Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Department of Orthopaedics, Nottingham University Hospitals NHS Trust - City Hospital, Nottingham, UK.
Disabil Rehabil. 2021 Oct;43(20):2882-2889. doi: 10.1080/09638288.2020.1721575. Epub 2020 Feb 23.
To evaluate the effect of hip precautions following total hip replacement (THR) by comparing outcomes of patients who received hip precautions with those who did not.
Before (phase 1) and after (phase 2) study with two consecutive cohorts of patients. In phase 1, patients were strictly educated about hip precautions. In phase 2, patients were not advised about precautions but encouraged to move as able. The primary outcome was the Oxford Hip Score (measuring pain and function) at three months. Secondary outcomes included Oxford Hip Score, activities of daily living (ADLs) (Nottingham Extended Activities of Daily Living), sleep (Pittsburgh Sleep Quality Index), mood (Hospital Anxiety and Depression Scale), and quality of life (QoL) (EQ-5 D).
A total 237 participants successfully underwent THR surgery, 118 participants in phase 1 and 119 in phase 2. At three months postoperatively, participants had significantly equivalent Oxford Hip Scores (MD= -0.82, 95% CI: -2.64 to 1.00). No significant differences between the groups were observed at six weeks and three months postoperatively for secondary outcomes.
Patients recovered at a similar rate regardless of whether they received hip precautions or not, with no increase in complications observed. The findings lend evidence to support decision-making around the removal of precautions.Implications for rehabilitationThe use of no hip precautions resulted in no additional benefit following primary total hip replacement surgery in terms of functional recovery.Patients who were not prescribed precautions had significantly less pain and greater function during the first week after surgery.Total hip replacement patients had similar outcomes at six weeks and three months postoperatively regardless of whether they received hip precautions or not.The study provides evidence to suggest that hip precautions may not be needed routinely following elective primary total hip replacement.
通过比较接受髋关节预防措施和未接受髋关节预防措施的患者的结果，评估全髋关节置换（THR）后髋关节预防措施的效果。
在有两个连续患者队列的研究之前（第 1 阶段）和之后（第 2 阶段）进行。在第 1 阶段，患者接受了严格的髋关节预防措施教育。在第 2 阶段，患者没有接受预防措施的建议，但鼓励他们尽可能移动。主要结果是三个月时的牛津髋关节评分（测量疼痛和功能）。次要结果包括牛津髋关节评分、日常生活活动（诺丁汉扩展日常生活活动）、睡眠（匹兹堡睡眠质量指数）、情绪（医院焦虑和抑郁量表）和生活质量（EQ-5D）。
共有 237 名参与者成功接受了 THR 手术，其中第 1 阶段 118 名，第 2 阶段 119 名。术后三个月，两组参与者的牛津髋关节评分相当（MD=-0.82，95%CI：-2.64 至 1.00）。在术后六周和三个月时，两组之间没有观察到次要结果的显著差异。
无论是否接受髋关节预防措施，患者的恢复速度相似，没有观察到并发症增加。研究结果为支持围绕去除预防措施的决策提供了证据。
在初次全髋关节置换手术后，不使用髋关节预防措施不会对功能恢复有额外益处。
未接受预防措施的患者在手术后第一周疼痛明显减轻，功能明显增强。
无论是否接受髋关节预防措施，患者在术后六周和三个月时的结果相似。
该研究提供了证据表明，在选择性初次全髋关节置换术后，髋关节预防措施可能不需要常规使用。
