Royal National Orthopaedic Hospital, Stanmore, UK.
Disabil Rehabil. 2022 Jun;44(12):2842-2848. doi: 10.1080/09638288.2020.1845825. Epub 2020 Nov 21.
Hip precautions are movement restrictions that are often advised following primary total hip arthroplasty (PTHA) for osteoarthritis (OA), but there is limited evidence supporting their effectiveness in preventing dislocation. This study aimed to explore the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA.
Semi-structured interviews were conducted with therapists and surgeons at six centres using precautions and six centres not using precautions across secondary or tertiary NHS sites in England. Interviews were transcribed verbatim and thematically analysed.
Interviews were conducted with fourteen surgeons and eighteen therapists. Of these clinicians, eight surgeons and ten therapists routinely advised precautions. Clinicians continued to use precautions to avoid dislocation by creating a boundary to movement, particularly important when dealing with patients who "push" these boundaries. Clinicians discontinued precautions because of a perceived negative impact on patients and the lack of supporting evidence. In the absence of a rise in dislocation rates for these centres, others have now changed practice.
This study offers insight into the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. The use of precautions remains controversial and further work is required to determine whether or not they should be advised.IMPLICATIONS FOR REHABILITATIONRedesign of future rehabilitation pathways for primary total hip arthroplasty should take into account viewpoints from across the multidisciplinary team to aid decision making.Concern for patient behaviours, dislocation and litigation may be barriers to changing practice for rehabilitation after primary total hip arthroplasty.Clinicians may be discontinuing hip precautions because of known surgical advances, a perceived negative impact on patients and a lack of supporting evidence for historical practice.Individualised rehabilitation considerations are necessary for patients with risk factors that predispose them to dislocation after primary total hip arthroplasty, regardless of whether hip precautions are advised as standard at their given centre.
髋关节预防措施是在原发性全髋关节置换术（PTHA）后常用于治疗骨关节炎（OA）的运动限制，但支持其预防脱位有效性的证据有限。本研究旨在探讨在 OA 接受 PTHA 后继续和停止髋关节预防措施的临床推理。
在英格兰的二级或三级 NHS 站点，在使用预防措施的六个中心和不使用预防措施的六个中心，使用半结构化访谈对治疗师和外科医生进行了调查，调查内容为预防措施和六类预防措施。访谈记录被逐字转录并进行主题分析。
对 14 名外科医生和 18 名治疗师进行了访谈。在这些临床医生中，有 8 名外科医生和 10 名治疗师常规建议使用预防措施。临床医生继续使用预防措施来避免脱位，方法是对运动形成限制，尤其是在处理那些“推动”这些限制的患者时，这一点尤为重要。临床医生停止使用预防措施是因为认为这会对患者产生负面影响，而且缺乏支持证据。在这些中心脱位率没有上升的情况下，其他中心现在已经改变了做法。
本研究深入了解了 OA 接受 PTHA 后继续和停止髋关节预防措施的临床推理。预防措施的使用仍然存在争议，需要进一步研究以确定是否应该建议使用。
在设计原发性全髋关节置换术的康复途径时，应考虑多学科团队的观点，以辅助决策。对患者行为、脱位和诉讼的担忧可能是改变原发性全髋关节置换术后康复实践的障碍。临床医生可能会停止使用髋关节预防措施，原因是已知的手术进展、对患者的负面影响以及对历史实践缺乏支持证据。对于有脱位风险的患者，无论其所在中心是否建议常规使用髋关节预防措施，都需要进行个体化的康复考虑。
