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Ammori MB, Soogumbur A, Sykes D, Francis N, Law E, Marshall P. Replacing hip precautions after hemiarthroplasty with a pose avoidance protocol. Injury 2024; 55:111340. [PMID: 38301490 DOI: 10.1016/j.injury.2024.111340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/10/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
AIMS After hip arthroplasty surgery, hip precautions are often implemented to minimise the risk of dislocation, although existing evidence does not support their effectiveness. At our institution, we replaced post-operative precautions with a novel pose avoidance protocol in patients undergoing hip hemiarthroplasty for neck of femur fracture. The objectives of our study were to validate this new protocol by assessing the incidence of dislocation before and after its introduction and evaluating its impact on the length of hospital stay. METHODS Between 20th September 2021 and 19th March 2023, 200 patients underwent 203 hip hemiarthroplasties. Hip precautions were replaced with the new pose avoidance protocol on 20th June 2022. Data were retrospectively collected and included patient demographics, Abbreviated Mental Test Score, American Society of Anaesthesiologists grade, surgical approach, prosthesis, dislocation, and mortality. RESULTS The incidence of dislocation within 90 days after hip hemiarthroplasty decreased from seven out of 98 cases (7.1%) before 20th June 2022 to one out of 105 cases (1.0%), p-value 0.030. However, there was no significant difference in the length of stay, with a median (interquartile range) of 19 (10 - 29) days before 20th June 2022, and 16 (11 - 22) days thereafter, p-value 0.242. A multivariate logistic regression confirmed the pose avoidance protocol and the anterolateral approach to be independent negative predictors of dislocation, p-value 0.030 (Odds Ratio [OR] 0.077) and p-value 0.005 (OR 0.022), respectively. CONCLUSIONS Hip precautions are unnecessary and potentially detrimental to patient outcomes following hemiarthroplasty. Replacing these precautions with our new pose avoidance protocol may have led to a significant reduction in dislocation rates and saved on the cost of adaptive equipment. We advocate for the anterolateral over the posterior approach in hip hemiarthroplasty to further mitigate the risk of dislocation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mohannad Basil Ammori
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP.
| | - Akash Soogumbur
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - David Sykes
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - Niamh Francis
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - Elizabeth Law
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - Paul Marshall
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
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Filippini M, Bortoli M, Montanari A, Pace A, Di Prinzio L, Lonardo G, Parisi SC, Persiani V, De Cristofaro R, Sambri A, De Paolis M, Fiore M. Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1220. [PMID: 37512031 PMCID: PMC10385644 DOI: 10.3390/medicina59071220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Background: Femoral neck fractures are an epidemiologically significant issue with major effects on patients and health care systems, as they account for a large percentage of bone injuries in the elderly. Hip hemiarthroplasty is a common surgical procedure in the treatment of displaced femoral neck fractures. Several surgical approaches may be used to access the hip joint in case of femoral neck fractures, each with its own benefits and potential drawbacks, but none of them has consistently been found to be superior to the others. This article aims to systematically review and compare the different approaches in terms of the complication rate at the last follow-up. Methods: an in-depth search on PubMed/Scopus/Web of Science databases and a cross-referencing search was carried out concerning the articles comparing different approaches in hemiarthroplasty and reporting detailed data. Results: A total of 97,576 hips were included: 1030 treated with a direct anterior approach, 4131 with an anterolateral approach, 59,110 with a direct lateral approach, and 33,007 with a posterolateral approach. Comparing the different approaches, significant differences were found in both the overall complication rate and the rate of revision surgery performed (p < 0.05). In particular, the posterolateral approach showed a significantly higher complication rate than the lateral approach (8.4% vs. 3.2%, p < 0.001). Furthermore, the dislocation rate in the posterolateral group was significantly higher than in the other three groups considered (p < 0.026). However, the posterolateral group showed less blood loss than the anterolateral group (p < 0.001), a lower intraoperative fractures rate than the direct anterior group (p < 0.035), and shorter mean operative time than the direct lateral group (p < 0.018). Conclusions: The posterolateral approach showed a higher complication rate than direct lateral approach and a higher prosthetic dislocation rate than the other three types of surgical approaches. On the other hand, patients treated with posterolateral approach showed better outcomes in other parameters considered, such as mean operative time, mean blood loss and intraoperative fractures rate. The knowledge of the limitations of each approach and the most common associated complications can lead to choosing a surgical technique based on the patient's individual risk.
