Evaluation of hip precautions following total hip replacement: a before and after study

Abstract

Purpose To evaluate the effect of hip precautions following total hip replacement (THR) by comparing outcomes of patients who received hip precautions with those who did not. Methods Before (phase 1) and after (phase 2) study with two consecutive cohorts of patients. In phase 1, patients were strictly educated about hip precautions. In phase 2, patients were not advised about precautions but encouraged to move as able. The primary outcome was the Oxford Hip Score (measuring pain and function) at three months. Secondary outcomes included Oxford Hip Score, activities of daily living (ADLs) (Nottingham Extended Activities of Daily Living), sleep (Pittsburgh Sleep Quality Index), mood (Hospital Anxiety and Depression Scale), and quality of life (QoL) (EQ-5 D). Results A total 237 participants successfully underwent THR surgery, 118 participants in phase 1 and 119 in phase 2. At three months postoperatively, participants had significantly equivalent Oxford Hip Scores (MD= −0.82, 95% CI: −2.64 to 1.00). No significant differences between the groups were observed at six weeks and three months postoperatively for secondary outcomes. Conclusions Patients recovered at a similar rate regardless of whether they received hip precautions or not, with no increase in complications observed. The findings lend evidence to support decision-making around the removal of precautions. Implications for rehabilitation The use of no hip precautions resulted in no additional benefit following primary total hip replacement surgery in terms of functional recovery. Patients who were not prescribed precautions had significantly less pain and greater function during the first week after surgery. Total hip replacement patients had similar outcomes at six weeks and three months postoperatively regardless of whether they received hip precautions or not. The study provides evidence to suggest that hip precautions may not be needed routinely following elective primary total hip replacement.