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

Abstract

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.

Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients

“… 2019 ) reporting similar results with other surgical approaches, hip precautions are still prescribed to patients in as many as two-thirds of hospitals (Gromov et al. 2019 ).…”

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

“…The use of postoperative restrictions following primary HA differs between Nordic countries, with between 19% (in Norway) and 50% (in Denmark) of hospitals performing primary HA allowing mobilization without any restrictions [ 38 ]. Over the last five years, there has been a strong tendency toward less restrictive mobilization, but still and especially in Norway, few hospitals allow mobilization without restrictions [ 38 ]. It has been a fear that fast-track HA and KA with no postoperative restrictions will lead to more hip dislocations and more reoperations.…”

Evaluation of hip precautions following total hip replacement: a before and after study

“…The surgical approach, surgeon experience and head size were significantly associated with whether patients were prescribed hip precautions and equipment [28]. In Nordic countries, a recent survey has highlighted there are discrepancies between countries (Denmark, Finland, Norway and Sweden), with 81% of in Norway prescribing precautions whilst 50% of hospitals in Denmark prescribe precautions [29]; the number of hospitals prescribing precautions in Sweden (62%) and Finland (59%) were similar. Whilst some countries are becoming more liberal about the use of hip precautions, there remains continued widespread use of them.…”