Are Postop Precautions Necessary for THA Patients?
Avoiding the typical post-surgical precautions after total hip arthroplasty (THA) — such as avoiding bending the hip past 90 degrees, turning the knee or foot inward, and crossing the leg past the middle of the body — may lead to shorter inpatient rehabilitation time and faster overall recovery.
That’s the conclusion of a study from the Marianjoy Rehabilitation Hospital in Wheaton, Illinois, which was presented at the recent annual meeting of the Association of Academic Physiatrists.
“We noticed postoperative hip precautions were being dictated by the surgeon’s preference rather than the operative technique,” said Noel Rao, MD, FAAPM, professor and chairman at Rosalind Franklin University of Medicine and Science and lead study investigator.
“Furthermore, surgeons using the same approach in the same surgical group varied on whether they placed patients under restrictions. Some did and some did not, which raised the question: What would be the impact of not having restrictions on hip dislocation rates and length of stay using the anterior surgical method?
“If reduced restrictions do not increase hip dislocation rates and patients have a shorter length of stay, they could be rehabilitated and reintegrated into the community sooner,” Dr. Rao said.
The researchers examined the medical records of 68 patients who underwent THA through the direct anterior approach and noted their functional independence measures (FIM) at admission, daily during their stay, and at discharge, as well as length of stay (LOS) and discharge disposition.
Thirty-one patients were admitted to inpatient rehabilitation without postoperative surgical precautions and 37 were admitted with precautions. The 2 groups were similar in age (average age 67 years) and both groups had similar FIM scores when admitted.
At the time of discharge, both groups had made similar progress in their overall FIM scores and their daily FIM improvements, but differed in LOS. The group who entered rehabilitation without postoperative precautions were typically discharged from the rehabilitation hospital 3 days sooner than those those who observed precautions (9 days and 12 days, respectively).
Ultimately, this translated to improved FIM efficiency for the non-precautions group compared with the precautions group. The non-precautions group also did significantly better in daily motor FIM and overall FIM gains.
“While both groups made similar overall progress during inpatient rehabilitation, the group that did not observe postoperative precautions made gains within a shorter timeframe as they did not have restrictions to follow and therefore did not have to spend time learning and consistently demonstrating hip precautions, which takes some time to accomplish,” Dr. Rao said of the findings.
“The absence of restrictions allowed these patients to improve their FIM scores quicker, resulting in a shorter length of hospital stay. Additionally, we anecdotally observed that reduced restrictions do not increase hip dislocation rates.”
Based on this study, Dr. Rao said healthcare professionals should not be overly concerned about using hip precautions after a direct anterior approach THA if the operating surgeon has made a clinical determination that the patient doesn’t need such precautions.
“With newer surgical techniques and improved expertise of surgeons, more patients are being discharged home directly following this procedure. This is more evident in patients not requiring hip precautions than in patients who have restrictions,” Dr. Rao said
“If this trend continues, we may want to look at expanding our existing outpatient therapy programs to accommodate more of these patients.”
Rao N, Aliga N, Devara D, Brady S, McKittrick M, Mroz M. Comparative inpatient rehabilitation outcomes of anterior total hip arthroplasty: with and without post-operative surgical precautions. Presented at the Association of Academic Physiatrists Annual Meeting, February 7-11, 2017, Las Vegas, Nevada.