Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 154 No. 1 (2024)

Clinical reasoning for the continuation or discontinuation of hip precautions after total hip arthroplasty in Switzerland: a qualitative study

  • Jaroslaw Krygowski
  • Leah Reicherzer
  • Thimo Marcin
DOI
https://doi.org/10.57187/s.3536
Cite this as:
Swiss Med Wkly. 2024;154:3536
Published
04.01.2024

Summary

BACKGROUND: Growing evidence raises doubts about the need for routine hip precautions after primary total hip replacements to reduce the risk of postoperative dislocation. However, hip precautions are still routinely and widely prescribed in postoperative care in Switzerland. We aimed to investigate experts’ clinical reasoning for hip precaution recommendations after total hip arthroplasty.

METHODS: Using a convenience sampling strategy, 14 semi-structured expert interviews were conducted with surgeons, physiotherapists, and occupational therapists in the vicinity of an inpatient rehabilitation clinic in Switzerland. Data analysis followed Mayring’s principle of inductive and deductive structuring content analysis.

RESULTS: Expert statements from the interviews were summarised into four main categories and 10 subcategories. Categories included statements on the incidences of dislocation and underlying risk factors; current preferences and use of hip precautions; their effect on physical function, anxiety, or costs; and patient’s adherence to the movement restrictions. Hip surgeons routinely prescribed hip precautions, although in different variations. Fear of dislocation and caution are barriers to changing current practice. Some surgeons are considering individualised prescribing based on patients’ risk of dislocation, which therapists would welcome.

CONCLUSION: A lack of clear instructions from the surgeon leads to ambiguity among therapists outside the acute hospital. A shared understanding of the need for and nature of hip precautions, guidelines from societies, or at least specific instructions from surgeons to therapists are warranted.

