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The Role of Patient Restrictions in Reducing the Prevalence of Early Dislocation Following Total Hip Arthroplasty

A Randomized, Prospective Study

¹ Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi: parvj{at}aol.com

Investigation performed at the Department of Orthopaedic Surgery, the Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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Methods: We performed a prospective, randomized study to evaluate the role of postoperative functional restrictions on the prevalence of dislocation following uncemented total hip arthroplasty through an anterolateral approach. Of the 630 eligible consecutive patients, 265 patients (303 hips) consented to be randomized into one of two groups (the "restricted" group or the "unrestricted" group). The patients in both groups were asked to limit the range of motion of the hip to <90° of flexion and 45° of external and internal rotation and to avoid adduction for the first six weeks after the procedure. The patients in the restricted group were instructed to comply with additional hip precautions during the first six weeks postoperatively. Specifically, these patients were managed with the placement of an abduction pillow in the operating room before bed transfer and used pillows to maintain abduction while in bed; used elevated toilet seats and elevated chairs in the hospital, in the rehabilitation facility, and at home; and were prevented from sleeping on the side, from driving, and from being a passenger in an automobile. All patients were followed for a minimum of six months postoperatively.

Results: There was one dislocation in the entire cohort (prevalence, 0.33%). This dislocation occurred in a patient in the restricted group during transfer from the operating table to a bed with an abduction pillow in place. Patients in the unrestricted group were found to return to side-sleeping sooner (p < 0.001), to ride in automobiles more often (p < 0.026), to drive automobiles more often (p < 0.001), to return to work sooner (p < 0.001), and to have a higher level of satisfaction with the pace of their recovery (p < 0.001) than those in the restricted group. There was an additional expenditure of approximately $655 per patient in the restricted group.

Conclusions: Total hip arthroplasty through an anterolateral approach is likely to be associated with a low dislocation rate. Removal of several restrictions did not increase the prevalence of dislocation following primary hip arthroplasty at our institution. However, it did promote substantially lower costs and was associated with a higher level of patient satisfaction as patients achieved a faster return to daily functions in the early postoperative period.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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