Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review Causes for revision of dual-mobility and standard primary total hip arthroplasty Rehabilitation following total hip arthroplasty evaluation over short follow-up time: randomized clinical trial. Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. [Clinical outcome following robotic assisted versus conventional total hip arthroplasty: a controlled and prospective study of seventy-one patients]. Preliminary application of computer-assisted patient-specific acetabular navigational template for total hip arthroplasty in adult single development dysplasia of the hip. The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. Cementless dual-mobility cup in total hip arthroplasty revision Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery. [Advantages of minimal invasive total hip replacement in the early phase of rehabilitation]. Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Clinical and radiological short-term complications after single-stage bilateral uncemented total hip arthroplasty Early complications of anterior supine intermuscular total hip arthroplasty. Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial. Reduced patient restrictions following total hip arthroplasty: study protocol for a randomized controlled trial Modified direct anterior approach in minimally invasive hip hemiarthroplasty in a geriatric population: a feasibility study and description of the technique
Purpose : Total hip arthroplasty ( THA ) is a common and effective treatment of hip osteoarthritis . Activity restrictions known as hip pre caution s are widely practice d in rehabilitation post THA , aim ing to foster healing and prevent hip dislocation . The focused clinical question was : Does the application of hip pre caution s in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation ? Methods : A comprehensive literature search was conducted for r and omized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up , with dislocation as an end point . Retrieved titles were assessed independently by 2 review ers for inclusion and underwent st and ardized data extraction . Results : Title search produced 80 potentially relevant articles . Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria . No eligible studies were found that concerned posterior approaches to hip arthroplasty , so the results of this review concern only anterolateral approaches . Neither included study showed any benefit of hip pre caution s in preventing dislocation . Conclusion : The rate of dislocation after anterolateral THA is low and is not improved by hip pre caution s. Hip pre caution s are associated with a slower return to activities , significant expense , and decreased patient satisfaction . Existing studies risk being compromised by a type II error , but a definitive study may be prohibitively large and expensive Introduction The causes for revision of primary total hip arthroplasty ( THA ) are various and quite well known . The developing use of dual-mobility THA ( DM-THA ) seems a relevant option to decrease the risk of instability . Due to lack of long-term follow-up , this innovative retentive concept is suspected to increase the risk of polyethylene ( PE ) wear . the aim of the study was to analyse the causes for  DM-THA revision and assess whether or not its occurrence is different from that of fixed-st and ard ( FS ) THA , particularly for aseptic loosening or wear and /or osteolysis . Material s and methods The SoFCOT group conducted an observational prospect i ve multicentre study from 1 January 2010 to 31 December 2011 . Inclusion criteria comprised an exhaustive collection of 2044 first-revision THAs with 251 DM-THAs and 1793 FS-THAs . After excluding complications linked to patient factors ( infection and periprosthetic fractures ) , we performed a matched case – control study ( matching ratio 1:1 ) comparing two groups of 133 THAs . Results Revisions for aseptic loosening or osteolysis/wear were as frequent in DM-THA ( 58.7 % ) as in FS-THA ( 57.1 % ) ( p 0.32 ) ; 7.5 % of DM-THA were revised for dislocation versus 19.5 % of FS-THA ( p 0.007 ) . Discussion Revision for osteolysis/wear and aseptic loosening were as frequent in DM-THA as in FS-THA ;  revision for dislocation was less frequent in DM-THA . This confirms the efficiency of the DM concept regarding the risk of dislocation . Causes for revision were different between groups , and revisions for dislocation were less frequent in DM-THA . Only prospect i ve comparative studies could provide reliable information that may support broader use of the DM concept UNLABELLED Hip osteoarthritis ( OA ) is a degenerative disease , and total hip arthroplasty ( THA ) is one of the surgical procedures of choice to improve the OA patient 's quality of life . Without a rehabilitation program , THA patients will develop functional limitations . A r and omized double-blind trial was performed between July 2009 and October 2011 to compare in a short follow-up time two groups of patients who underwent THA for OA . The THA protocol ( THAP ) group received verbal instructions and physiotherapy exercise demonstrations , and the THA physiotherapy care protocol ( THAPCP ) group received the same verbal instructions and demonstrations associated with daily exercise practice guided by a