When you think about hip replacement surgeries, chances are you envision experiencing lots of pain and being immobile for long periods of time while you recover.
However, low-risk patients undergoing a total hip replacement with a posterior approach can skip the standard hip precautions currently recommended for post-surgical recovery, according to a new study from the Hospital for Special Surgery (HSS) in New York .
Traditionally, most hip replacements have been done through a posterior approach, where the surgeon accesses the hip through the side or buttocks. However, more recently surgeons have started favouring the anterior approach, where the surgeon enters the body through the front of the hip, because it doesn’t involve standard hip precautions.
For a posterior approach, standard precautions include not flexing your hip past 90 degrees, not internally rotating your hip more than 10 degrees, using an elevated seat cushion at all times, and sleeping on your back for six weeks.
“The precautions can be limiting and cause fear in patients,” Peter Sculco, the study’s lead author and orthopaedic surgeon specialising in hip and knee replacement at HSS, said. “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.”
However, little data backs the standard hip precautions recommended for the posterior approach. In fact, Sculco said the current precautions are based on hip replacements done 25 years ago, adding: “We have changed a lot in terms of improving how we do hip replacements that has given us more confidence in the stability of our hips.
“Our understanding of the dynamic movement of the pelvis and how we put the parts in is much different. The quality of our soft tissue repair and closure at the end of surgery is much more robust.”
When patients are on strict precautions, they are not as active, which can slow down recovery. Sculco added if you minimise the hip precautions in an appropriate way, patients focus more on their recovery and less on the fear of hurting themselves.
In fact, the study found eliminating standard precautions currently recommended for post-surgical recovery did not increase the risk of hip dislocation.
For the study, researchers reviewed all patients undergoing a posterior primary uncemented total hip replacement from January 2014 to June 2016. Surgeons had the choice to put patients on standard precautions or a pose avoidance protocol, to avoid a single pose.
Researchers then matched patients in the pose avoidance cohort to a historical cohort of patients based on age, gender and body mass index that were treated with standard posterior hip precautions.
Within the first six weeks, post surgery, six dislocations occurred in the pose avoidance group (0.46 per cent) compared with seven in the matched group (0.53 per cent).
“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,” Sculco concluded.
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