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Affiliation(s)
- Matteo Filippini
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marta Bortoli
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Andrea Montanari
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Andrea Pace
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | | | - Gianluca Lonardo
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Valentina Persiani
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Roberto De Cristofaro
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Sambri
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Fiore
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Phang JK, Lim ZY, Yee WQ, Tan CYF, Kwan YH, Low LL. Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials. BMC Musculoskelet Disord 2023; 24:417. [PMID: 37231406 DOI: 10.1186/s12891-023-06512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Interventions provided after hip fracture surgery have been shown to reduce mortality and improve functional outcomes. While some systematic studies have evaluated the efficacy of post-surgery interventions, there lacks a systematically rigorous examination of all the post-surgery interventions which allows healthcare providers to easily identify post-operative interventions most pertinent to patient's recovery. OBJECTIVES We aim to provide an overview of the available evidence on post-surgery interventions provided in the acute, subacute and community settings to improve outcomes for patients with hip fractures. METHODS We performed a systematic literature review guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). We included articles that were (1) randomized controlled trials (RCTs), (2) involved post-surgery interventions that were conducted in the acute, subacute or community settings and (3) conducted among older patients above 65 years old with any type of non-pathological hip fracture that was surgically treated, and who were able to walk without assistance prior to the fracture. We excluded (1) non-English language articles, (2) abstract-only publications, (3) articles with only surgical interventions, (4) articles with interventions that commenced pre-surgery or immediately upon completion of surgery or blood transfusion, (5) animal studies. Due to the large number of RCTs identified, we only included "good quality" RCTs with Jadad score ≥ 3 for data extraction and synthesis. RESULTS Our literature search has identified 109 good quality RCTs on post-surgery interventions for patients with fragility hip fractures. Among the 109 RCTs, 63% of the identified RCTs (n = 69) were related to rehabilitation or medication/nutrition supplementation, with the remaining RCTs focusing on osteoporosis management, optimization of clinical management, prevention of venous thromboembolism, fall prevention, multidisciplinary approaches, discharge support, management of post-operative anemia as well as group learning and motivational interviewing. For the interventions conducted in inpatient and outpatient settings investigating medication/nutrition supplementation, all reported improvement in outcomes (ranging from reduced postoperative complications, reduced length of hospital stay, improved functional recovery, reduced mortality rate, improved bone mineral density and reduced falls), except for a study investigating anabolic steroids. RCTs involving post-discharge osteoporosis care management generally reported improved osteoporosis management except for a RCT investigating multidisciplinary post-fracture clinic led by geriatrician with physiotherapist and occupational therapist. The trials investigating group learning and motivational interviewing also reported positive outcome respectively. The other interventions yielded mixed results. The interventions in this review had minor or no side effects reported. CONCLUSIONS The identified RCTs regarding post-surgery interventions were heterogeneous in terms of type of interventions, settings and outcome measures. Combining interventions across inpatient and outpatient settings may be able to achieve better outcomes such as improved physical function recovery and improved nutritional status recovery. For example, nutritional supplementation could be made available for patients who have undergone hip fracture surgery in the inpatient settings, followed by post-discharge outpatient osteoporosis care management. The findings from this review can aid in clinical practice by allowing formulation of thematic program with combination of interventions as part of bundled care to improve outcome for patients who have undergone hip fracture surgery.
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Affiliation(s)
- Jie Kie Phang
- Centre for Population Health Research and Implementation (CPHRI), SingHealth Regional Health System, SingHealth, Singapore, Singapore
- Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore, Singapore
| | - Zhui Ying Lim
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
| | - Wan Qi Yee
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
| | - Cheryl Yan Fang Tan
- Bright Vision Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
| | - Yu Heng Kwan
- SingHealth Internal Medicine Residency Programme, Singapore, Singapore
- Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- Centre for Population Health Research and Implementation (CPHRI), SingHealth Regional Health System, SingHealth, Singapore, Singapore.
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore.
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore.
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Department of Post-Acute & Continuing Care, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168852, Singapore.
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Blanco JF, da Casa C, Fidalgo H, García-Iglesias MA, González-García L, Burón-Álvarez I, Sañudo S, García-Alonso M. Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T3-T11. [PMID: 36265783 DOI: 10.1016/j.recot.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS The women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.
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Affiliation(s)
- J F Blanco
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
| | - C da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - H Fidalgo
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - M A García-Iglesias
- Unidad de Documentación Clínica, Hospital Universitario de Salamanca, Salamanca, España
| | - L González-García
- Departamento de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Asistencial de Palencia, Palencia, España
| | - I Burón-Álvarez
- Departamento de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Asistencial de Palencia, Palencia, España
| | - S Sañudo
- Unidad de Documentación Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | - M García-Alonso
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Río Hortega, Valladolid, España
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5
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Blanco JF, da Casa C, Fidalgo H, García-Iglesias MA, González-Garcia L, Burón-Alvarez I, Sañudo S, García-Alonso M. Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:3-11. [PMID: 35973555 DOI: 10.1016/j.recot.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.