References

  1. Smith TO, Jepson P, Beswick A, Sands G, Drummond A, Davis ET, et al. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Musculoskeletal Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2016 Jul 4 [cited 2020 Dec 2]; Available from: http://doi.wiley.com/10.1002/14651858.CD010815.pub2 10.1002/14651858.CD010815.pub2 DOI: https://doi.org/10.1002/14651858.CD010815.pub2
  2. Knight SR, Aujla R, Biswas SP. Total Hip Arthroplasty - over 100 years of operative history. Orthop Rev (Pavia). 2011 Sep;3(2):e16. DOI: https://doi.org/10.4081/or.2011.e16
  3. SIRIS Report 2022 Annual Report of the Swiss National Joint Registry, Hip and Knee, 2012-2021.
  4. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007 Oct;370(9597):1508–19. 10.1016/S0140-6736(07)60457-7 DOI: https://doi.org/10.1016/S0140-6736(07)60457-7
  5. van der Weegen W, Kornuijt A, Das D. Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil. 2016 Apr;30(4):329–39. 10.1177/0269215515579421 DOI: https://doi.org/10.1177/0269215515579421
  6. Reimert J, Lockwood KJ, Hau R, Taylor NF. Are hip movement precautions effective in preventing prosthesis dislocation post hip arthroplasty using a posterior surgical approach? A systematic review and meta-analysis. Disabil Rehabil. 2022 Jun;44(12):2560–6. 10.1080/09638288.2020.1845404 DOI: https://doi.org/10.1080/09638288.2020.1845404
  7. Peters A, Ter Weele K, Manning F, Tijink M, Pakvis D, Huis In Het Veld R. Less Postoperative Restrictions Following Total Hip Arthroplasty With Use of a Posterolateral Approach: A Prospective, Randomized, Noninferiority Trial. J Arthroplasty. 2019 Oct;34(10):2415–9. 10.1016/j.arth.2019.05.038 DOI: https://doi.org/10.1016/j.arth.2019.05.038
  8. Allen FC, Skinner DL, Harrison J, Stafford GH. The effect of precautions on early dislocations post total hip arthroplasty: a retrospective cohort study. Hip Int. 2018 Sep;28(5):485–90. 10.1177/1120700018762175 DOI: https://doi.org/10.1177/1120700018762175
  9. Lightfoot CJ, Sehat KR, Coole C, Drury G, Ablewhite J, Drummond AE. Evaluation of hip precautions following total hip replacement: a before and after study. Disabil Rehabil. 2020 Feb;1–8. DOI: https://doi.org/10.1080/09638288.2020.1721575
  10. Tetreault MW, Akram F, Li J, Nam D, Gerlinger TL, Della Valle CJ, et al. Are Postoperative Hip Precautions Necessary After Primary Total Hip Arthroplasty Using a Posterior Approach? Preliminary Results of a Prospective Randomized Trial. J Arthroplasty. 2020 Jun;35(6 6S):S246–51. 10.1016/j.arth.2020.02.019 DOI: https://doi.org/10.1016/j.arth.2020.02.019
  11. Mikkelsen LR, Petersen MK, Søballe K, Mikkelsen S, Mechlenburg I. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. Eur J Phys Rehabil Med. 2014 Aug;50(4):383–93.
  12. Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthop. 2020 Dec;91(6):687–92. 10.1080/17453674.2020.1795598 DOI: https://doi.org/10.1080/17453674.2020.1795598
  13. Lightfoot CJ, Coole C, Sehat KR, Drummond AE. Hip precautions after total hip replacement and their discontinuation from practice: patient perceptions and experiences. Disabil Rehabil. 2020 Feb:1–7. DOI: https://doi.org/10.1080/09638288.2020.1722262
  14. Mandel RT, Bruce G, Moss R, Carrington RW, Gilbert AW. Hip precautions after primary total hip arthroplasty: a qualitative exploration of clinical reasoning. Disabil Rehabil. 2020 Nov;1–7. DOI: https://doi.org/10.1080/09638288.2020.1845825
  15. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004 Feb;24(2):105–12. 10.1016/j.nedt.2003.10.001 DOI: https://doi.org/10.1016/j.nedt.2003.10.001
  16. Bogner A, Littig B, Menz W. Interviews mit Experten [Internet]Wiesbaden: Springer Fachmedien Wiesbaden; 2014.[ [cited 2023 Jan 17]], Available from http://link.springer.com/10.1007/978-3-531-19416-5 10.1007/978-3-531-19416-5
  17. Mayring P. (2014). Qualitative content analysis: theoretical foundation, basic procedures and software solution. Klagenfurt. https://nbn-resolving.org/urn:nbn:de:0168-ssoar-395173 DOI: https://doi.org/10.1007/978-94-017-9181-6_13
  18. Rowan FE, Benjamin B, Pietrak JR, Haddad FS. Prevention of Dislocation After Total Hip Arthroplasty. J Arthroplasty. 2018 May;33(5):1316–24. 10.1016/j.arth.2018.01.047 DOI: https://doi.org/10.1016/j.arth.2018.01.047
  19. Coole C, Edwards C, Brewin C, Drummond A. What Do Clinicians Think about Hip Precautions following Total Hip Replacement? Br J Occup Ther. 2013 Jul;76(7):300–7. 10.4276/030802213X13729279114898 DOI: https://doi.org/10.4276/030802213X13729279114898
  20. Theaker J, Oldham J, Callaghan M, Parkes M. Assessment of patients’ self-reported levels of adherence to postoperative restrictions following total hip replacement. Physiotherapy. 2022 Dec;117:1–7. 10.1016/j.physio.2022.04.001 DOI: https://doi.org/10.1016/j.physio.2022.04.001
  21. Lightfoot CJ, Coole C, Sehat K, Brewin C, Drummond A. Clinicians’ experiences of discontinuing routine hip precautions following total hip replacement surgery: a qualitative analysis. Disabil Rehabil. 2022 Aug;44(16):4227–32. 10.1080/09638288.2021.1884759 DOI: https://doi.org/10.1080/09638288.2021.1884759

Most read articles by the same author(s)