Patient compliance with hip precautions 12 weeks following primary elective total hip arthroplasty

McNaught, Jamie; Davidson, D.C.; Ewen, Alistair; Welsh, F.; Maheshwari, Ramesh

doi:10.1007/s00402-021-03837-9

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…This percentage appears to be even lower by 12 weeks, according to the findings reported in a separate study, also utilizing a patient questionnaire 17 . McNaught et al reported that, of the 297 consecutive patients who attended their 12-week follow-up appointment, only 6.3% (19 patients) reported that they restricted their daily activities as prescribed for the full 12-week period.…”

Section: Perioperative Managementmentioning

confidence: 58%

What’s New in Hip Replacement

Morgan

2022

Journal of Bone and Joint Surgery

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Implant Design and Related Outcomes Dual MobilityDual-mobility cups do not reduce the revision risk for patients with acute femoral neck fracture, as concluded by Rogmark and Nauclér in an observational cohort of 2,242 patients with dual-mobility cups compared with a matched cohort of 6,726 patients treated with a conventional total hip implant 1 . The authors reported that, with implant revision surgery as the outcome, they "could not detect any differences between a total hip arthroplasty with a dual mobility cup and one with conventional bearing." Outcomes were similar and independent of whether the implants were inserted via a direct lateral or posterior approach as well as for subgroup analyses of revision for dislocation and infection. The authors concluded that improvements in the care of patients with hip fracture are most likely to come from elsewhere in the care pathway and "not in design variations of contemporary orthopedic implants."Cnudde et al. reported similar findings when they investigated patients with neurologic disease undergoing arthroplasty for femoral neck fracture 2 . Comparing hemiarthroplasty, conventional total hip arthroplasty (THA), and dual-mobility THA performed in 9,638 patients with conditions such as Alzheimer and Parkinson diseases, the authors found that there was an increased risk of dislocation when comparing hemiarthroplasty and THA with a <32-mm head but not with conventional THA with a 32-mm head (hazard ratio [HR], 1.54 [95% confidence interval (CI), 0.94 to 2.51]; p = 0.083) and THA with a dual-mobility implant (HR, 0.68 [95% CI, 0.26 to 1.84]; p = 0.451). Overall, the authors found no difference in the rate of reoperation or revision-free survival between any of the different prostheses or sizes of the femoral head. Cobalt-ChromiumUsing data from the National Joint Registry linked to U.K. National Health Service (NHS) English hospital inpatient episodes for 374,359 primary THAs, Deere et al. investigated 158,677 hips (42.4%) containing an implant with cobaltchromium 3 . With a maximum 14.5-year follow-up (mean [and Disclosure: The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJS/H172).

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Section: Perioperative Managementmentioning

confidence: 58%

What’s New in Hip Replacement

Morgan

2022

Journal of Bone and Joint Surgery

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“…Low compliance to treatments aimed to prevent total hip arthroplasty dislocations has also been described in a recent a study that reported that the majority of patients did not adhere to 12 weeks of mobilization restrictions but returned to their usual activities based on their pain and activity level. 18 There was a high number of re-dislocation events in both groups. A safe zone of the positioning of the acetabular cup after total hip arthroplasty has been described as a cup inclination of 40°± 10°and cup anteversion of 15°± 10°.…”

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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

Mosegaard

et al. 2022

Clin Rehabil

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Objective To investigate if using a hip bandage is more effective than standard care in the prevention of total hip arthroplasty re-dislocation in patients with a previous total hip arthroplasty dislocation. Design randomized controlled trial Setting Holstebro Regional Hospital and Viborg Regional Hospital Subjects A total of 99 patients, 51 women, mean 70.7 (SD 9.9) years were enrolled in an un-blinded, clinical randomized controlled trial. Interventions Participants with at least one previous total hip arthroplasty dislocation were randomized to either wearing a bandage reducing flexion, adduction, and internal rotation of the hip (intervention group) or to standard care (control group). The participants were followed for 12 weeks. Main follow-up measures were as follows: number of re-dislocations (primary outcome), hip disability measured with the Oxford Hip Score (0–48, 48 best), quality of life measured with the 36-Item Short Form Survey (0–100, 100 best), satisfaction with treatment and serious adverse events. Statistical analyses followed the intention-to-treat principle. Results No significant group differences were observed for the primary outcome re-dislocations (9 versus 15, P = 0.143) or for disability (11.3 versus 14.4, P = 0.161), quality of life (57.7 versus 48.3, P = 0.050) or satisfaction with treatment ( P = 0.562). There were 3 serious adverse events leading to total hip arthroplasty revision in the intervention group and 4 in the control group. Conclusion We found that a hip bandage is not superior to standard care in the prevention of total hip arthroplasty re-dislocation in those with a previous total hip arthroplasty dislocation.

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“…Our design is not able to assess the direct impact of the implementation of hip precautions, patient adherence, or healthcare practitioners’ compliance with guideline recommendations and subsequent omissions: 1 study evaluating hip precautions revealed that about 25% of patients in the hip precautions group did not adhere, while 20% in the no-precautions group followed some precautions unintentionally [ 26 ]. Additionally, 1 study on compliance found only 23% adhered to precautions after 6 weeks, despite 86% believing they could recall them [ 27 ], while another reported a mere 6% maintained restrictions for the full recommended timespan of 12 weeks [ 28 ]. Qualitative research shows challenges among healthcare providers, including doctors and nurses, in adapting to new protocols [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Discontinuing the recommendation of hip precautions does not increase the risk of early dislocation after primary total hip arthroplasty using 36-mm heads: a population-based study from the Danish Hip Arthroplasty Register

Iljazi,

Sørensen,

Winther-Jensen

et al. 2024

ActaO

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Background and purpose: Dislocation is a severe complication following total hip arthroplasty (THA). Hip precautions have been recommended in the initial postoperative period but evidence supporting this practice is limited. We therefore conducted a population-based study to evaluate the association between discontinuing recommending postoperative hip precautions and the risk of early dislocation.Methods: This is a cohort study with data from the Danish Hip Arthroplasty Register and the Danish National Patient Register. We included patients who underwent primary THA for osteoarthritis in 2004–2019 in public hospitals in the Capital Region of Denmark. The cohort was divided into the hip precautions group, comprising patients operated on between 2004 and 2009, and the no-precautions group operated on between 2014 and 2019. The primary outcome was the difference in the absolute risk of dislocation within 3 months post-surgery. The secondary outcome assessed the same risk within 2 years. We evaluated the difference in absolute risk using absolute risk regression (ARR).Results: The cumulative incidence of dislocation within 3 months was 2.9% (confidence interval [CI] 2.5–3.3) in the hip precautions group and 3.5% (CI 3.1–3.9) in the no-precautions group. The risk of dislocation was higher in the no-precautions group but failed to reach statistical significance in the crude (ARR 1.2, CI 0.9–1.6) and multivariate model (ARR 1.4, CI 0.9–2.2).Conclusion: We found a higher but statistically insignificant increase in the risk of early dislocation in the no-precautions group. The lack of significance in the association may be explained by the increased use of 36-mm femoral heads after the guideline revision.

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Patient compliance with hip precautions 12 weeks following primary elective total hip arthroplasty

Cited by 7 publications

References 16 publications

What’s New in Hip Replacement

What’s New in Hip Replacement

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

Discontinuing the recommendation of hip precautions does not increase the risk of early dislocation after primary total hip arthroplasty using 36-mm heads: a population-based study from the Danish Hip Arthroplasty Register

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