Is historical hip precaution a must after posterolateral approach of total hip arthroplasty?

Abstract

Introduction: Historical hip precautions by activities daily living restrictions were used to reduce hip dislocation risk but necessity questioned by the advancement in surgical techniques. This prospective cohort study hypothesis total hip arthroplasty (THA) patients with minimal precautions (MP) would not increase dislocation rate compared with conventional precautions (CP). Methodology: Fifty-five THA patients were recruited from March 2016 to June 2017 at Queen Mary Hospital. Surgeons allocated them to MP or CP group based on intra-operation stability. Occupational therapists adopted historical restriction to train CP group (n=29) but MP group (n=26) trained by minimal ADL restriction: hip flexion >90 degrees, internal rotation when turning and side lying sleeping without pillow. Dislocation rate was recorded, Harris Hip Score was measured by surgeon and EQ5D-5L quality of life (QOL) questionnaire were reported by patient at pre-operation and 12 months post operation. Results and Analysis: Only two dislocation reported in CP group but none dislocation reported in MP group. Independent sample T-Test shown at 12 months post operation, EQ5D-5L index score (MP=0.91, CP=0.81) of MP was significant different form CP (p=0.05). Health perception VAS score (MP=81.73, CP=71.86) of MP group was significant difference from CP group (p=0.01). Discussion and Conclusion: Minimal hip stability precautions proved to be better and safe for posterolateral surgical approach of THA cases compared with conventional hip precautions group. Less ADL restriction shown significant better QOL & health perception at one year post operation.