Document Detail

Hip dislocation: are hip precautions necessary in anterior approaches?
MedLine Citation:
PMID:  21076896     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In 2005, we reported removal of functional restriction after primary THA performed through the anterolateral approach did not increase the incidence of dislocation.
QUESTIONS/PURPOSES: To develop a current practice guideline, we evaluated the incidence of early dislocation after primary THA after implementation of a no-restriction protocol.
METHODS: Between January 2005 and December 2007, 2532 patients (2764 hips; 1541 women, 1223 men; mean age, 63.2 years [28-98 years]) underwent primary THA at our institution. Bilateral THA was performed in 232 patients (464 hips). The direct anterior or anterolateral approach was used in all patients. Femoral head size was 28, 32, or 36 mm. Patients were given no traditional functional restrictions postoperatively, such as use of elevated seats, abduction pillows, and restriction from driving. All patients received standard care at the judgment of the attending surgeon. One hundred forty-six patients missed followup appointments despite efforts to be contacted by telephone. The remaining 2386 of 2532 patients (94%) had a minimum followup of 6 months (mean, 14.2 months; range, 6-34 months).
RESULTS: Four known dislocations occurred in the followed cohort of 2386 patients with 2612 hips (0.15%) at a mean of 5 days (3-12 days) postoperatively, none related to high-impact trauma. One dislocation occurred in a patient with a history of developmental dysplasia of the hip, two dislocations occurred while at the toilet (one with a previous hip fracture treated with a modular system), and one dislocation was idiopathic.
CONCLUSIONS: We confirmed a low incidence of dislocation after primary THA in the absence of early postoperative restrictions. We conclude a no-restriction protocol does not increase the incidence of early dislocation after primary THA.
LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Camilo Restrepo; S M Javad Mortazavi; Justin Brothers; Javad Parvizi; Richard H Rothman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-11     Completed Date:  2011-02-24     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  417-22     Citation Subset:  AIM; IM    
The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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MeSH Terms
Aged, 80 and over
Arthroplasty, Replacement, Hip / methods*
Hip Dislocation / surgery*
Hip Joint / physiology,  surgery*
Middle Aged
Pennsylvania / epidemiology
Postoperative Care
Postoperative Complications / epidemiology,  prevention & control*
Range of Motion, Articular
Recovery of Function

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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