Varying but reduced use of postoperative mobilization restrictions after primary total hip arthroplasty in Nordic countries: a questionnaire-based study

Kirill Gromov; Anders Troelsen; Maziar Modaddes; Ola Rolfson; Ove Furnes; Geir Hallan; Antti Eskelinen; Perttu Neuvonen; Henrik Husted

doi:10.1080/17453674.2019.1572291

Authors

Kirill Gromov Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark; Danish Hip Arthroplasty Registry
Anders Troelsen Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark
Maziar Modaddes Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register
Ola Rolfson Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register
Ove Furnes The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
Geir Hallan The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
Antti Eskelinen Coxa Hospital for Joint Replacement, and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Finnish Hip Arthroplasty Registry
Perttu Neuvonen Coxa Hospital for Joint Replacement, and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Finnish Hip Arthroplasty Registry
Henrik Husted Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark

DOI:

https://doi.org/10.1080/17453674.2019.1572291

Abstract

Background and purpose — Mobilization has traditionally been restricted following total hip arthroplasty (THA) in an attempt to reduce the risk of dislocation and muscle detachment. However, recent studies have questioned the effect and rationale underlying such restrictions. We investigated the use of postoperative restrictions and possible differences in mobilization protocols following primary THA in Denmark (DK), Finland (FIN), Norway (NO), and Sweden (SWE).

Patients and methods — All hospitals performing primary THA in the participating countries were identified from the latest national THA registry report. A questionnaire containing questions regarding standard surgical procedure, use of restrictions, and postoperative mobilization protocol was distributed to all hospitals through national representatives for each arthroplasty registry.

Results — 83% to 94% (n = 167) of the 199 hospitals performing THA in DK, FIN, NO, and SWE returned correctly filled out questionnaires. A posterolateral approach was used by 77% of the hospitals. 92% of the hospitals had a standardized mobilization protocol. 50%, 41%, 19%, and 38% of the hospitals in DK, FIN, NO, and SWE, respectively, did not have any postoperative restrictions. If utilized, restrictions were applied for a median of 6 weeks. Two-thirds of all hospitals have changed their mobilization protocol within the last 5 years—all but 2 to a less restrictive protocol.

Interpretation — Use of postoperative restrictions following primary THA differs between the Nordic countries, with 19% to 50% allowing mobilization without any restrictions. There has been a strong tendency towards less restrictive mobilization over the last 5 years.