 8th week postoperatively. Most of these (83 patients) could remember all the precautions. Of the 97 who responded only 22 claimed to adhere to all of the precautions. 48 admitted to putting their own underwear on without the use of aids or assistance, and 38 had started walking without an aid. Due to the precautions 67 avoided leaving the house at some point and 63 were unable to perform desired activities. 84 stated that their sleep was affected. There were no dislocations among the 97 patients who responded; however, there was 1 dislocation among the 32 non-responders.InterpretationWe found that most patients did not adhere to hip precaution advice. Precautions have a detrimental effect on patient activity and sleep. In view of the limited efficacy in reducing dislocation rate, we question the use of precautions in the primary arthroplasty setting.

Varying but reduced use of postoperative mobilization restrictions after primary total hip arthroplasty in Nordic countries: a questionnaire-based study

“…Furthermore, a recent study showed that while most patients can remember all of the restrictions recommended at 8 weeks after surgery only one-fifth adhere to all restrictions, suggesting that even if restrictions are prescribed most patients do not adhere to them (Lee et al. 2017).…”

“…2016, Lee et al. 2017). Authors KG, AT, and HH drafted the questionnaire, whereafter all other authors were asked to review it.…”

What are the postoperative experiences of patients who have undergone hip and knee joint replacement? A literature review

“…A proportion of patients post joint replacement are left dissatisfied experiencing some functional disability and may be failing to comprehend their ultimate level of physical function (Wylde et al 2007). Although most participants are informed preoperatively of what physical ability is likely to be postoperatively, including common precautions (Lee et al 2017), perhaps the emphasis on this is not enough. In terms of preoperative education, the addition of realistic activities/hobbies individuals are likely to be able to participate in post surgery may help to meet expectations.…”

Capsular Ligament Function After Total Hip Arthroplasty

“…However, the cadaveric model allows experimentation and measurements that may not be ethically possible in live patients, while maintaining realistic anatomical and material properties that may not be realized in other laboratory or computational approaches. Our cadaver data may, therefore, help to interpret clinical findings in the early postoperative period when the risk of hip instability is greatest 35,[43][44][45] and may help to determine the need for, and value of, lifestyle restrictions and hip precautions, which continue to be keenly debated 34,[46][47][48][49][50] . It may also be the case that balancing the capsule appropriately at time zero would initiate appropriate biomechanical conditions for better long-term function, but this would certainly need a clinical project to evaluate.…”