physiotherapist . The outcomes that were assessed preoperatively and 15 d postoperatively in 106 patients were muscle strength force , goniometry , Medical Outcomes Study 36-Item Short Form Health Survey , and Merle d'Aubigné and Postel score . Higher muscle strength force scores and degrees in range of motion were found in the THAPCP group . Higher improvements were also observed for the THAPCP group compared with the THAP group in the Merle d'Aubigné and Postel score . At the end of the follow-up period , the intervention in the THAPCP group improved functional capacity , quality of life , mobility , muscle strength , goniometry , and pain . It appears to be a safe tool for accelerating recovery in THA patients . CLINICAL TRIAL REGISTRATION Clinical Trials.gov ; NCT01491048 OBJECTIVE Dislocation is a well-known complication after  total hip arthroplasty ( THA ) , and is the second-highest cause of revision surgery . Our objective was to assess the effect of preoperative patient education on the occurrence of  hip dislocation  within 6 months after primary THA . METHODS Between 1998 and 2007 , we conducted a prospect i ve cohort study at the Geneva University Hospital Department of Orthopaedic Surgery , including all primary THAs performed via an anterolateral transgluteal approach with the use of a 28-mm diameter head .  The preoperative education session was introduced in June 2002 and included advice on muscle strengthening exercises and postoperative restrictions of range of motion as a means of preventing dislocation . The main outcome was the incidence of dislocation within 6 months of surgery . RESULTS A total of 597 patients who underwent 656 THAs between June 2002 and June 2007 participated in the education session , whereas 1,641 patients who underwent 1,945 procedures did not . Forty-six dislocations occurred over the study period , 5 ( 0.8 % ) in participants and 41 ( 2.1 % ) in non participants ( absolute risk reduction 1.3 % ; 95 % confidence interval [ 95 % CI ] 0.4 , 2.3 ) , with the time interval between surgery and dislocation being significantly shorter among participants ( 0.2 versus 1.2 months ) . Non participants had a 2.8 times higher risk of dislocation than participants ( unadjusted odds ratio [ OR ] 2.80 ; 95 % CI 1.10 , 7.13 ) . Adjustment for age , sex , comorbidities , and prior surgery did not change the results ( adjusted OR 2.79 ; 95 % CI 1.09 , 7.15 ) . CONCLUSION Our findings suggest that participation in a preoperative patient education session may reduce the risk of dislocation within 6 months after THA AIM Robotic assisted total hip arthroplasty  remains controversial , since wider exposure of the proximal femur and placement of the leg in maximal hip adduction and external rotation using a rigid leg-holder apparatus may impair significantly the hip abductors . Consequently , it is the purpose of this study to analyse and report both clinical outcome and hip abductor function following robotic assisted versus conventional total hip arthroplasty . MATERIAL AND METHODS 36 robotic-assisted ( CASPAR , Orto-Maquet , Rastatt , Germany ) and 35 conventional cementless total hip arthroplasties  were followed on average for 18 months regarding incidence of complications , Harris hip score , the scoring system according to Merle d'Aubigné and Postel , hip abductor function ( using a spring-balance ) , and incidence of Trendelenburg 's sign ( according to the Kuhfuss-classification ) . Statistical analysis was performed in case of continuous data using the t test and the Mann-Whitney test , respectively , and in case of categorical data using Fisher 's exact test and the chi-squared test , respectively . The level of significance was set as p < 0.05 . RESULTS Average duration of surgery ( CASPAR : 100.6 min ; conventional : 51.5 min ; p < 0.0001 ) as well as average loss of haemoglobin ( CASPAR : 4.5 mg/dL ; conventional : 3.3 mg/dL ; p = 0.0002 ) differed significantly , whereas the incidence of complications ( CASPAR : two dislocations , one sciatic paresis , one deep infection ; conventional : one dislocation , two fissures ) , revision rate ( CASPAR : 5.6 % ; conventional : 2.9 % ) , and incidence of heterotopic ossifications ( CASPAR : 30.6 % ; conventional : 17.1 % ) was comparable following both procedures ( p > 0.05 ) . Improvement of the Harris hip score also was comparable in both groups ( CASPAR : 40.9 to 86.1 points ; conventional : 39.5 to 88.0 points ; p = 0.21 ) , whereas improvement of the score according to Merle d'Aubigné and Postel was significantly greater following the manual procedure ( CASPAR : 10.1 to 16.0 points ; conventional : 8.3 to 16.6 points ; p < 0.0001 ) . Differences between the two groups were also significant regarding hip abductor function ( CASPAR : 76.1 % ; conventional : 93.8 % of the contralateral hip ; p < 0.0001 ) and incidence of Trendelenburg 's sign ( CASPAR : 61.1 % ; conventional : 25.7 % ; p = 0.0014 ) . CONCLUSION The significant functional impairment following robotic assisted THA should be taken critically into consideration prior to initiating such procedure BACKGROUND The considerable variation in anatomical abnormalities of hip joints associated with different types of developmental dysplasia of hip ( DDH ) makes reconstruction in total hip arthroplasty ( THA ) difficult . It is desirable to create