Hip precautions how long after surgery

Hip precautions focus on limiting the internal rotation, external rotation, adduction, and flexion of the hip.

These actions place the hip in positions of risk postsurgery, before capsular and other soft tissue elements around the replaced joint have healed in the early postoperative period.

When modeled, these maneuvers led to a high rate of dislocation, lending theoretical support to hip precautions. Moreover, although prescribing hip precautions may appear an innocuous intervention, adverse effects such as delaying return to normal activity, difficulty in nursing care, falls risk, loss of condition, and joint range of motion need to be considered.

The focused clinical question was: In patients who have had a THA does the application of hip precautions versus unrestricted activities significantly decrease the risk of prosthetic dislocation. Despite the routine prescription of hip precautions post-THA across Australia, there have been no Australian randomized controlled trials RCTs , systematic reviews, or meta-analyses to review their efficacy in practice, prompting a need for evaluation of the current data.

In this study, we sought to systematically review the available clinical evidence concerning the benefits of hip precautions to patients and their role in preventing hip dislocation post THA. Studies that were included in the systematic review comprised of randomized controlled trials or cohort studies with a comparative group. Studies had to have follow-up of at least 6 months, allow the independent effect of hip precautions to be evaluated, and include specific information concerning dislocation and reoperation.

Case series and case reports are excluded from the review owing to the high potential for bias in these study designs. Case—control studies except where nested as part of a cohort study and economic evaluations were also excluded. Studies were considered from the year onward to reflect contemporary practice and prosthesis design. Language was restricted to those in English and the search included published work and conference abstracts.

Where only abstract information was available, a sensitivity analysis was performed. The last search took place on the April 3, All titles and abstracts retrieved by this search were considered independently by 2 authors for eligibility. Where studies suggested that they might meet the eligibility criteria, the full text of the study was obtained. The full-text articles were then assessed for eligibility again by 2 independent reviewers.

All studies were assessed for quality using the Jadad criteria. Data extraction was performed by all 3 authors using a piloted data extraction form primarily addressing the number of patients in the study, the type of precautions advised, the nature of the control group, and the frequency of dislocation and reoperation in each group.

Where differences emerged in the data extraction, they were resolved by consensus. We evaluated risk of bias at study level.

In the data synthesis, studies were assessed on a quality basis and a sensitivity analysis was performed to explore the effect of quality on outcome. The principle summary measure was the risk ratio between the treatment and the comparator groups at 6 months.

From 80 articles in our initial search, 5 articles were retrieved 15 , 16 for data extraction Figure 1. Of those 5, 2 RCTs met our eligibility criteria. This systematic review yielded few primary studies concerning the effectiveness of hip precautions post-THA. Two RCTs were found. Randomization appeared to be correctly conducted, and all patients were accounted for at follow-up.

Both of these studies therefore score 2 out of a possible 3 on the Jadad criteria. This heterogeneity precludes pooling of data between the reviews. Neither study found any benefit from hip precautions, but only 1 dislocation occurred in patients so there is a high probability of a type II error, which is an error that occurs when one accepts a null hypothesis that is actually false.

One further study with a comparison group was identified. The ascertainment of the primary outcome of concern, prosthesis dislocation, was not collected systematically but relied upon reporting and database screening of the individual surgical practices as well as presentations to the hospital where the study had been conducted. The intervention was a multidisciplinary preoperative education session delivered to patients over 3 hours, which included recommendations about restricting movements and advice on seats and cars.

The session also incorporated other components including a description of dislocation, a detailed explanation of the prosthesis, and direct contact with a senior surgeon. It is therefore impossible to dissect any one component that may be responsible for any effect.

Participation in the program was voluntary, attracting These selection criteria may have introduced volunteer bias, and no assessment of actual behavior or concurrent interventions such as advice from other sources during the admission was performed.

The comparison groups were those not volunteering to participate and a historical group being those who were operated on prior to the availability of the educational program. It was felt that these methodological issues introduced sufficient bias that the results not be valid for inclusion in this systematic review.

