Are Hip Precautions Necessary?

Seema MarshallThe George Washington University

Clinical Internship I

Greatest during first 3 months post-op For anterior or lateral approaches – greatest

risk with extension & external rotation For posterior approach – greatest risk with

excessive hip flexion & internal rotation Other risk factors: age, bone loss, RA,

cognitive function, component orientation, implant design

Risk of dislocation

Posterior approach

Anterior approach

Anterolateral Posterior

Pros

Lower dislocation rate

Preserves abductor function

Smaller incision siteBetter recovery

immediately post-op

Cons Abductor weaknessReportedly higher dislocation rates

Anterolateral vs Posterior

Approach Rate

Posterior with soft tissue repair* 0.49-1.01%

Posterior without soft tissue repair

4.46%

Anterior-lateral 0.70%

Direct lateral 0.43%

Rate of dislocation by approach

Study Rate

Talbot et al., 2002499 patients

0.6%

Peak et al., 2005265 patients

0.33%

Ververeli et al., 200981 patients

0

Restrepo et al., ongoing2532 patients

0.15%

Rate of dislocation – no precautions

Faster recovery◦ Earlier ambulation◦ Earlier return to

driving Increased patient

satisfaction Less financial

burden

Benefits of no precautions

http://www.orthopedicmotion.com/orthotics.htm

http://www.handicappedequipment.org/tag/recommended-toilet-seats-after-surgery/

No increase in dislocation without precautions for anterior approach

Dislocation rates in posterior approach with soft tissue repair are comparable to anterior approach

Need further studies to confirm safety of posterior approach without precautions

Conclusions

D’Angelo F, Murena L and Cherubino P. The unstable total hip replacement. Indian Journal of Orthopaedics. 2008; 42:252-259.

Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, and Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clinical Orthopaedics and Related Research. 2006; 447:34-38.

Restrepo C, Mortazavi SMJ, Brothers J, Parvizi J, and Rothman RH. Hip dislocation: are hip precautions necessary in anterior approaches? Clin Orthop Relat Res. 2011; 469(2):417-422.

Palan J, Beard DJ, Murray DW, Andrew JG and Nolan J. Which approach for total hip arthroplasty. Clin Orthop Relat Res. 2009; 467:473-477.

References