Hip replacement patients who do not receive the traditional warnings about post-operative movement and activities are no more likely to have a dislocation after surgery than those who do, according to new published research by the Getting It Right First Time (GIRFT) team.
Rehabilitation precautions once routinely issued to primary total hip arthroplasty (THA, or hip replacement) patients include advice not to bend the leg at the hip past 90 degrees or to twist more than 20 degrees while recovering from surgery. However, recent studies have failed to identify any evidence to suggest such precautions either reduce dislocation rates or improve patient outcomes, and orthopaedic teams have begun to stop issuing such advice and the package of equipment and therapist support associated with it.
GIRFT’s research team* reviewed the records of almost 230,000 patients who had primary THA** in England between 2011 and 2019 for the new study, published in The Journal of Arthroplasty. Of the 230,000, 1,800 (c.0.8%) had dislocations within six months of surgery. In hospitals where the traditional precautions were stopped, the dislocation rate was 0.8% both before and after the decision to stop.
Among the same group, the average length of time patients stayed in hospital (length of stay, or LoS) reduced from four days to three and there was no increase in the rate of emergency readmissions in the first month after surgery.
In 2019, 66% of patients were operated on at hospitals where hip precautions were still used. It is estimated that if precautions had been stopped in all hospitals in England that year, the potential saving to the NHS from fewer bed days, staffing and equipment could have been more than £25m.
With no evidence of an increase in dislocation or 30-day emergency readmission rates after stopping post-operative hip precautions, the study concludes that the benefits of stopping – reduced LoS, reduced risk of hospital-acquired infection, reduced costs and improved bed usage – can support orthopaedic teams to address the waiting list backlog resulting from the COVID-19 pandemic.
This study provides evidence to support the GIRFT high-volume low complexity (HVLC) elective total primary hip replacement pathway, which does not include post-operative hip precautions as part of an enhanced recovery.
*GIRFT’s team included litigation clinical lead John Machin, senior research associate William Gray and GIRFT Chair Professor Tim Briggs, alongside Ally Roberts and Louise Kenworthy of East Suffolk and North Essex NHS Foundation Trust, and Andrew Manktelow of Nottingham University Hospitals NHS Trust.
**The research team focused on primary total hip replacements only, not complex or revision surgery.