Abstract
Introduction:
The routine use of posterior hip dislocation precautions is typically utilized postoperatively following total hip arthroplasty via a posterior surgical approach. This has included use of an abduction pillow and limiting adduction, internal rotation and flexion more than 90 degrees for a minimum of 6 weeks postoperatively. This may slow the course of rehabilitation, increase the length of hospital stay and the total cost of the procedure, and add additional anxiety to the patient. We conducted this study to see if posterior hip precautions are necessary after total hip arthroplasty via a posterior approach when the hip meets certain intraoperative criteria for stability.
Methods and Materials:
All patients in our institute undergo routine hip stability testing during primary total hip arthroplasty via a posterior approach. Before October 2010, all of our primary total hip arthroplasty patients were placed on routine hip precautions. We stopped hip precautions in October 2010 for all the patients who were noted to meet hip stability criteria intraoperatively. We prospectively compared the consecutive patients who underwent this procedure without hip precautions with a retrospective control group of patients who had hip precautions.
Results:
we had 650 patients in each group. In the case group, there was 1 postoperative dislocation (0.2%) within the first 3 months after surgery. In the control group (with hip precautions), 2 patients (0.3%) sustained hip dislocation within 3 months after surgery (p = 0.5). The mean hospital stay was 2.5 (0–11) days for the case group and 2.7 (1–9) days for the control group (p = 0.03). Patients in the case group were discharged to home more often compared to the control group (83.7% versus 83.4%), but the difference was not significant (p = 0.48). There was no difference in the Harris Hip score improvement between the two groups. Higher percentage of the patients in the case group received larger femoral head implant (35% versus 14%, p < 0.001) and elevated rim polyethylene liner (70% versus 57%, p < 0.001).
Conclusion:
Intraoperative hip stability testing is necessary for all patients who undergo primary total hip arthroplasty via a posterior approach. If the hip is not stable intraoperatively, the surgeon should ensure that all sources of potential instability have been evaluated and managed. This may include implant sizing, implant position, and all sources of internal and external impingement. Use of a larger diameter head and elevated rim polyethylene may help with the stability of the hip. If the hip meets our stability criteria intraoperatively, we feel that formal hip precautions may not be necessary postoperatively.
