Barnsley Lara, Barnsley Leslie, Page Richard
Orthopaedic Department Geelong Hospital Barwon Health, Geelong, Victoria, Australia.
Rheumatology Department Concord Repatriation General Hospital, Concord, New South Wales, Australia.
Geriatr Orthop Surg Rehabil. 2015 Sep;6(3):230-5. doi: 10.1177/2151458515584640.
Total hip arthroplasty (THA) is a common and effective treatment of hip osteoarthritis. Activity restrictions known as hip precautions are widely practiced in rehabilitation post THA, aiming to foster healing and prevent hip dislocation. The focused clinical question was: Does the application of hip precautions in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation?
A comprehensive literature search was conducted for randomized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up, with dislocation as an end point. Retrieved titles were assessed independently by 2 reviewers for inclusion and underwent standardized data extraction.
Title search produced 80 potentially relevant articles. Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria. No eligible studies were found that concerned posterior approaches to hip arthroplasty, so the results of this review concern only anterolateral approaches. Neither included study showed any benefit of hip precautions in preventing dislocation.
The rate of dislocation after anterolateral THA is low and is not improved by hip precautions. Hip precautions are associated with a slower return to activities, significant expense, and decreased patient satisfaction. Existing studies risk being compromised by a type II error, but a definitive study may be prohibitively large and expensive.
全髋关节置换术（THA）是治疗髋关节骨关节炎的一种常见且有效的方法。在THA术后康复中广泛实行的称为髋关节预防措施的活动限制，旨在促进愈合并防止髋关节脱位。重点临床问题是：与无限制活动相比，THA术后患者应用髋关节预防措施是否能显著降低假体脱位风险？
对随机对照试验或有比较组且随访至少6个月、以脱位为终点的队列研究进行全面文献检索。检索到的标题由2名评审员独立评估是否纳入，并进行标准化数据提取。
标题检索产生了80篇潜在相关文章。检索出5篇文章进行数据提取，其中2篇符合预先设定的纳入标准。未找到关于髋关节置换术后路手术的符合条件的研究，因此本综述结果仅涉及前外侧入路。两项纳入研究均未显示髋关节预防措施在预防脱位方面有任何益处。
前外侧THA术后脱位率较低，髋关节预防措施并不能改善这一情况。髋关节预防措施与活动恢复较慢、费用高昂以及患者满意度降低相关。现有研究存在II类错误的风险，但一项确定性研究可能规模过大且成本过高。
