Hemiarthroplasty for hip fracture: Are post-operative hip precautions necessary?

Purpose

The purpose of patients being asked to follow post-operative 'hip precautions' is to restrict range of movement at the hip joint in order to reduce the risk of dislocation.

There has been increasing recent evidence in literature to suggest that these hip precautions may not be required following hip surgery.

Following discussion and consideration of the evidence available, all orthopaedic surgeons at our Orthopaedic Trauma unit agreed to discontinue the implementation of these hip precautions for all patients undergoing trauma hip hemiarthroplasty; and jointly signed a paper informing of this decision.

The aim of this study was therefore to assess any effects of this change upon the post-operative dislocation rate for this patient group.

Approach

Relevant data was retrospectively retrieved for the last 100 patients receiving hemiarthroplasty for a hip fracture prior to the change of practice; and then for the initial 100 patients who were not asked to follow the precautions.

Hip dislocation rate was calculated at 12 weeks, and one year, post-operatively.

Outcomes

There were no cases of hip dislocation in either group of patients - both at the 12 week and one year post-operative timescales.

There was no increase in hip dislocation rate following the decision to cease the use of post-operative hip precautions for this patient group.

This study therefore further confirms that restrictive precautions are not routinely required following surgical management of a hip fracture with hemiarthroplasty.

Implications

Results have been shared for reference within our Orthopaedic directorate, with the conclusion that the change of practice will continue at our hospital site. Subsequently, this information has informed a change of practice at the other acute hospital that manages Orthopaedic Trauma within our Trust.

Discussions are currently ongoing regarding a potential trial of also discontinuing the use of hip precautions for patients receiving full total hip replacement for management of their hip fracture.

Fund acknowledgements

There were no funding implications to completion of this project.

Additional notes

This work was presented at Physiotherapy UK 2019

Please see the attached Innovations poster below.