Hip dislocation: are hip precautions necessary in anterior approaches?

Abstract

Background: In 2005, we reported removal of functional restriction after primary THA performed through the anterolateral approach did not increase the incidence of dislocation.

Questions/purposes: To develop a current practice guideline, we evaluated the incidence of early dislocation after primary THA after implementation of a no-restriction protocol.

Methods: Between January 2005 and December 2007, 2532 patients (2764 hips; 1541 women, 1223 men; mean age, 63.2 years [28-98 years]) underwent primary THA at our institution. Bilateral THA was performed in 232 patients (464 hips). The direct anterior or anterolateral approach was used in all patients. Femoral head size was 28, 32, or 36 mm. Patients were given no traditional functional restrictions postoperatively, such as use of elevated seats, abduction pillows, and restriction from driving. All patients received standard care at the judgment of the attending surgeon. One hundred forty-six patients missed followup appointments despite efforts to be contacted by telephone. The remaining 2386 of 2532 patients (94%) had a minimum followup of 6 months (mean, 14.2 months; range, 6-34 months).

Results: Four known dislocations occurred in the followed cohort of 2386 patients with 2612 hips (0.15%) at a mean of 5 days (3-12 days) postoperatively, none related to high-impact trauma. One dislocation occurred in a patient with a history of developmental dysplasia of the hip, two dislocations occurred while at the toilet (one with a previous hip fracture treated with a modular system), and one dislocation was idiopathic.

Conclusions: We confirmed a low incidence of dislocation after primary THA in the absence of early postoperative restrictions. We conclude a no-restriction protocol does not increase the incidence of early dislocation after primary THA.

Level of evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.