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Precautions after Total Hip Replacement: Have We Gone Too Far?

Posted on: 04/11/2005
After a total hip replacement (THR) patients are restricted in what they can and can't do. The idea is to prevent early hip dislocation. But do these restrictions really make a difference? That's the focus of this study.

Two groups of patients with a THR were included. Care before, during, and after surgery was the same for all patients. Both groups were asked to avoid bending the hip more than 90 degrees. Rotating the hip too far in one direction or the other was also limited.

One group (restricted group) had some extra guidelines. They had to use a special abduction pillow between the legs right after the surgery while still in the operating room. Pillows were used in bed to keep the legs apart. Raised chairs and toilet seats were also used. Patients in the restricted group were told not to sleep on their sides. They weren't allowed to drive or even ride in a car for six weeks.

After six months there was only one hip dislocation. It occurred in the restricted group when the patient was moved from the operating table to the bed. The abduction pillow was in place at the time.

Results of other measures showed greater patient satisfaction in the unrestricted group. They returned to their normal daily activities sooner. This included side sleeping at three weeks after surgery compared to almost six weeks in the restricted group. Driving or riding in a car occurred sooner and more often in the first six weeks for the unrestricted group. In the final measure of outcomes, patients in the unrestricted group went back to work three weeks sooner than the other patients.

The purpose of this study was to find out if extra hip precautions are really needed after a THR. The authors conclude that only range of motion restrictions are needed for six weeks after THR. Use of pillows and added restriction for sleeping, sitting, and driving are not necessary.

E. Louis Peak, MD, et al. The Role of Patient Restrictions in Reducing the Prevalence of Early Dislocation Following Total Hip Arthroplasty. In The Journal of Bone and Joint Surgery. February 2005. Vol. 87-A. No. 2. Pp. 247-253.

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