Postoperative Hip Precautions for Osteoarthritis

Overseen By Brett Levine, MD,MS.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Rush University Medical Center

Disqualifiers: Allergy, Previous surgeries, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether certain hip precautions after hip replacement surgery help prevent hip dislocation and improve recovery. Participants will be divided into two groups: one group will follow specific precautions, such as avoiding excessive hip bending or crossing legs, while the other group will have no such restrictions. The study aims to determine if these precautions affect the speed of returning to daily activities and satisfaction with recovery. Individuals with noninflammatory arthritis undergoing their first hip replacement may be suitable for this study. As an unphased trial, it offers participants the chance to contribute to valuable research that could enhance recovery protocols for future patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

What prior data suggests that these hip precautions are safe for postoperative patients?

Research shows that hip precautions after hip replacement surgery might not be necessary to prevent dislocations. Studies have found no significant difference in dislocation rates whether these precautions are followed or not. Thus, avoiding actions like excessive bending of the hip or crossing the legs might not increase the risk of dislocation.

Some research also suggests that omitting these precautions can help patients resume daily activities more quickly and feel more satisfied after surgery. While some doctors still recommend these precautions for the first six weeks, recent studies question their necessity.

Regarding safety, no strong evidence indicates that skipping these precautions is harmful. The decision to use them appears more rooted in tradition than in clear safety concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it challenges the traditional approach to postoperative hip care. Typically, after hip surgery due to osteoarthritis, patients follow strict precautions like avoiding bending the hip past 90º, not crossing their legs, and avoiding twisting at the waist. This trial is exploring whether skipping these restrictions leads to similar recovery outcomes. If successful, it could simplify recovery by eliminating these precautions, potentially making the healing process more comfortable and less restrictive for patients.

What evidence suggests that this trial's treatments could be effective for osteoarthritis?

Research has shown that hip precautions after hip replacement surgery might not be necessary to prevent dislocations. In this trial, some participants will receive hip precautions, while others will not. Studies have found no significant difference in dislocation rates between patients who follow these precautions and those who do not. Skipping these restrictions could help patients return to their daily activities faster and increase satisfaction. Additionally, avoiding hip precautions might save time and money. These findings suggest that not using hip precautions could be just as effective and more beneficial for recovery. ^{1 2 3 6 7}

Who Is on the Research Team?

Omar Behery, MD

Principal Investigator

Orthopedics Surgeon

Are You a Good Fit for This Trial?

This trial is for patients with noninflammatory arthritis who are having their first total hip replacement through the posterior approach. They must understand and follow study procedures but can't join if they have allergies to materials used in the study or previous major surgeries on the affected joint.

Inclusion Criteria

Patients must be able to understand and comply with study procedures

I am having my first total hip replacement surgery through the back of the hip by a surgeon from this hospital.

My arthritis is not caused by inflammation.

Exclusion Criteria

I have had surgery on the affected joint, but only arthroscopy.

Allergy or intolerance to the study materials

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo total hip arthroplasty and are assigned to either receive or not receive hip precautions for the first six weeks after surgery

6 weeks

Follow-up

Participants are monitored for dislocation, use of assistive devices, and return to activities of daily living

1 year

What Are the Treatments Tested in This Trial?

Interventions

• Hip Precautions
• No Hip Precautions

Trial Overview The study is testing whether following 'hip precautions' after a hip replacement surgery affects dislocation rates, recovery of daily activities, patient satisfaction, and cost-effectiveness compared to not using these precautions.

How Is the Trial Designed?

Group I: No Hip Precautions Experimental Treatment 1 Intervention

Patients will not be prescribed hip precautions in the first 6 weeks after surgery. The hip precautions that will no longer be prescribed are: no hip flexion past 90º, no crossing the legs, and no twisting at the waist.

Group II: Hip Precautions Active Control 1 Intervention

Patients will receive the following hip precautions: no hip flexion past 90º, no crossing the legs, and no twisting at the waist for the first six weeks after surgery.

Who Is Running the Clinical Trial?

Rush University Medical Center

Lead Sponsor

Trials

448

Recruited

247,000+

Published Research Related to This Trial

A study involving interviews with 14 surgeons and 18 therapists revealed that while some clinicians continue to recommend hip precautions after total hip arthroplasty to prevent dislocation, others have stopped due to concerns about negative impacts on patients and a lack of evidence supporting their effectiveness.

