Aims In order to prevent dislocation of the hip after total hip arthroplasty (THA), patients have to adhere to precautions in the early post-operative period. The hypothesis of this study was that a protocol with minimal precautions after primary THA using the posterolateral approach would not increase the short-term (less than three months) risk of dislocation.
Patients and Methods We prospectively monitored a group of unselected patients undergoing primary THA managed with standard precautions (n = 109, median age 68.9 years; interquartile range (IQR) 61.2 to 77.3) and a group who were managed with fewer precautions (n = 108, median age 67.2 years; IQR 59.8 to 73.2). There were no significant differences between the groups in relation to predisposing risk factors. The diameter of the femoral head ranged from 28 mm to 36 mm; meticulous soft-tissue repair was undertaken in all patients. The medical records were reviewed and all patients were contacted three months post-operatively to confirm whether they had experienced a dislocation.
Results There were no dislocations in the less restricted group and one in the more restricted group (p = 0.32).
Conclusion For experienced surgeons using the posterolateral approach at THA and femoral heads of diameter ≥ 28 mm, it appears safe to manage patients in the immediate post-operative period with minimal precautions to protect against dislocation. Larger studies with adequate statistical power are needed to verify this conclusion.
Take home message: Experienced orthopaedic surgeons using the posterolateral approach for THA should not fear an increased dislocation rate if they manage their patients with a minimal precautions protocol.
Cite this article: Bone Joint J 2016;98-B:589–94.
A. Kornuijt: Study design and protocol writing, Data collection and data management, manuscript writing.
D. Das: Study design, Manuscript review and editing, Performed surgeries and experiment.
T. Sijbesma: Study design, Manuscript review and editing, Performed surgeries and experiment.
W. van der Weegen: Study design and protocol writing, Data collection, Data management and statistical analysis, Manuscript review and editing, Submitting of manuscript.
Acknowledgement: We thank H. J. Hoekstra, R. van Drumpt and R. Bogie for the inclusion of their THA surgery procedures.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by J. Scott and first proof edited by G. Scott.
- Received June 16, 2015.
- Accepted November 10, 2015.
- ©2016 The British Editorial Society of Bone & Joint Surgery