The rate of dislocation is not increased when minimal precautions are used after total hip arthroplasty using the posterolateral approach

Kornuijt, Anke; Das, Dirk; Sijbesma, Thea; Weegen, Walter van der

doi:10.1302/0301-620x.98b5.36701

Cited by 40 publications

(31 citation statements)

References 33 publications

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“…Besides asking if the hospitals used any mobilization restrictions at all following primary THA, we also asked about specific restrictions employed and specific aids given to the patients as a part of the standard mobilization protocol (Kornuijt et al. 2016, Lee et al. 2017).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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Background and purpose — Mobilization has traditionally been restricted following total hip arthroplasty (THA) in an attempt to reduce the risk of dislocation and muscle detachment. However, recent studies have questioned the effect and rationale underlying such restrictions. We investigated the use of postoperative restrictions and possible differences in mobilization protocols following primary THA in Denmark (DK), Finland (FIN), Norway (NO), and Sweden (SWE). Patients and methods — All hospitals performing primary THA in the participating countries were identified from the latest national THA registry report. A questionnaire containing questions regarding standard surgical procedure, use of restrictions, and postoperative mobilization protocol was distributed to all hospitals through national representatives for each arthroplasty registry. Results — 83% to 94% (n = 167) of the 199 hospitals performing THA in DK, FIN, NO, and SWE returned correctly filled out questionnaires. A posterolateral approach was used by 77% of the hospitals. 92% of the hospitals had a standardized mobilization protocol. 50%, 41%, 19%, and 38% of the hospitals in DK, FIN, NO, and SWE, respectively, did not have any postoperative restrictions. If utilized, restrictions were applied for a median of 6 weeks. Two-thirds of all hospitals have changed their mobilization protocol within the last 5 years—all but 2 to a less restrictive protocol. Interpretation — Use of postoperative restrictions following primary THA differs between the Nordic countries, with 19% to 50% allowing mobilization without any restrictions. There has been a strong tendency towards less restrictive mobilization over the last 5 years.

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Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“… 2015 , Kornuijt et al. 2016 ). A systematic review and meta-analysis including 1,122 procedures (528 with strict precautions and 594 with relaxed precautions) showed no difference in dislocation rate; however, there was an earlier resumption of ADLs and increased patient satisfaction in the relaxed precaution group (van der Weegen et al.…”

Section: Discussionmentioning

confidence: 99%

“… 2015 ), therefore a sample size of approximately 4,000 THAs would be required for a randomized controlled trial to determine whether dislocation rates differ between precaution and non-precaution groups (Kornuijt et al. 2016 ). Despite this, several cohort studies have failed to identify a benefit to hip precautions (Peak et al.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study which abandoned sleeping restrictions and employed normal toilet and chair heights but disallowed combined flexion, internal rotation and adduction found no difference in dislocation when compared with a standard protocol group (Kornuijt et al. 2016 ). A study of 2,764 THAs given no functional restrictions postoperatively was unable to identify a difference in dislocation rate when compared with those given standard restrictions (Restrepo et al.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…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.…”

Section: Neck Lengthmentioning

confidence: 99%

Capsular Ligament Function After Total Hip Arthroplasty

Arkel¹,

Ng²,

Muirhead-Allwood³

et al. 2018

The Journal of Bone and Joint Surgery

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Background: The hip joint capsule passively restrains extreme range of motion, protecting the native hip against impingement, dislocation, and edge-loading. We hypothesized that following total hip arthroplasty (THA), the reduced femoral head size impairs this protective biomechanical function. Methods: In cadavers, THA was performed through the acetabular medial wall, preserving the entire capsule, and avoiding the targeting of a particular surgical approach. Eight hips were examined. Capsular function was measured by rotating the hip in 5 positions. Three head sizes (28, 32, and 36 mm) with 3 neck lengths (anatomical 0, +5, and +10 mm) were compared. Results: Internal and external rotation range of motion increased following THA, indicating late engagement of the capsule and reduced biomechanical function (p < 0.05). Internal rotation was affected more than external. Increasing neck length reduced this hypermobility, while too much lengthening caused nonphysiological restriction of external rotation. Larger head sizes only slightly reduced hypermobility. Conclusions: Following THA, the capsular ligaments were unable to wrap around the reduced-diameter femoral head to restrain extreme range of motion. The posterior capsule was the most affected, indicating that native posterior capsule preservation is not advantageous, at least in the short term. Insufficient neck length could cause capsular dysfunction even if native ligament anatomy is preserved, while increased neck length could overtighten the anterior capsule. Clinical Relevance: Increased understanding of soft-tissue balancing following THA could help to prevent instability and improve early function. This study illustrates how head size and neck length influence the biomechanical function of the hip capsule in the early postoperative period.

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The rate of dislocation is not increased when minimal precautions are used after total hip arthroplasty using the posterolateral approach

Abstract: Experienced orthopaedic surgeons using the posterolateral approach for THA should not fear an increased dislocation rate if they manage their patients with a minimal precautions protocol. Cite this article: Bone Joint J 2016;98-B:589-94.

Cited by 40 publications

References 33 publications

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

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

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

Capsular Ligament Function After Total Hip Arthroplasty

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