Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Authors

  • Christoffer B Korfitsen Danish Health Authority, Evidence-based Medicine, Copenhagen; Cochrane Denmark & Centre for Evidence-Based Medicine Odense (CEBMO), Department of Clinical Research, University of Southern Denmark; Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense https://orcid.org/0000-0003-2159-7662
  • Lone R Mikkelsen Department of Clinical Medicine, Aarhus University; Elective Surgery Centre, Silkeborg Regional Hospital https://orcid.org/0000-0003-3540-7874
  • Marie-Louise Mikkelsen Danish Health Authority, Evidence-based Medicine, Copenhagen
  • Jeanett F Rohde Danish Health Authority, Evidence-based Medicine, Copenhagen; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Capital Region, Frederiksberg
  • Pætur M Holm The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse- Ringsted Hospitals; The Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark
  • Simon Tarp Danish Health Authority, Evidence-based Medicine, Copenhagen https://orcid.org/0000-0001-5254-6580
  • Holger-Henning F Carlsen Særslev Medical Center, Søndersø
  • Kirsten Birkefoss Danish Health Authority, Evidence-based Medicine, Copenhagen
  • Thomas Jakobsen Department of Orthopaedics, Aalborg University Hospital
  • Erik Poulsen Department of Sports Science and Clinical Biomechanics, University of Southern Denmark https://orcid.org/0000-0002-3837-5452
  • Jane S Leonhardt Department of Orthopedics, Lillebaelt Hospital, Vejle
  • Søren Overgaard Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg; University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences https://orcid.org/0000-0001-6829-4787
  • Inger Mechlenburg Department of Clinical Medicine, Aarhus University; Department of Public Health, Aarhus University; Department of Orthopaedics, Aarhus University Hospital, Denmark https://orcid.org/0000-0001-5432-8691

DOI:

https://doi.org/10.2340/17453674.2023.11958

Keywords:

Hip, Meta-analysis, Movement precautions, Osteoarthritis, Systematic review, Total hip arthroplasty

Abstract

Background and purpose: Hip precautions are routinely prescribed to patients with osteoarthritis to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach. However, recommendations have been based on very low certainty of evidence. We updated the evidence on the influence of hip precautions on early recovery following THA by this systematic review.
Materials and methods: We performed systematic searches for randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL published from 2016 to July 2022. 2 reviewers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analyses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was the risk of hip dislocations within 3 months of surgery. Other outcomes were long-term risk of dislocation and reoperation, self-reported and performance-based assessment of function, quality of life, pain, and time to return to work.
Results: 4 RCTs and 5 NRSs, including 8,835 participants, were included. There may be no or negligible difference in early hip dislocations (RCTs: risk ratio [RR] 1.8, 95% confidence interval [CI] 0.6–5.2; NRS: RR 0.9, CI 0.3–2.5). Certainty in the evidence was low for RCTs and very low for NRSs. Finally, precautions may reduce the performance-based assessment of function slightly, but the evidence was very uncertain. For all other outcomes, no differences were found (moderate to very low certainty evidence).
Conclusion: The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA to prevent hip dislocations. However, the results might change with high-quality studies.

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References

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Published

2023-04-05

How to Cite

Korfitsen, C. B., Mikkelsen, L. R., Mikkelsen, M.-L., Rohde, J. F., Holm, P. M., Tarp, S., Carlsen, H.-H. F., Birkefoss, K., Jakobsen, T., Poulsen, E., Leonhardt, J. S., Overgaard, S., & Mechlenburg, I. (2023). Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthopaedica, 94, 141–151. https://doi.org/10.2340/17453674.2023.11958

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