HIP PRECAUTIONS: NECESSARYOR RESTRICTIVE

INTRO: Total hip arthroplasty (THA) is a commonly performed major surgical operation that
is widely recognized as an effective treatment for osteoarthritis. The most common
complication of a THA is dislocation of the prothesis. In an attempt to reduce dislocation rates,
“hip precautions” were created. These precautions restrict certain hip movements and limit
activities a patient can perform. They have become a standard component of post-operative
care, however are they really necessary?

METHODS: “Hip precautions” was typed into the search bar of Queen’s database. The first
6 randomized controlled trials published 2015 or later that examined the efficacy of hip
precautions were included.

RESULTS: 1,810 participants across 6 studies were randomized into either precaution or no
precaution groups. All studies included implemented standard postoperative precautions
consisting of no flexion > 90 degrees, no adduction past neutral, and no internal rotation. The
no precautions group were allowed to mobilize as they wished, aside from 2 studies that didn’t
allow combined full flexion, adduction, and internal rotation (Kornuijt et al., 2016; Chan et al.,
2021). Four of the six studies utilized either a posterior or posterolateral surgical approach, one
used a direct lateral (Jobory et al., 2019) and one included both posterior and anterolateral
approaches (Lightfoot et al., 2021). In five of the six studies, the no precautions group had less
dislocations than the precautions group (see table). Four of the six studies examined other
outcome measures, however Chan et al. was the only study to find a meaningful significant
change after one year post-op (in favour of no precautions). Three studies found small changes
in other outcomes up to 6 weeks post op (see table), however the majority of functional
outcomes were statistically similar between groups.

CONCLUSION: Hip precautions are not associated with greater dislocation rates after THA
via a posterior/posterolateral approach. No precautions show promising results regarding ADL
performance, pain, and length of hospital stay compared to standard precautions, although
further research is needed with proper longterm follow up. Future research should be
conducted focused on anterior/anterolateral approach to assess the efficacy of precautions
across all surgical approaches. As for now, hip precautions are not required after THA via
posterior/posterolateral approaches.
 Precautions No Precautions Approach Outcomes

Tetreault N= 295 N = 299 - posterior Dislocations: 1 less in

2020 - normal - option to use pillow NP group
precautions* between legs -NP less difficulty
with ADL’s, earlier
return to driving,
more time spent
sleeping on side at 6
weeks
Dietz 2019 N= 159 N = 154 - posterolateral Dislocations: 1 less in
-normal - no precautions NR group
precautions* -NP lower HOOS Jr.
score at 2 weeks
post-op

Lightfoot N = 118 N = 119 -posterior (n=82 Dislocations: 1 more

2021 -normal -no precautions, each group) in the NP group (3
precautions + specialized equipment -anterolateral (n= altogether, 2 were
education on only provided to 36 P and 37 NP) posterior, 1
ADL’s with patients that required anterolateral)
precautions, and a it -NP greater Oxford
standard package Hip Scores at one
of equipment week post-op
Jobory 2019 N = 168 N = 226 -lateral Dislocations: 1 from
(**hemi -normal -no precautions each group
precautions*
after #)
Kornuijt N = 109 N = 108 -posterolateral Dislocations: 1 less in
2016 -normal -no combined full hip NP group
precautions* + flexion, IR, and
equipment + no adduction
driving and
mandatory
crutches
Chan 2021 N= 29 N= 26 -posterolateral Dislocations: 2 less in
- normal - -no combined flexion, NP group
precautions* + adduction, IR -NP had shorter
sleep supine and length of stay and
elevated better health
equipment perceptions at one
year