Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients

Figures & data

Study flow showing papers searched, screened, and included in the review, with reasons for exclusion.

Table 1. Data collected from each study using a pre-set data collection form

Authors (study design, number of centers, and follow-up duration)
	Patients	Male:female	Indication	Prosthesis	Femoral head	Dislocation
Group	n (%)	ratio	for surgery ^a	fixation, n (%) ^b	size, n (%)	rate, n/N (%)
Mikkelsen et al. 2014 (Non-randomized controlled study, 1 center, follow-up: 3 and 6 weeks)
Restricted	146 (40)	53:47	Osteoarthritis	C: 125 (86)	≤ 32 mm: 5 (4)	2/146 (2.7)
				U: 5 (3)	36 mm: 85 (70)
				H: 15 (10)	40 mm: 29 (24)
					≥ 44 mm: 3 (2)
Unrestricted	219 (60)	52:48	Osteoarthritis	C:190 (87)	≤ 32 mm: 9 (4)	6/219 (1.4)
				U: 8 (4)	36 mm: 125 (57)
				H: 21 (10)	40 mm: 66 (30)
					≥ 44 mm: 9 (4)
Allen et al. 2018 (Retrospective cohort study, 1 center, follow-up: 6 weeks)
Restricted	866 (79.1)	Not	PO: 754	Not reported	Not reported	10/866 (1.15)
		reported	NOF: 7
			Other ^c: 105
Unrestricted	334 (20.9)	Not	PO: 304	Not reported	Not reported	4/334 (1.20)
		reported	NOF: 3
			Other ^c: 27
van der Weegen et al. 2019 (Cohort study, 1 center, follow-up: 90 days)
Restricted	1,102 (51.2)	37:63	PO: 1,068	C: 597 (54.2)	≤ 28 mm: 594 (53.9)	28/1,102 (2.5)
			Other ^d—34	U: 495 (44.9)	≥ 32 mm: 508 (46.1)
				H: 10 (0.9)
Unrestricted	1,049 (48.8)	38:62	PO: 1,011	C: 436 (41.6)	≤ 28 mm: 443 (42.2)	17/1,049 (1.6)
			Other ^d: 38	U: 597 (56.9)	≥ 32 mm: 606 (57.8)
				H: 16 (1.5)
Peters at al. 2019 (Prospective, randomized, non-inferiority study, 1 center, follow-up: 8 week)
Restricted	203 (49.8)	46:54	Osteoarthritis	Not reported		3/203 (1.48)
Unrestricted	205 (50.2)	40:60	Osteoarthritis	Not reported	32 mm in all patients	3/205 (1.46)
Dietz et al. 2019 (Randomized, controlled study, 3 centers, follow-up: 2–6 weeks, 3–6 months, and 1 year)
Restricted	145 (51.1)	56:44	NOF excluded	Not reported	35.3 mm ^d [34.9–35.7]	2/145 (1.4)
Unrestricted	139 (48.9)	49:51	NOF excluded	Not reported	34.7 mm ^d [34–35]	1/139 (0.7)
Kornuijt et al. 2016 (Prospective, comparative safety study, 1 center, follow-up: 3 month)
Restricted	109 (50.2)	31:69	PO: 101	C: 53 (49)	≤ 28 mm: 51 (47)	1/109 (0.9)
			Other ^d: 8	U: 56 (51)	≥ 32 mm: 58 (53)
Unrestricted	108 (49.8)	36:64	PO: 102	C: 40 (37)	≤ 28 mm: 42 (39)	0/108 (0)
			Other ^d: 6	U: 68 (63)	≥ 32 mm: 66 (61)
Gromov et al. 2015 (Retrospective, non-inferiority study, data from DNPR ^e, follow-up: 90 days)
Restricted	946 (41.6)	45:55	Not reported	Not reported	28 mm: 946 (100)	32/946 (3.4)
					32 mm: 0 (0)
					36 mm: 0 (0)
Unrestricted	1,329 (58.4)	39:61	Not reported	Not reported	28 mm: 33 (3)	37/1,329 (2.8)
					32 mm: 403 (30)
					36 mm: 890 (67)

^a PO = primary osteoarthritis; NOF = neck of femur fracture.

^b C = cemented; U = uncemented; H = hybrid.

^c Secondary arthritis or inflammatory arthritis.

^d Mean (95% CI)

^e DNPR = Danish National Patient Registry.

Table 4. Average age of patients involved in studies

	Average age
Study	Restricted	Unrestricted
Mikkelsen et al. 2014, mean (SD)	69 (10)	68 (10)
Allen et al. 2018, mean [IQR]	72 [14]	71 [14]
van der Weegen et al. 2019, mean [IQR]	69 [14]	69 [13]
Peters et al. 2019, mean (SD)	64 (10)	64 (10)
Dietz et al. 2019 mean (95% CI)	63 (61–64)	63 (62–65)
Kornuijt et al. 2016, mean (IQR)	69 [16]	67 [13]
Gromov et al. 2015, mean (range)	67 (20–99)	69 (15–104)

Mikkelsen L R, Petersen M K, Soballe K, Mikkelsen S, Mechlenburg I. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. Eur J Phys Rehabil Med 2014; 50(4): 383–93.

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Allen F C, Skinner D L, Harrison J, Stafford G H. The effect of precautions on early dislocations post total hip arthroplasty: a retrospective cohort study. Hip Int 2018; 28(5): 485–90.

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van der Weegen W, Kornuijt A, Das D, Vos R, Sijbesma T. It is safe to use minimal restrictions following posterior approach total hip arthroplasty: results from a large cohort study. Hip Int 2019; 29(6): 572–7.

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Dietz M J, Klein A E, Lindsey B A, Duncan S T, Eicher J M, Gillig J D, Smith B R, Steele G D. Posterior hip precautions do not impact early recovery in total hip arthroplasty: a multicenter, randomized, controlled study. J Arthroplasty 2019; 34(7S): S221–S7.

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Kornuijt A, Das D, Sijbesma T, van der Weegen W. The rate of dislocation is not increased when minimal precautions are used after total hip arthroplasty using the posterolateral approach: a prospective, comparative safety study. Bone Joint J 2016; 98-b(5): 589–94.

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Gromov K, Troelsen A, Otte K S, Orsnes T, Ladelund S, Husted H. Removal of restrictions following primary THA with posterolateral approach does not increase the risk of early dislocation. Acta Orthop 2015; 86(4): 463–8.

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Peters A, ter Weele K, Manning F, Tijink M, Pakvis D, Veld R. Less postoperative restrictions following total hip arthroplasty with use of a posterolateral approach: a prospective, randomized, noninferiority trial. J Arthroplasty 2019; 34(10): 2415–9.

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