For years, the anterior approach for hip replacements has been preferred by orthopedic surgeries to avoid the strict precautions associated with the posterior approach.
But recent evidence has shown that posterior hip precautions may not be as serious with the latest advancements in surgery.
In this article, I’ll discuss how minimal hip precautions can be discussed with patients for both physical and occupational therapy.
New posterior hip protocol for PT and OT
In this new study, Dr Sulco explains “Minimizing precautions and simplifying the postoperative recovery is part of the larger simplification of surgery where we are using more selected resources and interventions for people, instead of blanketing everyone with the same kind of protocols.”
These new hip guidelines are probably not for everyone, especially those who are at risk dislocation (Read below). But the majority of your patients should be able to skip hip precautions and avoid extreme positions such as bending more than 90 degrees in combination with internal rotation.
Exercise caution with these new guidelines provided below.
Standard Hip Precautions vs Minimal Hip Precautions
As per evidence based practice, the reasons why minimal posterior hip precautions can be used are:
- Current “standard” posterior hip precautions are based on precautions from 25 years ago.
- The current quality of soft tissue repair and closure is now much more robust than in years past. (repair of the posterior capsule & external rotator muscle repair)
- There are now many surgeons with extensive experience in posterior hip replacements. Evidence shows that experienced surgeons (> 15 years) have decreased dislocation rates.
- There is now more common use of larger diameter femoral heads > 28 mm.
- There is concern related to standard precautions causing patient fear, sleep dissatisfaction, & these patients tend to be less active, which can hamper recovery.
Minimal Precautions have shown same or less dislocation rates in patients without risk factors.
Risk Factors that increase rate of dislocation
Patient Factors
- Age
- Gender (Female higher risk)
- BMI greater than 30
- prior hip surgery
- Diagnoses of Avascular necrosis, acute fracture, or non-union fractures, & inflammatory arthritis
Surgeon Factors
- Surgeons with < 15 years experience
- Surgeons that see low volume of posterior THA patients
- Femoral head size (some research states no effect of femoral head diameter)
Conclusion
As you can see, these new hip precautions are not for everyone. It’s best to have a conversation with your surgeon to see what he or she thinks about implementing this program.
You can find a link to the article here.
David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.
