Question for Physiotherapists

Posterior Approach
Posterior hip precautions include limitation of flexion beyond 90°, limitation of internal rotation in flexion, avoiding crossing legs, and avoiding lying on your side post operatively. A recent large systematic review by Crompton et al¹ of 6900 patients showed no difference in dislocation rate after posterior THR in patients using no precautions versus standard precautions. Interestingly there was also no difference in patient reported outcomes in either group, implying use of you precautions does not affect post-operative rehabilitation. Preliminary results of a randomised controlled by Treteault et al² trial in the Journal of Arthroplasty also show no difference in dislocation rate.

Anterolateral approach
Standard hip precautions following an anterolateral approach involve avoiding external rotation of the hip, crossing legs and avoidance of hyperextension. A recent systematic review by Barnsley et al³ has shown no benefit with the use of precautions on dislocation rate following anterolateral approach for THR. A separate study also noted no deleterious effects on post-operative rehab or recovery when using hip precautions. This approach is commonly used for hemiarthroplasty for fracture due to its lower dislocation rate.

Summary
The use of hip precautions should always be guided by the operative surgeon. Emerging evidence shows the need for precautions may not be necessary, however there is no evidence that they adversely affect patients rehabilitation or recovery following total hip arthroplasty.

I offer total hip replacement via direct anterior approach to selected patients based on their degree of deformity, previous surgeries and body habitus. For complex primary hip replacements and patients with high BMI, I perform my total hip replacements via a posterior approach.

Dr Christopher Spelman