Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. A systematic review of psychological interventions in total hip and knee arthroplasty Reduced patient restrictions following total hip arthroplasty: study protocol for a randomized controlled trial Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Evaluation of reducing postoperative hip precautions in total hip replacement: a randomized prospective study. Can Dual Mobility Cups prevent Dislocation in All Situations After Revision Total Hip Arthroplasty? Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. Dislocation after total hip arthroplasty using Hueter anterior approach.
Purpose : Total hip arthroplasty ( THA ) is a common and effective treatment of hip osteoarthritis . Activity restrictions known as hip pre caution s are widely practice d in rehabilitation post THA , aim ing to foster healing and prevent hip dislocation . The focused clinical question was : Does the application of hip pre caution s in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation ? Methods : A comprehensive literature search was conducted for r and omized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up , with dislocation as an end point . Retrieved titles were assessed independently by 2 review ers for inclusion and underwent st and ardized data extraction . Results : Title search produced 80 potentially relevant articles . Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria . No eligible studies were found that concerned posterior approaches to hip arthroplasty , so the results of this review concern only anterolateral approaches . Neither included study showed any benefit of hip pre caution s in preventing dislocation . Conclusion : The rate of dislocation after anterolateral THA is low and is not improved by hip pre caution s. Hip pre caution s are associated with a slower return to activities , significant expense , and decreased patient satisfaction . Existing studies risk being compromised by a type II error , but a definitive study may be prohibitively large and expensive BACKGROUND It is currently unknown whether functional restrictions following total hip arthroplasty can reduce the prevalence of early postoperative dislocation . Our hypothesis was that dislocation was more likely to occur in patients who were not placed on these restrictions . METHODS We performed a prospect i ve , r and omized study to evaluate the role of postoperative functional restrictions on the prevalence of dislocation following uncemented total hip arthroplasty through an anterolateral approach . Of the 630 eligible consecutive patients , 265 patients ( 303 hips ) consented to be r and omized into one of two groups ( the " restricted " group or the " unrestricted " group ) . The patients in both groups were asked to limit the range of motion of the hip to < 90 degrees of flexion and 45 degrees of external and internal rotation and to avoid adduction for the first six weeks after the procedure . The patients in the restricted group were instructed to comply with additional hip pre caution s during the first six weeks postoperatively . Specifically , these patients were managed with the placement of an abduction pillow in the operating room before bed transfer and used pillows to maintain abduction while in bed ; used elevated toilet seats and elevated chairs in the hospital , in the rehabilitation facility , and at home ; and were prevented from sleeping on the side , from driving , and from being a passenger in an automobile . All patients were followed for a minimum of six months postoperatively . RESULTS There was one dislocation in the entire cohort ( prevalence , 0.33 % ) . This dislocation occurred in a patient in the restricted group during transfer from the operating table to a bed with an abduction pillow in place . Patients in the unrestricted group were found to return to side-sleeping sooner ( p < 0.001 ) , to ride in automobiles more often ( p < 0.026 ) , to drive automobiles more often ( p < 0.001 ) , to return to work sooner ( p < 0.001 ) , and to have a higher level of satisfaction with the pace of their recovery ( p < 0.001 ) than those in the restricted group . There was an additional expenditure of approximately $ 655 per patient in the restricted group . CONCLUSIONS Total hip arthroplasty through an anterolateral approach is likely to be associated with a low dislocation rate . Removal of several restrictions did not increase the prevalence of dislocation  following primary hip arthroplasty at our institution . However , it did promote substantially lower costs and was associated with a higher level of patient satisfaction as patients achieved a faster return to daily functions in the early postoperative period Background The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality , anxiety , depression and negative thinking styles can influence outcomes and recovery from surgery . The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip ( THA ) and knee arthroplasty ( TKA ) , in improving patient reported joint outcomes . Methods An extensive literature search was conducted according to Preferred Reporting Items for Systematic review s and Meta-Analyses guidelines . Search terms included psychology , interventions , and orthopaedics . Articles were included if they were r and omised controlled trials ( RCTs ) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty . Results A total of 19,489 titles were screened . Seven studies met the inclusion criteria and were included . Five of seven studies did not show improvements in patient reported outcomes after surgery . Specifically , psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies . Conclusion The current literature does not support routine psychological interventions for TKA and THA . However , it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy . This gap in the literature is surprising , considering the importance of the role of psychological factors in recovery . Further RCTs with long term follow ups , multidisciplinary involvement , and more comprehensive and focused interventions that go beyond educating patients are needed . Future studies should account for the dem and effect , include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others , and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA Background Total hip arthroplasty ( THA ) is a very common procedure in orthopedic surgery . In the Netherl and s , 25,642 primary THAs were performed in 2013 . Postoperative hip dislocation is one of the major complications and has been reported in 0.5 to 10.6 % of patients after primary THA.Several reports regarding the use of an anterolateral surgical approach have shown that a non-restriction or reduced restriction protocol does not increase the dislocation rate . For the posterolateral surgical approach it has been suggested that patient restrictions might be unnecessary but the amount of available literature is scarce . As such , r and omized controlled trials aim ed at investigating restrictions following THA using a posterior approach are strongly recommended . The aim of this prospect i ve r and omized controlled trial is to investigate the non-inferiority hypothesis concerning the early dislocation rate after THA in patients with and without the use of a reduced restriction protocol . Methods / Design After providing informed consent a group of 456 patients with symptomatic coxarthrosis will be r and omized to receive a THA either with care as usual , i.e. receiving postoperative restrictions including the advice to sleep in a supine position for the first 8 weeks postoperatively , or reduced restrictions with no recommendations regarding the position during sleeping . Primary outcome measure will be the percentage of early dislocations within the first 8 weeks after THA . Secondary outcome measures will be patient satisfaction , time to functional recovery , quality of sleep and patient ’s self-reported compliance with postoperative instructions . Discussion To our knowledge this will be the first r and omized controlled trial that compares a reduced restriction protocol with a restricted protocol following THA using a posterolateral surgical approach . Our hypothesis is that a reduced restriction protocol following THA with use of a posterolateral surgical approach has no influence on the early dislocation rate compared to a restricted protocol . Instead , embracing a reduced restriction protocol might even contribute to a higher quality of sleep , thereby facilitating a faster uptake and return to daily functions in patients after THA.Trial registration Clinical Trials.gov NCT02107248 , registration date 3 April 2014 INTRODUCTION Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty . The type of arthroplasty to be used , either hemi- or total hip arthroplasty , remains controversial as total hip replacements potentially have a higher rate of dislocation . HYPOTHESIS Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck . PATIENTS AND METHODS In a multicenter prospect i ve study conducted in France over an inclusion time of 3 months , all displaced fractures of the femoral neck treated with arthroplasty  were operated on with insertion of a dual mobility cup . Patients had clinical and radiological assessment at 3 , 6 , and 9 months postoperative . RESULTS Two hundred and fourteen hips in 214 patients with a mean age of 83 years ( range , 70 - 103 years ) were included . None of the patients was lost to follow-up . The mortality rate after 9 months was 19 % . Two patients ( 1 % ) had early postoperative infection successfully treated with lavage and antibiotics . Three patients ( 1.4 % ) , operated through a posterior approach , presented one postoperative dislocation , all of which were posterior . Reduction was performed through closed external manipulation under general anesthesia . There was no recurrence of dislocation . DISCUSSION This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemiarthroplasties . Dual mobility cups might therefore be considered a valuable option to prevent postoperative dislocation when treating displaced intracapsular fractures of the proximal femur in elderly patients if a total hip replacement is recommended . Further study is needed before extending the indications for total hip arthroplasty following a fracture of the femoral neck , to assess the potential cost and complications of a longer procedure with its potential acetabular complication , and weigh them against the potential benefits Currently , many rehabilitation protocol s for total hip replacements ( THRs ) include activity restrictions to prevent postoperative dislocation . There is increasing dem and for more efficient and safe rehabilitation protocol s. This r and omized prospect i ve