patient-specific design s for THA procedures . In the cases of adult single DDH , an accuracy-improved method has been developed for acetabular cup prosthesis implantation of hip arthroplasty . METHODS From October 2007 to November 2008 , 22 patients with single DDH ( according to the Crowe st and ard , all dysplasia hips were classified as type I ) were scanned with spiral CT pre-operatively . These patients scheduled for THA were r and omly assigned to undergo either conventional THA ( control group , n = 11 ) or navigation template implantation ( NT group , n = 11 ) . In the NT group , three-dimensional ( 3D ) CT pelvis image data were transferred to a computer workstation and 3D models of the hip were reconstructed using the Mimics software . The 3D models were then processed by the Imageware software . In brief , a template that best fitted the location and shape of the acetabular cup was ' reversely ' built from the 3D model , the rotation centre of the pathological hip determined by mirroring that of the healthy site , and a guiding hole in the template was then design ed . The navigational templates were manufactured using a rapid prototyping machine . These navigation templates guide acetabular component placement . RESULTS Based on the predetermined abduction angle 45 ° and anteversion angle 18 ° , after 1 year follow-up , the NT group showed significantly smaller differences ( 1.6 ° ± 0.4 ° , 1.9 ° ± 1.1 ° ) from the predetermined angles than those in the control group ( 5.8 ° ± 2.9 ° , 3.9 ° ± 2.5 ° ) ( P < 0.05 ) . CONCLUSIONS The template design s facilitated accurate placement of acetabular components in dysplasia of acetabulum . The hip 's center of rotation in DDH could be established using computer-aided design , which provides a useful method for the accurate location of prosthesis with a low cost-performance ratio without excessive technical workload on the surgical team BACKGROUND It is currently unknown whether functional restrictions following total hip arthroplasty can reduce the prevalence of early postoperative dislocation . Our hypothesis was that dislocation was more likely to occur in patients who were not placed on these restrictions . METHODS We performed a prospect i ve , r and omized study to evaluate the role of postoperative functional restrictions on the prevalence of dislocation following uncemented total hip arthroplasty through an anterolateral approach . Of the 630 eligible consecutive patients , 265 patients ( 303 hips ) consented to be r and omized into one of two groups ( the " restricted " group or the " unrestricted " group ) . The patients in both groups were asked to limit the range of motion of the hip to < 90 degrees of flexion and 45 degrees of external and internal rotation and to avoid adduction for the first six weeks after the procedure . The patients in the restricted group were instructed to comply with additional hip pre caution s during the first six weeks postoperatively . Specifically , these patients were managed with the placement of an abduction pillow in the operating room before bed transfer and used pillows to maintain abduction while in bed ; used elevated toilet seats and elevated chairs in the hospital , in the rehabilitation facility , and at home ; and were prevented from sleeping on the side , from driving , and from being a passenger in an automobile . All patients were followed for a minimum of six months postoperatively . RESULTS There was one dislocation in the entire cohort ( prevalence , 0.33 % ) . This dislocation occurred in a patient in the restricted group during transfer from the operating table to a bed with an abduction pillow in place . Patients in the unrestricted group were found to return to side-sleeping sooner ( p < 0.001 ) , to ride in automobiles more often ( p < 0.026 ) , to drive automobiles more often ( p < 0.001 ) , to return to work sooner ( p < 0.001 ) , and to have a higher level of satisfaction with the pace of their recovery ( p < 0.001 ) than those in the restricted group . There was an additional expenditure of approximately $ 655 per patient in the restricted group . CONCLUSIONS Total hip arthroplasty through an anterolateral approach is likely to be associated with a low dislocation rate . Removal of several restrictions did not increase the prevalence of dislocation  following primary hip arthroplasty at our institution . However , it did promote substantially lower costs and was associated with a higher level of patient satisfaction as patients achieved a faster return to daily functions in the early postoperative period Purpose Dislocation is a frequent complication in total hip arthroplasty ( THA ) revision . Cup fixation is the second concern . In order to know outcomes at two years , we prospect ively followed a continuous series of 78 patients to demonstrate that  cementless dual-mobility cup ( DMC ) used in revision THA  is safe as regards dislocation risk and bone fixation . Method We enrolled 78 consecutive patients ( 79 cases ) in a prospect i ve study . Mean interval between index surgery and revision was 12.9 years . Mean age at revision was 75.5 years . Two types of cementless DMC were used : a st and ard DMC in 68 cases with low- grade bone defect ( Paprosky grade 1 and 2 ) , and a specific design reconstruction DMC in 11 cases with severe bone