The findings suggest that the use of hip precautions is controversial, and there is a need for individualized rehabilitation strategies that consider patient-specific risk factors for dislocation, as well as the evolving practices in surgical techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hip precautions after primary total hip arthroplasty: a qualitative exploration of clinical reasoning. Mandel, RT., Bruce, G., Moss, R., et al.[2022]

A systematic review of 9 studies involving 8,835 participants found no significant difference in the risk of early hip dislocations after total hip arthroplasty (THA) between patients who followed hip precautions and those who did not.

The evidence suggests that routinely prescribing hip precautions post-surgery may not be necessary, as they could slightly reduce functional performance without significantly preventing dislocations, indicating a need for higher-quality studies to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Korfitsen, CB., Mikkelsen, LR., Mikkelsen, ML., et al.[2023]

In a study of 346 patients who underwent posterior total hip arthroplasty (THA), eliminating hip precautions did not increase the dislocation rate, with 0% dislocation in the no precaution group compared to 2.29% in the precaution group.

All dislocations occurred in the hip precaution group, and there were no significant differences in patient-reported outcomes at 2, 6, or 12 weeks, suggesting that hip precautions may not be necessary for patients achieving specific intraoperative stability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patients Achieving 90°/45°/0° Intraoperative Stability Do Not Require Hip Precautions Following Posterior Approach Total Hip Arthroplasty: A Prospective Randomized Study. Mounts, MR., Turner, RA., Patel, NB., et al.[2022]

In a study involving 313 patients who underwent total hip arthroplasty, not using hip precautions post-surgery did not lead to better recovery outcomes compared to standard precautions, except for a lower HOOS Jr score at 2 weeks.

The rate of dislocations was similar between the two groups, with 1.3% in the standard hip precautions group and 0.7% in the no hip precautions group, indicating that eliminating precautions did not increase dislocation risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Posterior Hip Precautions Do Not Impact Early Recovery in Total Hip Arthroplasty: A Multicenter, Randomized, Controlled Study. Dietz, MJ., Klein, AE., Lindsey, BA., et al.[2020]

Patients who received hip precautions after total hip replacement had mixed feelings; some found them restrictive while others felt reassured, indicating a psychological impact on recovery.

Those without hip precautions experienced less anxiety about dislocation but lacked guidance on safe rehabilitation, suggesting that while precautions may increase fear, clear instructions are essential for recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hip precautions after total hip replacement and their discontinuation from practice: patient perceptions and experiences. Lightfoot, CJ., Coole, C., Sehat, KR., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4536510/

Are Hip Precautions Necessary Post Total Hip Arthroplasty ... Hip precautions are associated with a slower return to activities, significant expense, and decreased patient satisfaction. Existing studies risk being ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT02686528

NCT02686528 | Postoperative Hip Precautions After Total ... The purpose of this study is to determine if hip precautions, which are instructions that limit functional use of a hip replacement after surgery, affect the ...

3. actaorthop.org actaorthop.org/actao/article/view/11958

Hip precautions after posterior-approach total ... The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA to prevent hip dislocations.

4. journals.lww.com journals.lww.com/md-journal/fulltext/2024/12130/no_need_for_hip_precautions_after_total_hip.62.aspx

No need for hip precautions after total hip arthroplasty... This meta-analysis showed that there was no statistically significant difference in hip dislocation rates with or without HP after THA ...

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0883540320301625

Are Postoperative Hip Precautions Necessary After Primary ... Power analysis showed that 579 hips per group are needed to demonstrate an increase in dislocation rate from 0.5% to 2.5% with 80% power.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10626929/

Rehabilitation Phases, Precautions, and Mobility Goals ... Most surgeons recommend maintaining hip precautions for the first 6 weeks following THA, while about 10% of surgeons recommend them for 12 weeks [37].

7. journals.sagepub.com journals.sagepub.com/doi/10.1177/22104917251336772

A scoping review on the recommendations of hip ... Recent studies suggest that removing post-total hip arthroplasty precautions may not increase dislocation risk but can improve functionality ...