Patients Achieving 90°/45°/0° Intraoperative Stability Do Not Require Hip Precautions Following Posterior Approach Total Hip Arthroplasty: A Prospective Randomized Study

Mounts, Marlie R; Turner, Rachael; Patel, Nimesh B.; Snelling, Erin N; Phillips, Raquel E; Levesque, Dean A; Foran, Jared R.H.

doi:10.1016/j.arth.2022.01.028

Cited by 7 publications

(24 citation statements)

References 23 publications

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“…The meta-analysis, including 2 RCTs 49,52 showed a RR 1 (CI 0.1 -9.6) based on 1 late dislocation in 462 patients in both groups (0.2%). The absolute risk difference was 0 fewer per 1,000 (95%CI: 2 fewer -19 more).…”

Section: Late Hip Dislocationsmentioning

confidence: 96%

“…The median early dislocation rate in the four RCTs was 0.8% (range 0.5-1.5). [49][50][51][52] The meta-analysis showed a RR of 1.8 (CI 0.6-5.2) based on 10 dislocations in 810 patients (1.2%) in the precaution group and 5 dislocations in 806 patients (0.6%) in the control group. The absolute risk difference was 5 more per 1,000 (CI 2 fewer -26 more) in precaution group.…”

Section: Early Hip Dislocationsmentioning

confidence: 99%

“…The updated searches identified 1,860 unique references, of which 67 were screened in full text. Of these, 59 were excluded, leaving four new RCTs [49][50][51][52] and four new NRS 28,53-55 for inclusion. Figure 1 shows the study selection process.…”

Section: Study Selectionmentioning

confidence: 99%

“…In the four single-center RCTs, 1,616 patients were randomized to either hip precautions or no or minimal precautions for six 49,50,52 or eight 51 weeks. In the intervention groups, all patients were at least instructed to avoid hip flexion beyond 90°, adduction beyond the midline, and internal rotation, with Peters et al limiting patients to supine sleeping.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Patients in the control groups were not instructed to follow any precautions in three trials, 49,50,52 and Peters et al, patients were advised to avoid the combination of hip flexion beyond 90°, adduction beyond the midline, and internal rotation. 51 See Table 1 for study characteristics.…”

Section: Study Characteristicsmentioning

confidence: 99%

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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: Late Hip Dislocationsmentioning

confidence: 96%