Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients

Abstract

Background and purpose — Hip precautions limiting flexion, adduction, and internal rotation have been prescribed traditionally to minimize dislocation rates following THA. We assessed the prevalence of hip dislocation following pos- terior approach total hip arthroplasty without postoperative hip precautions.

Methods — A systematic review of multiple medical databases was performed using the PRISMA guidelines and checklist. All clinical outcome studies that reported disloca- tion rates and postoperative instructions following posterior approach, primary surgery, published within the last 6 years, were included.

Results — 6,900 patients were included from 7 Level I– IV studies, with 3,517 treated with and 3,383 without pre- cautions. There was no statistically significant difference in the rates of dislocation between groups (2.2% in restricted group vs. 2.0% in unrestricted group). All but 1 study dem- onstrated no statistically significant differences in patient- reported outcome scores between restricted and unrestricted groups, including those pertaining to return to function, con- fidence, and pain.

Interpretation — The review found no impact on dis- location rates following total hip arthroplasty performed through a posterior approach, regardless of the use of hip precautions. We also found no impact of the prescription of hip precautions on patient-reported outcome scores.