Effectiveness of a bandage to prevent re-dislocation after total hip arthroplasty in patients with a previous hip dislocation. A randomized controlled trial with 12-week follow-up

Mechlenburg, Inger; J, Knak; Mosegaard, Sebastian Breddam; Axelsen, Mette; Jensen, Niels Krarup; Hansen, Torben Bæk; Stilling, Maiken

doi:10.1177/02692155221081462

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…9,10 The patient does not appear to achieve full relieving potential, 11 and a substantial proportion experience recurring dislocations. 12 The surgical approach is considered the most important risk factor for dislocation. A posterior (posterolateral) surgical approach is associated with a higher risk of dislocation than a lateral surgical approach.…”

Section: Introductionmentioning

confidence: 99%

Hip precautions after posterior approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Korfitsen¹,

Mikkelsen²,

Mikkelsen³

et al. 2022

Preprint

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Background and purpose: Hip precautions are routinely prescribed to patients with osteoarthritis to decrease dislocation rates post total hip arthroplasty (THA) using a posterior approach. However, recommendations have been based on very low certainty of evidence. This systematic review aimed to update the evidence on the influence of hip precautions on early recovery following THA.Materials and methods: We performed systematic searches for published randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL from 2016 to July 2022. Two reviewers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analyses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was risk of hip dislocations within three months of surgery. Other outcomes were long-term risk of dislocation, reoperation, levels of self-reported function, quality of life, pain, performance-based assessment of function, and time to return to work.Results: 4 RCTs and 5 NRSs, including 8,835 participants, were included. Certainty in the evidence was low. There may be no or negligible difference in early hip dislocations (RCT: risk ratio (RR): 1.8, 95% confidence interval (CI) 0.6 - 5.2; NRS: RR: 0.9, CI 0.3 - 2.5). For all other outcomes, no differences were found.Interpretation: The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA. However, the certainty in the estimates is moderate to very low, and the results are likely to change with higher-quality studies.

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Section: Introductionmentioning

confidence: 99%

Hip precautions after posterior approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Korfitsen¹,

Mikkelsen²,

Mikkelsen³

et al. 2022

Preprint

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“…Dislocation has been reported in 2–4% of cases after hip arthroplasty and is considered a serious complication associated with reduced quality of life and anxiety ( 1 ). The patients do not appear to achieve full relieving potential ( 2 ), and a substantial proportion experience recurring dislocations ( 3 ). The surgical approach is considered the most important risk factor for dislocation ( 4 ).…”

mentioning

confidence: 99%

Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Korfitsen

Mikkelsen

et al. 2023

ActaO

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Background and purpose: Hip precautions are routinely prescribed to patients with osteoarthritis to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach. However, recommendations have been based on very low certainty of evidence. We updated the evidence on the influence of hip precautions on early recovery following THA by this systematic review.Materials and methods: We performed systematic searches for randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL published from 2016 to July 2022. 2 reviewers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analyses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was the risk of hip dislocations within 3 months of surgery. Other outcomes were long-term risk of dislocation and reoperation, self-reported and performance-based assessment of function, quality of life, pain, and time to return to work.Results: 4 RCTs and 5 NRSs, including 8,835 participants, were included. There may be no or negligible difference in early hip dislocations (RCTs: risk ratio [RR] 1.8, 95% confidence interval [CI] 0.6–5.2; NRS: RR 0.9, CI 0.3–2.5). Certainty in the evidence was low for RCTs and very low for NRSs. Finally, precautions may reduce the performance-based assessment of function slightly, but the evidence was very uncertain. For all other outcomes, no differences were found (moderate to very low certainty evidence).Conclusion: The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA to prevent hip dislocations. However, the results might change with high-quality studies.

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Clinical efficacy of proximal femoral nail anti-rotation in elderly patients with intertrochanteric fractures with negative medial cortical support: A comparison of lithotomy and scissor position techniques

Lin,

Chen,

Zhou

2024

Journal of Back and Musculoskeletal Rehabilitation

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Background Femoral intertrochanteric fractures are a prevalent type of hip fracture among the elderly population. And proximal femoral nail anti-rotation (PFNA) is the leading surgical technique for managing femoral intertrochanteric fractures in this patient population. Objective This study aimed to evaluate the clinical efficacy of proximal femoral nail anti-rotation (PFNA) in managing intertrochanteric fractures in elderly patients with negative medial cortical support. Additionally, the outcomes associated with two different nail positioning techniques were investigated. Methods Elderly patients with femoral intertrochanteric fractures with negative medial cortical support, treated between January 2017 and January 2021, were included. A retrospective analysis of their clinical data was conducted. Patients were categorized into two groups based on the positioning technique: lithotomy position group (n = 40) and scissor position group (n = 40). Baseline characteristics, perioperative indicators, hidden blood loss, and Harris hip scores were compared. Results The groups exhibited no significant differences in baseline characteristics, incision length, or postoperative tip-apex distance. The scissor position group experienced fewer fluoroscopies, shorter surgical durations, and lower Visual Analogue Scale (VAS) scores for the unaffected limb on postoperative day 1 compared to the lithotomy position group. No significant differences in hidden blood loss were observed between the groups. The Harris hip score for the unaffected side showed no significant differences between the scissor position group on postoperative day 1 and postoperative month 1. However, in the lithotomy position group, the Harris hip score of the unaffected side on postoperative day 1 was significantly lower than that at postoperative month 1. Additionally, the Harris hip score for the unaffected side on postoperative day 1 was substantially higher in the scissor position group compared to the lithotomy position group, although there were no significant differences between the two groups at postoperative month 1. Conclusion PFNA in the scissor position demonstrated advantages over the lithotomy position, including reduced fluoroscopy usage, shorter surgical duration, and less trauma to the unaffected limb. These findings indicate its effectiveness in managing intertrochanteric fractures in elderly patients with negative medial cortical support.

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Effectiveness of a bandage to prevent re-dislocation after total hip arthroplasty in patients with a previous hip dislocation. A randomized controlled trial with 12-week follow-up

Cited by 3 publications

References 19 publications

Hip precautions after posterior approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Hip precautions after posterior approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Clinical efficacy of proximal femoral nail anti-rotation in elderly patients with intertrochanteric fractures with negative medial cortical support: A comparison of lithotomy and scissor position techniques

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