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Affiliation(s)
- J F Blanco
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
| | - C da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - H Fidalgo
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - M A García-Iglesias
- Clinical Documentation Unit, Hospital Universitario de Salamanca, Salamanca, Spain
| | - L González-Garcia
- Orthopaedic Surgery and Traumatology Department, Complejo Hospitalario Asistencial de Palencia, Palencia, Spain
| | - I Burón-Alvarez
- Orthopaedic Surgery and Traumatology Department, Complejo Hospitalario Asistencial de Palencia, Palencia, Spain
| | - S Sañudo
- Clinical Documentation Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M García-Alonso
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Río Hortega, Valladolid, Spain
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Jobory A, Kärrholm J, Hansson S, Åkesson K, Rogmark C. Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register. Acta Orthop 2021; 92:413-418. [PMID: 33821752 PMCID: PMC8381924 DOI: 10.1080/17453674.2021.1906517] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Reported revision rates due to dislocation after hemiarthroplasty span a wide range. Dislocations treated with closed reduction are rarely reported despite the fact that they can be expected to constitute most of the dislocations that occur. We aimed to describe the total dislocation rate on the national level, and to identify risk factors for dislocation.Patients and methods - We co-processed a national cohort of 25,678 patients in the Swedish Hip Arthroplasty Register, with the National Patient Register (NPR) and Statistics Sweden. Dislocation was defined as the occurrence of any ICD-10 or procedural code related to hip dislocation recorded in the NPR, with a minimum of 1-year-follow-up. In theory, all early dislocations should thereby be traced, including those treated with closed reduction only.Results - 366/13,769 (2.7%) patients operated on with direct lateral approach dislocated, compared with 850/11,834 (7.2%) of those with posterior approach. Posterior approach was the strongest risk factor for dislocation (OR = 2.7; 95% CI 2.3-3.1), followed by dementia (OR = 1.3; CI 1.1-1.5). The older the patients, the lower the risk of dislocation (OR = 0.98 per year of age; CI 0.98-1.0). Neither bipolar design nor cementless stems influenced the risk.Interpretation - The choice of posterior approach and dementia was associated with an increased dislocation risk. When hips treated with closed reduction were identified, the frequency of dislocation with use of direct lateral and posterior approach more than doubled and tripled, respectively, compared with when only revisions due to dislocation are measured.
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Affiliation(s)
- Ammar Jobory
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö,Correspondence:
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Susanne Hansson
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö
| | - Kristina Åkesson
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö,Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg
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Giannoudis VP, Chloros GD, Bastian JD, Giannoudis PV. Can immediate mobilisation following fragility hip fractures always be safely achieved? Injury 2020; 51:2734-2736. [PMID: 33308644 DOI: 10.1016/j.injury.2020.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- V P Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | - G D Chloros
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | - J D Bastian
- Department of Orthopaedic and Trauma § Surgery, University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - P V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.
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Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthop 2020; 91:687-692. [PMID: 32718213 PMCID: PMC8023879 DOI: 10.1080/17453674.2020.1795598] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hip precautions limiting flexion, adduction, and internal rotation have been prescribed traditionally to minimize dislocation rates following THA. We assessed the prevalence of hip dislocation following posterior approach total hip arthroplasty without postoperative hip precautions. Methods - A systematic review of multiple medical databases was performed using the PRISMA guidelines and checklist. All clinical outcome studies that reported dislocation rates and postoperative instructions following posterior approach, primary surgery, published within the last 6 years, were included. Results - 6,900 patients were included from 7 Level I-IV studies, with 3,517 treated with and 3,383 without precautions. There was no statistically significant difference in the rates of dislocation between groups (2.2% in restricted group vs. 2.0% in unrestricted group). All but 1 study demonstrated no statistically significant differences in patient-reported outcome scores between restricted and unrestricted groups, including those pertaining to return to function, confidence, and pain. Interpretation - The review found no impact on dislocation rates following total hip arthroplasty performed through a posterior approach, regardless of the use of hip precautions. We also found no impact of the prescription of hip precautions on patient-reported outcome scores.
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Affiliation(s)
- Jack Crompton
- Royal Free Hospital, London,Division of Surgery and Interventional Science, University College London, UK
| | - Liza Osagie-Clouard
- Royal Free Hospital, London,Institute of Orthopaedics and Musculoskeletal Sciences, University College London,Correspondence:
| | - Akash Patel
- Royal Free Hospital, London,Division of Surgery and Interventional Science, University College London, UK
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