Low-risk Hip Replacement Patients Can Skip Standard Hip Precautions

Patients undergoing total hip arthroplasty who are considered low-risk can bypass the standard precautions currently recommended for postoperative recovery, according to researchers at the Hospital for Special Surgery (HSS) in New York City.

In the past decade, surgeons used the anterior approach over the posterior approach for performing total hip replacements because it didn’t require standard hip precautions. However, limited data exist corroborating the standard precautions for the posterior approach. These precautions include:

  • Not flexing your hip past 90 degrees.
  • Not internally rotating your hip more than 10 degrees.
  • Constant use of an elevated seat cushion, as well as a grabber for anything retrieved from the ground.
  • Ensuring that you always sleep on your back.

“The precautions can be limiting and cause fear in patients,” said Dr. Peter Sculco, MD, an orthopedic surgeon at HSS who specializes in hip and knee replacement and the study’s lead author, in a press release about the research. “Sleeping on your back is very uncomfortable for many people. You often hear from physical therapists that patients are relieved when they can finally cross their legs and sleep on their side.”

In this retrospective cohort study, researchers analyzed all patients at HSS who underwent a posterior primary uncemented hip replacement from January 2014 to June 2016. Surgeons were given the option to either place patients on standard precautions or a pose avoidance protocol, to avoid a flexed external position that occurs when a person puts on their shoe or shaves their leg. In the pose avoidance cohort, 1,311 patients met the inclusion criteria, and the minimum follow-up was six weeks. Researchers matched patients (1:1) in the pose avoidance group to a historical cohort of patients based on gender, age, and body mass index (BMI) that were treated using standard posterior hip precautions.

Standard Precautions Deemed Unnecessary

According the study results, within the first six postoperative weeks, six dislocations transpired in the pose avoidance group (0.46%) juxtaposed to seven in the matched group (0.53%), suggesting no discernible difference in outcomes, statistically or clinically.

“Our results suggest that the standard postoperative precautions in patients undergoing total hip arthroplasty through the posterior approach without known risk factors for instability are unnecessary,” said Dr. Sculco. “We may find that precautions don’t make sense for any of our patients, but we need to look at in a stepwise fashion.”

The researchers also noted that risk factors for instability include neuromuscular issues, such as stroke, Parkinson’s disease, and lumbar spine fusions.

“The bottom line of the study is in recent years, we have learned more about interventions that matter after joint replacement and those that don’t really have efficacy,” continued Dr. Sculco. “Minimizing precautions and simplifying the postoperative recovery is part of the larger simplification of surgery where we are using more selected resources and interventions for people, instead of blanketing everyone with the same kind of protocols.”