Minimal hip stability precautions are equally good and saft to conventional precautions after total hip replacement

Abstract

Introduction: Advancement in surgical techniques and more common use of larger diameter femoral heads allowed minimal hip stability precautions with less restriction in activities of daily living (ADL). We studied the outcomes from safe and health-related quality of life perspectives in a prospective cohort for patients with primary and revision total hip replacement (THR). Objectives: Minimal precautions (MP) would not increase the rate of dislocation nor deteriorate quality of life compared with conventional precautions (CP) protocol. Methodology: 37 THR patients were recruited from March 2016 to March 2017 at Queen Mary Hospital. They were divided into MP and CP groups according to surgeon decision. CP group received conventional ADL training by occupational therapists (OT). Patients in MP group received ADL training by OT according to MP protocol which allowed leaning forward, cross-leg, squat and some combined movement hip flexion, external rotation, abduction immediately post-operation. At pre-operation, three and 12 months post-operation, patients quality of life (QOL) were assessed by QOL questionnaire EQ5D-5L via interview. EQ5D-5L composed of five questions measuring five dimensions of health: mobility; self-care; usual activities; pain; anxiety/ depression in a five-point Likert scale. EQ5D-5L rating transformed into a index score that ranging from 1 (no problem) to -0.281 (extreme problems). EQ5D5L also composed of one question asking on overall health perception, ranging from 0 to 100, 0 (extreme poor) to 100 (very good). On the other hand, rate of dislocation at three and 12 months post operation was collected via phone calls. One-way ANOVA was used to analyse the EQ5D-5L scores and dislocation rate within and between groups difference at different time points. Results: 37 patients (MP=17; CP=20), primary THR in MP:CP (88%:60%). Only one dislocation reported in CP group who was a patient suffered from femoral nerve palsy post operation and fell one month post operation causing dislocation but none dislocation reported in MP group. The index score of both groups at three and 12 months post operation with no significant difference (12 months: MP=0.865; CP=0.829) and also to health perception (12 months: MP=80.4; CP=74.3). However, significant improvement of index score and health perception (p<.001) was shown within both groups between pre-operation and three months post-operation. This improvement could sustain in 12 months post operation. In conclusion, minimal hip stability precautions proved to be equally good and safe for THR cases compared with conventional hip precautions.