loss ( Paprosky grade 3 ) . Results At two years of follow-up , 68 patients were review ed ; four were lost to follow-up . , and six patients were deceased . We identified three types of situations at risk : st and ard risk ( 33 cases ) , Paprosky grade 1 or 2 ; medium risk ( 37 cases ) , revision for recurrent instability ( 21 ) , periprosthetic fractures ( 14 ) or severe loosening Paprosky grade 3 without femorotomy ( 2 ) ; high risk ( nine cases ) , revision for severe loosening with a femorotomy . One ( 1.3 % ) patient dislocated her hip at one month without recurrence . Revision rate for dislocation was 0 % ; two ( 2.7 % ) early mechanical failures occurred . Conclusion Considering outcomes of this series , cementless DMC can be suggested in THA revision surgery OBJECTIVE To evaluate the effect of a short preoperative exercise intervention on the functional status , pain , and muscle strength of patients before and after total joint arthroplasty . METHODS A total of 108 men and women scheduled for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) were r and omized to a 6-week exercise or education ( control ) intervention immediately prior to surgery . We assessed outcomes through question naires and performance measures . Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery . RESULTS Among THA patients , the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score ( improvement of 2.2 in exercisers versus decline of 3.9 in controls ; P = 0.02 ) and Short Form 36 physical function score ( decline of 0.4 in exercisers versus decline of 14.3 in controls ; P = 0.003 ) . No significant differences were seen in TKA patients . Exercise participation increased muscle strength preoperatively ( 18 % in THA patients and 20 % in TKA patients ) , whereas the control patients had essentially no change in strength ( P > 0.05 for exercise versus education in both THA and TKA groups ) . Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients ( adjusted odds ratio 0.27 , 95 % confidence interval 0.074 - 0.998 ) . The intervention had no effects on outcomes 8 and 26 weeks postoperatively . CONCLUSION A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA . Additionally , exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation OBJECTIVE To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery .  DESIGN This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1 year after total hip arthroplasty ( THA ) .  Temporospatial , kinetic , and kinematic data as well as functional outcomes were collected . Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries . SETTING A controlled laboratory study . PARTICIPANTS This study examined 35 patients with primary , unilateral THA . The THA surgical approaches that were used in these patients included 12 direct lateral , 18 posterior , and 11 anterolateral . All the patients were assessed 1 year after THA . Patients were excluded from the study if they had contralateral hip pain or pathology , or any prior lower extremity total joint replacements . MAIN OUTCOME MEASUREMENTS Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected . In addition , a series of physical performance measures were collected . RESULTS No main effects for the physical performance measures or biomechanical variables were observed among the approach groups . Significant limb-to-limb asymmetries were observed among all the patients , with decreased sagittal plane range of motion , peak extension , and peak vertical ground reaction forces on the operative side . CONCLUSION The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable . However , 1 year after THA , the patients demonstrated asymmetric gait patterns regardless of surgical approach , which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA UNLABELLED In arthroplasty the term " minimal invasive " not only refers to the length of the skin incision but more so to its soft tissue and thereby muscle-protecting features . STUDY AIM The aim of this study is to compare the early postoperative mobilisation and rehabilitation of the different surgical approaches in cementless total hip arthroplasty . METHODS 27 patients underwent a total hip replacement ( Trilogy cup , MAYO stem ) via a ventral minimal invasive approach ( one incision technique ) ( MIS group ) . 23 patients underwent a total hip replacement with the same implant via a anterolateral transgluteal approach ( st and ard group ) . We evaluated the Harris Hip Score ( HHS ) , the visual analogue scale ( VAS ) for pain and patient satisfaction preoperatively as well as 3 days , 10 days , 6 weeks and 3 months postoperatively . RESULTS After 3 and 10 days the MIS group showed better scores for pain , gait and mobilisation as well as for the overall HHS compared to the st and ard group . These differences could not be shown 6 weeks postoperatively . The MIS group had a significantly higher rate of complications with 22 % transient impairment of the lateral cutaneous nerve . CONCLUSION The patients of the MIS group showed a better mobilisation and rehabilitation during the early postoperative period . This can be attributed to the lessened intraoperative damage of to soft tissue and especially muscle damage . Due to the increased rate of nerve irritations , we modified our surgical approach . The minimal invasive approach to modern hip joint