Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. Reduced patient restrictions following total hip arthroplasty: study protocol for a randomized controlled trial A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR) Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial. Dislocation after total hip arthroplasty using Hueter anterior approach. [Clinical effects of comprehensive rehabilitation after minimally invasive total hip arthroplasty]. Quality of life after dislocation of hip arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up Waiting for total hip arthroplasty: avoidable loss in quality time and preventable deterioration. Impact of lifestyle on perioperative smoking cessation and postoperative complication rate. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. Can Dual Mobility Cups prevent Dislocation in All Situations After Revision Total Hip Arthroplasty? Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Exercise Improves Early Functional Recovery After Total Hip Arthroplasty Surgical dislocation of the hip versus arthroscopic treatment of femoroacetabular impingement: a prospective matched-pair study with average 2-year follow-up. Dislocation of Primary Total Hip Arthroplasty with 36 and 40-mm Femoral Heads
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 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 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 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 Objective : To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement . Design : Single blinded feasibility r and omised controlled trial , with data collection prior to the intervention , and at 4 , 12 , and 26 weeks following surgery . Setting : Recruitment from two NHS orthopaedic outpatient centres in the West Midl and s , UK . Subjects : Patients awaiting primary total hip replacement due to osteoarthritis were recruited . Following pre-operative assessment , patients were individually r and omised to intervention or control by a computer-generated block r and omisation algorithm stratified by age and centre . Interventions : The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations , assessed home safety , and provided appropriate adaptive equipment . The control group received treatment as usual . Outcomes : The study assessed the feasibility of recruitment procedures , delivery of the intervention , appropriateness of outcome measures and data collection methods . Health related quality of life and re source use were recorded at 4 , 12 and 26 weeks . Results : Forty-four participants were recruited , 21 were r and omised to the  occupational therapy  intervention and 23 to usual care . Analysis of 26 week data included 18 participants in the intervention group and 21 in the control . The intervention was delivered successfully with no withdrawals or crossovers ; 5/44 were lost to follow-up with further missing data for participation and re source use . Conclusions : The feasibility study provided the information required to conduct a definitive trial . Burden of assessment would need to be addressed . A total of 219 patients would be required in an efficacy trial 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 A prospect i ve study including 1764 hips has been carried out to evaluate the frequency of dislocation while using the Hueter anterior approach and the correlated factors . The dislocation group was compared with the patients without dislocation . We observed 27 dislocations ( 1.5 % ) . The dislocation rate when using 28 mm head diameter was 0.5 % . Two patients underwent a revision for recurrent dislocations . Correlated factors for dislocation were male sex , high body mass index , etiology of osteonecrosis , low head diameter , high bleeding , and low postoperative ROM . Dislocation risk while using Hueter approach is one of the lowest in the literature . The main disadvantages are the necessity for a specific orthopedic table and a more difficult exposure of the femur OBJECTIVE To explore clinical effects of comprehensive rehabilitation therapy for function restore of hip joint after minimally invasive total hip arthroplasty . METHODS From March 2006 to February 2008 , 100 patients were r and omly divided into the treatment group and the control group . Fifty patients in the treatment group , including 21 males and 29 females , ranging in age from 56 to 78 years , with an average of ( 67.2 + /- 11.0 ) years . Fifty patients in the control group , including 26 males and 24 females , ranging in age from 54 to 79 years , with an average of ( 65.5 + /- 11.5 ) years . The course of disease of the two groups were 10 to 15 years . The comprehensive rehabilitations such as joint range of motion , the activities of daily living and restoring muscle strength were performed step-by-step in the treatment group under the guidance of the therapist at the 2nd day after hip arthroplasty . Above rehabilitations were not performed in the control group . The postoperative functional recovery of hip joint , the Harris scores and X-ray were analyzed and compared between the two groups . RESULTS All the patients were followed and the duration averaged 13 months ( 12 to 14 months ) . The therapeutic effects of the two groups had statistical differences , Zc = 12.72 , P<0.001 . In the treatment group , the average Harris score was ( 94.50 + /- 29.87 ) , 32 patients got an excellent result , 12 good , 4 poor and 2 bad . While in the control group , above data were ( 63.50 + /- 19.97 ) , 12 , 15 , 7 and 16 respectively . The therapeutic effects of treatment group were better than those of control group . The X-ray showed that there were no hip prosthesis loosening , femoral neck fractures and other complications . CONCLUSION The early comprehensive rehabilitation after minimally invasive total hip replacement is the key to decrease postoperative complications and to decide the success or failure of surgery Purpose A primary arthroplasty constitutes a st and ard procedure in the treatment