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

Abstract

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.

Hip & Pelvis

“…We were delighted to see this systematic review and meta-analysis from a team in Copenhagen (Denmark), which aimed to assess the influence of hip precautions on early recovery following THA in patients with primary hip osteoarthritis (OA). 8 The review team identified four randomized controlled trials (RCTs) and five non-…”

“…We were delighted to see this systematic review and meta-analysis from a team in Copenhagen (Denmark) , which aimed to assess the influence of hip precautions on early recovery following THA in patients with primary hip osteoarthritis (OA). 8 The review team identified four randomized controlled trials (RCTs) and five non-randomized studies (NRSs) reporting the outcomes of 8,835 participants. The main outcome of interest was risk of hip dislocation at the three-month follow-up point.…”