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.

Keywords:

• Hip precautions
• total hip replacement
• functional outcomes
• quality of life
• rehabilitation

Acknowledgements

The authors wish to acknowledge all staff of Nottingham Elective Orthopaedic Services (NEOS) who participated and assisted with the study and the wider research group. They would also like to particularly thank Prof Bridget Scammell, Cathy Brewin, and Laura Garratt for their assistance with the study, and the “Hip champions” who implemented the new regime (Karen Hawkins, Lauren Hutchinson, Sarah Hopkins, Sarah Roworth, Chantel Moir, Nova Charles, Gillian Kruszewski, Glenda Cope, Dawn Menzies, Claire Ashby, Bridget Greengrass, and Claire McElhorne).

The authors would like to gratefully acknowledge all patients who participated in this study.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author contributions

CJL, KRS, CC, GD, and AD were involved in study conception and design. CJL collected and cleaned the data with assistance from JA. CJL, CC, and AD performed data analysis, and CJL wrote the first draft of the manuscript. All authors were involved in data interpretation and critically revised the manuscript and gave final approval for submission.

Additional information

Funding

CJL was funded by School of Health Sciences, University of Nottingham for her PhD.