of patients with displaced fractures of the femoral neck . Although dislocation of the prosthesis remains a significant clinical problem , there are no previous reports on its influence on health-related quality of life ( HRQoL ) . We analysed how a dislocation of the hip arthroplasty influenced the patients ’ HRQoL. Methods In total 319 consecutive patients with a displaced fracture of the femoral neck treated with a primary arthroplasty were included in a prospect i ve cohort study . We used a mixed-effects model regression analysis to evaluate factors of importance for HRQoL ( EQ-5Dindex score ) during the first 12 months following surgery . Results A dislocation of the arthroplasty occurred in 21 of the 319 patients ( 7 % ) , 8 of whom had a single dislocation and 13 recurrent dislocations . At 4 months , the EQ-5Dindex score displayed a significantly worse outcome for patients with recurrent dislocations compared to patients with no dislocation ( P = 0.001 ) , and a trend towards a worse outcome for patients with a single dislocation ( P = 0.08 ) . At 12 months , the mean EQ-5Dindex score of patients with recurrent dislocations was still substantially lower ( P = 0.001 ) , while the EQ-5Dindex score for patients with a single dislocation had returned to a level similar to that of patients with no dislocation . Our analysis of the EQ-5D dimensions indicates that the difference was mainly due to perceived difficulties in self-care and usual activities and increased problems with anxiety/depression . Conclusions A recurrent dislocation of the hip arthroplasty in the treatment of patients with femoral neck fractures seems to result in a persisting deterioration in the HRQoL , while patients with a single dislocation seem to experience only a temporary deterioration This study was conducted to determine the effect of waiting times for total hip arthroplasty  in terms of loss in quality -adjusted life years and additional burden perceived . A second goal was to study the effect of waiting times and preoperative function scores on postoperative outcome scores . Data were collected prospect ively from a cohort of 161 patients waiting for total hip arthroplasty .  The Oxford Hip score , Western Ontario and McMaster Universities Osteoarthritis Index , SF-36 , and the EuroQol health status instruments were administered when the patient was placed on the waiting list , preoperatively , and 3 and 12 months after surgery . The disease-specific scores especially showed a significant deterioration during the waiting time . Moreover , a considerable loss of quality -adjusted life years occurred simply by postponing surgery . Although we found no direct effect of waiting time on postoperative outcomes , patients in a later phase of the disease process did not improve to the level achieved by patients with better preoperative function OBJECTIVE The aim was to examine to what extent lifestyle , education , social support , and comorbidity predict the ability of perioperative smoking cessation , and are associated with the development of important postoperative complications . DESIGN The design was a r and omized clinical trial . SETTING University hospitals in Copenhagen , Denmark , were the setting s. PARTICIPANTS AND METHODS One hundred twenty patients scheduled for primary elective hip or knee arthroplasty were r and omized to either smoking intervention or st and ard care .  Tobacco and alcohol consumption , exercise and eating habits , level of education , matrimonial status , and the  presence of social support  were registered . The data gathered concerned smoking cessation/reduction and severe postoperative morbidity . RESULTS Men and patients with a good social network were more likely to successfully quit smoking . Smoking intervention successfully reduced the incidence of postoperative complications , as did weekly exercise exceeding 4 h , and having a high education level . CONCLUSIONS This study emphasizes that smoking intervention programs in health care setting s are highly effective in reducing postoperative risks in hip and knee arthroplasty BACKGROUND Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement ( THR ) . AIM To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR . DESIGN Non-r and omized , controlled study . SETTING Inpatient . POPULATION 365 consecutively included THR patients . METHODS Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a st and ard package of assistive devices ( restricted group ) . This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs ( unrestricted group ) . Question naires on function , pain , quality of life ( HOOS ) , anxiety ( HADS ) , working status and patient satisfaction were completed before THR , 3 and 6 weeks after . RESULTS The HOOS function score at the 3 measurement times was ( mean ± SD ) ; unrestricted group : 46 ± 17 - 76 ± 9 - 83 ± 14 compared to restricted group : 43 ± 16 - 81 ± 14 - 83 ± 13 . Changes over time was significantly higher in the restricted group ( P=0.004 ) . Return to work 6 weeks after THR for the unrestricted group compared to restricted group was : 53 % versus 32 % ( P=0.045 ) . No significant differences between groups in pain , symptoms , quality of life , anxiety/depression , hip dislocations and patient satisfaction . CONCLUSION This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices , but the difference was eliminated after 6 weeks . Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work . CLINICAL REHABILITATION IMPACT It is possible to reduce movement restrictions and use of assistive devices considerably . More research on safety issues is needed to eluci date the effect of unrestricted rehabilitation on hip dislocation UNLABELLED The outcome of a single design of dual mobility cup was prospect ively evaluated in a continuous series of 994 revision THAs with respect to dislocation and intra-prosthetic dislocation ( IPD ) . At a 7.3-year mean follow-up , the dislocation rate was 1.5 % and the IPD rate was 0.2 % . The 2 IPD occurred in acetabular-only revisions and were related to a poor head-to-neck ratio with early impingement and wear at the polyethylene mobile component chamfer . Dual mobility cups demonstrated a low dislocation rate in revision THA but did not compensate for potential perioperative technical errors . In addition , IPD did not appear to be a concern with respect to the benefit in term of instability prevention though caution is advised in acetabular-only revision associated with a poor head-to-neck ratio . LEVEL OF EVIDENCE Therapeutic study -Level IV 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 The purpose of this prospect i ve , r and omized study was to apply an 8-week customized exercise program to patients ( Group E ) scheduled for total hip arthroplasty , followed by a postsurgery exercise program , and show the effect on functional recovery compared with control subjects ( Group C ) who received no additional exercise apart from routine in-hospital physical therapy .  Strength , range of motion , and physical function tests were completed by 57 patients at Week 8 and Week 1 before surgery and at Weeks 3 , 12 , and 24 postoperatively . No differences between the exercise and control groups were observed at baseline . By 1 week before surgery , patients in Group E had shown significant improvements for Western Ontario and McMaster Universities Osteoarthritis Index ( total score , stiffness , and physical function components ) , and combined hip strength . Patients in Group E had improved hip flexion range of motion in the diseased hip compared with patients in Group C. Significant differences in outcome measures between Group E and Group C were observed throughout the postoperative phase from Weeks 3 to 24 . The current study showed that customized perioperative exercise programs are well tolerated by patients with end-stage hip arthritis , and are effective in improving early recovery of physical function after total hip arthroplasty PURPOSE The purpose of this study was to prospect ively compare outcomes of patients receiving surgical hip dislocation and those undergoing arthroscopic treatment for femoroacetabular impingement ( FAI ) , using a matched-pair analysis . METHODS Between January 2008 and August 2011 , patients aged 30 years or younger with a diagnosis of FAI treated with surgical dislocation or arthroscopy were included . Patients were excluded with Tönnis grade 2 or greater , dysplasia , Legg-Calve-Perthes disease , and previous hip surgery . Patients treated with surgical dislocation  were pair-matched to patients treated arthroscopically in a 1:2 ratio . Patient-reported outcomes were prospect ively obtained in all patients preoperatively and postoperatively at 3 months , at 1 year , at 2 years , and at latest follow-up . Alpha angles were measured preoperatively and postoperatively for both groups . Revision surgery and complications were recorded for each group . RESULTS Ten patients were included in the surgical dislocation group , and 20 pair-matched patients were included in the arthroscopic group . We obtained 100 % follow-up at a mean of 24.8 months in the open group and 25.5 months in the arthroscopic group . Preoperative scores were similar between the 2 groups ; significant improvements were made postoperatively for both groups . When we compared the 2 groups , the change in Hip Outcome Score-Sport-Specific Subscale ( 42.8 v 23.5 , P = .047 ) and 2-year Non-Arthritic Hip Score ( 94.2 v 85.7 , P = .01 ) were significantly higher in the arthroscopic group . Both groups showed a significant decrease in the alpha angle postoperatively ( P = .775 ) . CONCLUSIONS Favorable results were shown with both approaches , with significant improvement in all patient-reported outcome measures and high patient satisfaction ratings . However , arthroscopic treatment of FAI showed greater improvement in the Hip Outcome Score-Sport-Specific Subscale and a higher absolute Non-Arthritic Hip Score at an average 2-year follow-up . LEVEL OF EVIDENCE Level II , prospect i ve matched-pair comparative study Some authors suggest the use of larger ( 36 and 40 mm ) femoral heads against highly cross-linked polyethylene acetabular liners will reduce the prevalence of early dislocation after primary total hip arthroplasty ( THA ) . We prospect ively followed 61 consecutive patients at high risk for dislocation to determine the prevalence of early dislocation after primary THA with 36 and 40 mm femoral heads .  We established specific indications for the use of these larger heads in primary arthroplasty . There were 65 hips in 61 patients with a minimum followup of 1 year ( mean 2 years , range 1 - 4 years ) . There were 55 36 mm heads and 10 40 mm heads . All arthroplasties were performed by the posterior approach with capsular repair . The prevalence of early dislocation was 4.6 % ( 3 of 65 ) . There was one patient with an anterior dislocation and two with posterior dislocation . No patient underwent reoperation for dislocation . There was no dislocation in the 10 hips that had a 40 mm head . We identified no complications related to the larger femoral heads . The use of larger femoral heads did not notably reduce the prevalence of early dislocation after primary THA in high risk patients compared to historical controls . Therapeutic study : Level IV , case series . See Guidelines for Authors for a complete description of levels of evidence
Patients in the unrestricted group resumed activities significantly faster and were more satisfied with their pace of recovery .
Conclusion : A more liberal lifestyle restrictions and pre caution s protocol will not lead to worse dislocation rates after total hip arthroplasty , but will lead to earlier and better resumption of activities and higher patient satisfaction .
These results appear to hold up for various surgical approaches
Objective : A systematic literature review and meta- analysis on the effectiveness of lifestyle restrictions and pre caution s to prevent dislocation after total hip arthroplasty .