Removal of restrictions following primary THA with posterolateral approach does not increase the risk of early dislocation

Abstract

Background and purpose Patient education and mobilization restrictions are often used in an attempt to reduce the risk of dislocation following primary THA. To date, there have been no studies investigating the safety of removal of mobilization restrictions following THA performed using a posterolateral approach. In this retrospective non-inferiority study, we investigated the rate of early dislocation following primary THA in an unselected patient cohort before and after removal of postoperative mobilization restrictions.Patients and methods From the Danish National Health Registry, we identified patients with early dislocation in 2 consecutive and unselected cohorts of patients who received primary THA at our institution from 2004 through 2008 (n = 946) and from 2010 through 2014 (n = 1,329). Patients in the first cohort were mobilized with functional restrictions following primary THA whereas patients in the second cohort were allowed unrestricted mobilization. Risk of early dislocation (within 90 days) was compared in the 2 groups and odds ratio (OR)—adjusted for possible confounders—was calculated. Reasons for early dislocation in the 2 groups were identified.Results When we adjusted for potential confounders, we found no increased risk of early dislocation within 90 days in patients who were mobilized without restrictions. Risk of dislocation within 90 days was lower (3.4% vs 2.8%), risk of dislocation within 30 days was lower (2.1% vs 2.0%), and risk of multiple dislocations (1.8% vs 1.1%) was lower in patients who were mobilized without restrictions, but not statistically significantly so. Increasing age was an independent risk factor for dislocation.Interpretation Removal of mobilization restrictions from the mobilization protocol following primary THA performed with a posterolateral approach did not lead to an increased risk of dislocation within 90 days.

Reduced length of uninterrupted institutional stay after implementing a fast-track protocol for primary total hip replacement

“… 2014 , Gromov et al. 2015 ). Apart from studies on LOS which included only hospitals discharging 100% of patients home (Husted et al.…”

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

“…The 90-day rate of dislocation did not change in Denmark after precautions were abandoned in the primary hip setting (Gromov et al. 2015 ).…”

Rehabilitation of revision total hip replacement: A multi‐centre survey of current practice

“…The weak evidence surrounding hip precautions is recognized. Many dislocations are linked to factors that cannot be altered with precautions (Gromov et al, ) and studies in primary THR populations provide no clear evidence of benefit (Barker et al, ; Gromov et al, ; Mikkelsen, Petersen, Søballe, Mikkelsen, & Mechlenburg, ; van der Weegen, Kornuijt, & Das, ). Indeed, there is some evidence that removing restrictions may improve the time taken to resume functional activities (Gromov et al, ; Mikkelsen & Petersen et al, ; van der Weegen et al, ).…”

“…Many dislocations are linked to factors that cannot be altered with precautions (Gromov et al, 2015) and studies in primary THR populations provide no clear evidence of benefit (Barker et al, 2013;Gromov et al, 2015; van der Weegen, Kornuijt, & Das, 2016). Indeed, there is some evidence that removing restrictions may improve the time taken to resume functional activities (Gromov et al, 2015;van der Weegen et al, 2016). This is an important issue for RTHR.…”