study evaluates the need for hip restrictions following a modified anterolateral procedure . From 2004 to 2008 , 81 patients seeking elective THRs were r and omly assigned into a st and ard rehabilitation group or an early rehabilitation group . The st and ard group included restrictions to avoid hip flexion > 90 degrees and avoidance of riding in a car for the first postoperative month . The early group had no flexion or car riding restrictions . Forty-three patients were in the st and ard group and 38 patients were in the early group . There were no significant demographic differences between the 2 groups . All patients completed the Short Form 12- question Health Survey and Harris Hip Score preoperatively and at 4 weeks , 1 month , 3 months , and 1 year postoperatively . The time-points at which the patient first drove and ambulated with a cane , without a cane , and without a limp were also collected . No incidents of dislocation occurred . Patients in the early group were faster to ambulate with only a cane ( P=.03 ) , without a cane ( P<.001 ) , and without a limp ( P=.003 ) . They also drove earlier ( P=.02 ) . Pace of recovery was the only significant difference between the 2 groups . The early rehabilitation protocol increases the pace of recovery compared to a pathway with hip pre caution s without increasing complications UNLABELLED The outcome of a single design of dual mobility cup was prospect ively evaluated in a continuous series of 994 revision THAs with respect to dislocation and intra-prosthetic dislocation ( IPD ) . At a 7.3-year mean follow-up , the dislocation rate was 1.5 % and the IPD rate was 0.2 % . The 2 IPD occurred in acetabular-only revisions and were related to a poor head-to-neck ratio with early impingement and wear at the polyethylene mobile component chamfer . Dual mobility cups demonstrated a low dislocation rate in revision THA but did not compensate for potential perioperative technical errors . In addition , IPD did not appear to be a concern with respect to the benefit in term of instability prevention though caution is advised in acetabular-only revision associated with a poor head-to-neck ratio . LEVEL OF EVIDENCE Therapeutic study -Level IV OBJECTIVE Dislocation is a well-known complication after  total hip arthroplasty ( THA ) , and is the second-highest cause of revision surgery . Our objective was to assess the effect of preoperative patient education on the occurrence of  hip dislocation  within 6 months after primary THA . METHODS Between 1998 and 2007 , we conducted a prospect i ve cohort study at the Geneva University Hospital Department of Orthopaedic Surgery , including all primary THAs performed via an anterolateral transgluteal approach with the use of a 28-mm diameter head .  The preoperative education session was introduced in June 2002 and included advice on muscle strengthening exercises and postoperative restrictions of range of motion as a means of preventing dislocation . The main outcome was the incidence of dislocation within 6 months of surgery . RESULTS A total of 597 patients who underwent 656 THAs between June 2002 and June 2007 participated in the education session , whereas 1,641 patients who underwent 1,945 procedures did not . Forty-six dislocations occurred over the study period , 5 ( 0.8 % ) in participants and 41 ( 2.1 % ) in non participants ( absolute risk reduction 1.3 % ; 95 % confidence interval [ 95 % CI ] 0.4 , 2.3 ) , with the time interval between surgery and dislocation being significantly shorter among participants ( 0.2 versus 1.2 months ) . Non participants had a 2.8 times higher risk of dislocation than participants ( unadjusted odds ratio [ OR ] 2.80 ; 95 % CI 1.10 , 7.13 ) . Adjustment for age , sex , comorbidities , and prior surgery did not change the results ( adjusted OR 2.79 ; 95 % CI 1.09 , 7.15 ) . CONCLUSION Our findings suggest that participation in a preoperative patient education session may reduce the risk of dislocation within 6 months after THA A prospect i ve study including 1764 hips has been carried out to evaluate the frequency of dislocation while using the Hueter anterior approach and the correlated factors . The dislocation group was compared with the patients without dislocation . We observed 27 dislocations ( 1.5 % ) . The dislocation rate when using 28 mm head diameter was 0.5 % . Two patients underwent a revision for recurrent dislocations . Correlated factors for dislocation were male sex , high body mass index , etiology of osteonecrosis , low head diameter , high bleeding , and low postoperative ROM . Dislocation risk while using Hueter approach is one of the lowest in the literature . The main disadvantages are the necessity for a specific orthopedic table and a more difficult exposure of the femur
Patients in the unrestricted group resumed activities significantly faster and were more satisfied with their pace of recovery .
Conclusion : A more liberal lifestyle restrictions and pre caution s protocol will not lead to worse dislocation rates after total hip arthroplasty , but will lead to earlier and better resumption of activities and higher patient satisfaction .
These results appear to hold up for various surgical approaches
Objective : A systematic literature review and meta- analysis on the effectiveness of lifestyle restrictions and pre caution s to prevent dislocation after total hip arthroplasty .