Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
J Arthroplasty. 2018 Oct;33(10):3201-3205. doi: 10.1016/j.arth.2018.05.043. Epub 2018 Jun 6.
A traditional method to reduce dislocation risk following total hip arthroplasty involves prescribing postoperative precautions and ambulatory equipment to patients. The purpose of this study was to determine the prevalence of postoperative precaution and equipment use among North American arthroplasty surgeons for patients undergoing primary total hip arthroplasty.
We conducted a survey of American Association of Hip and Knee Surgeons and Canadian Arthroplasty Society members using an electronic questionnaire format to determine how often precautions and equipment were prescribed, and whether their use was associated with surgical approach and other surgeon demographics.
Of the respondents, 44% universally prescribed precautions while 33% never prescribed precautions. Use of the posterolateral approach, surgeon experience, and larger head size use were significantly associated (P < .01) with precaution and equipment use. Direct anterior approach surgeons were significantly less likely to prescribe precautions (P < .0001) and significantly less likely to prescribe equipment (P < .0001).
Although postoperative precautions continue to be used to some degree by the majority of members, their consumption of healthcare resources through utilization of additional care providers and purchasing of equipment, known association with reduced patient satisfaction, and lack of supporting evidence make them a target for future scrutiny.
为降低全髋关节置换术后脱位风险,传统方法是向患者开具术后注意事项和助行器具处方。本研究旨在确定北美关节置换外科医生在为行初次全髋关节置换术的患者开具术后注意事项和使用助行器具的情况。
我们采用电子问卷形式对美国髋关节和膝关节外科医师协会及加拿大关节置换协会成员进行了调查,以确定他们开具注意事项和器具处方的频率,以及这些使用是否与手术入路和其他外科医生特征有关。
在回答问题的外科医生中,44%的医生普遍开具注意事项,33%的医生从不开具注意事项。后外侧入路、医生经验和使用大头假体与开具注意事项和使用器具显著相关(P <.01)。直接前入路外科医生开具注意事项的可能性显著降低(P <.0001),开具器具的可能性也显著降低(P <.0001)。
尽管大多数医生在某种程度上仍继续使用术后注意事项,但通过使用额外的医护提供者和购买设备来消耗医疗资源,已知这会降低患者满意度,且缺乏支持证据,这使得它们成为未来审查的目标。