In considering these results, it is important to assess any adverse effects from applying hip precautions. Both the included studies considered the benefits of not applying hip precautions. Peak et al noted a faster return to activities of daily living ADLs , lower costs, and a higher degree of patient satisfaction in the unrestricted group. Similarly, Ververeli et al found a faster pace of recovery and an earlier return to driving in the unrestricted group.

The 2 other studies retrieved were prospective case series with no comparison group and therefore failed to meet our a priori inclusion criteria. All retrieved studies concerned only anterolateral approaches to THA, and these results can only pertain to patients who are managed with this technique.

This systematic review found no evidence to support the use of hip precautions following anterolateral THA for the prevention of hip dislocation. Moreover, patients assigned to hip precautions had slower rehabilitation and return to usual ADLs. The strength of this review is the application of an explicit clinical question, a predefined search, inclusion strategy, and multiple assessors of articles to be included.

These serve to enhance the reliability of the conclusions and offer important advantages over narrative reviews, which risk including biased studies that may distort the true effect. The weaknesses of this review are that the number of included studies is small but this is a failing of the existing literature.

These results only pertain to anterolateral approaches to THA and cannot be applied to posterior approaches, where the baseline rate of dislocation is higher and the beneficial effects of hip precautions are unknown. We did not perform a sensitivity analysis including results from non-RCT studies. There was only 1 study that included a comparison group but the intervention was not specifically hip precautions, follow-up was not systematic, and participation was voluntary.

In those studies where the outcomes of the dislocations were reported, they were benign events usually not requiring surgery and not associated with morbidity. Total hip arthroplasty dislocation is common in patients older than 80 years of age. Those with poor muscular tone, femoral neck fractures, acetabular dysplasia, cerebral palsy, muscular dystrophy, and intellectual impairment are all associated with an increased dislocation rate.

The 5 retrieved studies 15 — 17 , 19 , 20 covered a total of THA patients, with a total of 54 dislocations reported. People can maximize rest time and reduce the chance of falls by planning ahead. For example:. Read more about how to prepare the home for recovery from hip replacement surgery. A physical therapist can help a patient achieve certain rehabilitation goals. If a patient wants to swim freestyle, the physical therapist will teach exercises to prepare the hip for flutter kicking.

Regardless of individual goals, physical therapy is essential to hip replacement rehabilitation. Patients who attend their physical therapy appointments and do their prescribed exercises tend to recover more quickly and have better outcomes than those who do not.

Hip replacement patients are given a long list of things not to do—do not bend the hips or knees further than 90 degrees, do not cross the legs, do not lift the leg to put on socks, and much more. These movement restrictions protect the new hip from dislocation. After hip replacement surgery many patients are tempted to do too much at once, risking injury or dislocation.

Alternatively, other people delay getting back into a regular routine longer than necessary. Each patient must work with a doctor and physical therapist to find the right balance between activity and rest. That balance will change over time—for as long as a year—as hip function improves and stabilizes.

How can you care for yourself at home? What are some precautions for self-care after hip replacement surgery posterior? Hip Replacement Posterior Precautions: Don't bend your hip too far. Hip Replacement Posterior Precautions: Don't cross your legs. Other tips Go slowly when you climb stairs. Make sure the lights are on. Have someone watch you, if you can. When you climb stairs: Step up first with your unaffected leg.

Then bring the affected leg up to the same step. Bring your crutches or cane up. To go down stairs, reverse the order.

First, put your crutches or cane on the lower step. Then bring the affected leg down to that step. Finally, step down with the unaffected leg. You can ride in a car, but stop at least once every hour to get out and walk around. You may want to sleep on your back. Don't reach down too far to pull up blankets when you lie in bed.

If your doctor recommends exercises, do them as directed. You can cut back on your exercises if your muscles start to ache, but don't stop doing them. When should you call for help? For example, call if: You passed out lost consciousness. You have sudden chest pain and shortness of breath, or you cough up blood.

You have severe pain in your chest.