Standard precautions currently recommended for postsurgical total hip replacement recovery may not benefit low-risk patients, according to research presented at the 2019 American Academy of Orthopaedic Surgeons Annual Meeting, March 12-16 in Las Vegas.
Researchers retrospectively reviewed all patients undergoing a posterior primary uncemented total hip replacement between January 2014 to June 2016 at Hospital for Special Surgery in New York City. Patients either followed standard precautions or a pose avoidance protocol to avoid a flexed external rotation position.
Four things to know:
1. In some cases, surgeons have begun performing anterior hip replacements becuas they don't involve the standard hip precautions that the posterior approach does. The standard precautions for the posterior approach include:
- Avoid flexing the hip past 90 degrees
- Not internally rotating the hip more than 10 degrees
- Employing elevated seat cushions all the time
- Using a grabber to retrieve items from the ground
- Sleeping on your back for six weeks
However, some patients undergoing posterior hip replacements may also do well without the precautions.
2. Eliminating standard precautions did not increase the risk of hip dislocation for the low risk population. "The majority of patients we see are low risk; 90 percent of patients probably qualify for minimized precautions," said Peter K. Sculco, MD, the study's lead author and an orthopedic surgeon at New York City-based Hospital for Special Surgery. Data shows hip precautions can make a difference for patients with poor hip dislocation.
3. A total of 1,311 patients met the inclusion criteria for the pose avoidance cohort. The study authors matched patients to a historical patient cohort based on age, sex and body mass index that were treated with standard posterior hip precautions.
4. Within the first six weeks postoperatively, six dislocations occurred in the pose avoidance group — 0.46 percent — compared with seven in the matched group —0.53 percent. The difference was not clinically significant.