arthroplasty remains a non-st and ard technique . Compared to the st and ard approach it carries additional risks ( like nerve damage and malpositioning of the implants and thus should remain in the h and s of the experienced orthopaedic surgeon in specialised orthopaedic centres BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature Abstract Purpose Economic crisis time gives to efficient procedures an important role in healthy system . Total hip replacement is a common bilateral orthopedic procedure , but there exists an important controversy to perform it in single or two stages . Our aim is to report our clinical and radiological short-term complications of bilateral uncemented total hip arthroplasty in a single time . Material s and methods We have retrospectively review ed the patients treated between 2000 and 2011 in our center by bilateral uncemented total hip replacement in a single time .  We have review ed the medical history and analyzed by age , diagnosis and ASA parameters related to the procedure , hospital stay , transfusion requirements and clinical complications . Radiological evaluation was made with anteroposterior hip radiograph evaluation ( acetabular radiolucencies and stem migration ) . Functional assessment was carried out by the Merle D’Aubigné score . Results Seventeen patients with mean age of 47.4 ( 18–68 ) years were review ed with a mean follow-up of 44.3 ( 6–172 ) months . ASA distribution : 29.4 % grade I ; 52.9 % grade II and 17.6 % grade III . Merlé D’Aubigné score improved from 11.01 to 16.45 . Hospital stay was 6 days . Transfusion requirements were two hematic concentrates for each patient . Two external popliteal sciatic nerve neurapraxias fully recovered at follow-up . Radiological results showed one case of axial migration . Conclusions With proper patient selection and multidisciplinary team , the bilateral uncemented total hip arthroplasty in a single time has low complication rates . Our results could be used in the development of future r and omized controlled trials or prospect i ve cohort studies .Level of evidence IV Anterior supine intermuscular total hip arthroplasty ( THA ) performed on a fracture table has been increasingly used for primary THA . Accurate cup placement , low incidence of dislocation , shorter hospital stay , and faster return of function are potential benefits of the technique . However , a high complication rate , particularly during a surgeon 's learning curve , has been reported . A retrospective analysis of 61 consecutive anterior supine intermuscular primary THAs with at least 6-month follow-up was performed . All procedures were performed using the anterior supine intermuscular approach with cementless implants under fluoroscopic guidance on a fracture table . Prospect ively collected data were retrospectively review ed to evaluate the early complication rate and radiographic accuracy of implant placement . Five ( 8.2 % ) intraoperative complications were observed : including 3 trochanteric fractures and 2 calcar fractures , 4 of which required cable fixation during the index procedure . One nondisplaced trochanteric fracture was treated conservatively . One patient sustained an injury of the lateral femoral cutaneous nerve . Postoperative complications included 1 anterior dislocation , 1 infected superficial hematoma , 1 stem subsidence , and 1 loose stem , with the latter 2 presenting as increasing thigh pain postoperatively and requiring stem revision . The overall complication rate was 16.4 % ( 10/61 ) . Overall , 3 patients ( 4 hips ; 6.5 % ) required reoperation . No femoral or sciatic nerve injuries occurred , and no patient was diagnosed with venous thromboembolism . All intraoperative fractures occurred during the first 32 cases , and none during the last 29 cases . A potentially high incidence of complications with the anterior supine intermuscular THA exists during a surgeon 's learning curve in an academic setting OBJECTIVE To investigate the effects of a late-phase exercise program for patients who underwent total hip arthroplasty ( THA ) 4 to 12 months earlier . DESIGN A single-blind , r and omized controlled trial . SETTING Exercises were performed in subjects ' homes . Exercise instruction and measurements taken before and after the trial were performed in an outpatient research and treatment center . PARTICIPANTS Convenience sample of 34 adults 4 to 12 months post-THA r and omly allocated to experimental or control groups . Twenty-eight subjects completed the study . INTERVENTION An 8-week , hip-exercise intervention , during which the control group received basic isometric and active range of motion exercises ; the experimental group received strength and postural stability exercises . MAIN OUTCOME MEASURES Score on the 12-Item Hip Question naire ; fear of falling ; hip flexor , extensor , abductor , and knee extensor muscle torque ; and postural stability in single stance . RESULTS There was a statistically significant improvement in all measures of self-perceived function , muscle strength ( hip flexors , 24.4 % ; hip extensors , 47.8 % ; hip abductors , 41.2 % ; knee extensors , 23.4 % ) , and postural stability ( 36.8 % ) in the experimental group and no significant change in the control group . Neither group had statistically significant changes in fear of falling measures . CONCLUSIONS An exercise program emphasizing weight bearing and postural stability significantly improved muscle strength , postural stability , and self-perceived function in patients 4 to 12 months after THA Background Total hip arthroplasty ( THA ) is a very common procedure in orthopedic surgery . In the Netherl and s , 25,642 primary THAs were performed in 2013 . Postoperative hip dislocation is one of the major complications and has been reported in 0.5 to 10.6 % of patients after primary THA.Several reports regarding the use of an anterolateral surgical approach have shown that a non-restriction or reduced restriction protocol does not increase the dislocation rate . For the posterolateral surgical approach it has been suggested that patient restrictions might be unnecessary but the amount of available literature is scarce . As such , r and omized controlled trials aim ed at investigating restrictions following THA using a posterior approach are strongly recommended . The aim of this prospect i ve r and omized controlled trial is to investigate the non-inferiority hypothesis concerning the early dislocation rate after THA in patients with and without the use of a reduced restriction protocol . Methods / Design After providing informed consent a group of 456 patients with symptomatic coxarthrosis will be r and omized to receive a THA either with care as usual , i.e. receiving postoperative restrictions including the advice to sleep in a supine position for the first 8 weeks postoperatively , or reduced restrictions with no recommendations regarding the position during sleeping . Primary outcome measure will be the percentage of early dislocations within the first 8 weeks after THA . Secondary outcome measures will be patient satisfaction , time to functional recovery , quality of sleep and patient ’s self-reported compliance with postoperative instructions . Discussion To our knowledge this will be the first r and omized controlled trial that compares a reduced restriction protocol with a restricted protocol following THA using a posterolateral surgical approach . Our hypothesis is that a reduced restriction protocol following THA with use of a posterolateral surgical approach has no influence on the early dislocation rate compared to a restricted protocol . Instead , embracing a reduced restriction protocol might even contribute to a higher quality of sleep , thereby facilitating a faster uptake and return to daily functions in patients after THA.Trial registration Clinical Trials.gov NCT02107248 , registration date 3 April 2014 Introduction The direct anterior approach ( DAA ) is generally accepted method for minimal invasive arthroplasty of the hip . As good results for total hip arthroplasty are already published , there is a lack of evidence for the implantation of bipolar hip hemiarthroplasty ( BHH ) in elderly patients with osteoporosis after femoral neck fracture . Material s and methods For hip arthroplasty using a direct anterior approach ( DAA ) in elderly patients with femoral neck fractures , a number of modifications of the original technique are being described . The modified DAA considers in particular the co-morbidity and the bone quality of the geriatric patient population . A consecutive series of 16 hemiarthroplasties using this technique is presented . In all 16 cases , the BHH was implanted in modified DAA technique . Mobility measured by 4-item Barthel Index , pain via visual analogue scale ( VAS ) , duration of surgery , external length of incision and blood loss were evaluated . Results There was no major operative complication during the procedures . The pain level decreased from 7 ( preoperatively ) to 0 at postoperative day 40 . The Barthel Index increased from 5 at first postoperative day to 40 at day 40 . Early postoperative mobilisation is efficiently accelerated . Mean operating time was 71 min ; the medium skin incision length was 8 cm . The mean haemoglobin level decreased from 118 g/dl preoperatively to 101 g/dl at first postoperative day . Conclusion The described modifications of the DAA help to implant a BHH gently in elderly patients with increasing risk of complications like iatrogenic fractures , wound or prosthesis infections and haematoma . This will hopefully lead to a faster rehabilitation and lower mortality rate for patients with femoral neck fractures in the future
AUTHORS ' CONCLUSIONS Very low quality evidence is available from single trials , thus we are uncertain if hip pre caution s with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA .
BACKGROUND Total hip arthroplasty ( THA ) is one of the most common orthopaedic operations performed worldwide .
Painful osteoarthritis of the hip is the primary indication for THA .
Following THA , people have conventionally been provided with equipment , such as raised toilet seats and chairs , and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees , or adduction or rotation past the midline .
These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation .
However , the appropriateness of these recommendations has been question ed .
OBJECTIVES To assess the effects of provision of assistive devices , education on hip pre caution s , environmental modifications and training in activities of daily living ( ADL ) and extended ADL ( EADL ) for people undergoing THA .