Skip to main content
SpringerLink
Log in

Minimal invasive posterior total hip arthroplasty: are 6 weeks of hip precautions really necessary?

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Postoperative hip dislocations have been reported in 0.5 to 10.6 % of patients after primary posterolateral total hip arthroplasty (THA). Hip precautions are currently recommended for 6 weeks postoperatively to reduce early dislocation and facilitate healing of the posterior soft tissue repair.

Materials and methods

To determine the impact of a modified 4-week precaution protocol on the dislocation rate, 698 consecutive patients (797 hips) operated by a single surgeon between September 2008 and December 2012 were retrospectively evaluated. All patients had a standard THA using a minimal invasive posterior approach with posterior soft tissue repair and 28–36-mm head size. 98.7 % of the patients were available for follow-up.

Results

There were eight (1 %) dislocations in 797 hips in the first 12 months after surgery with 4 weeks of hip precautions. The average time to dislocation was 7.5 weeks after surgery (range 1.0–16.9 weeks); two dislocations (25 %) took place in the first 4 weeks.

Conclusions

Shortening the time of posterolateral hip precautions from 6 to 4 weeks after surgery does not increase the risk of postoperative dislocation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hummel MT, Malkani AL, Yakkanti MR, Baker DL (2009) Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplasty 24(6 Suppl):73–76. doi:10.1016/j.arth.2009.04.026

    Article  PubMed  Google Scholar 

  2. Pellicci PM, Bostrom M, Poss R (1998) Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res 355:224–228

    Article  PubMed  Google Scholar 

  3. Hailer NP, Weiss RJ, Stark A, Karrholm J (2012) The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthopaedica 83(5):442–448. doi:10.3109/17453674.2012.733919

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lubbeke A, Suva D, Perneger T, Hoffmeyer P (2009) Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. Arthritis Rheum 61(4):552–558. doi:10.1002/art.24340

    Article  PubMed  Google Scholar 

  5. Robinson RP, Robinson HJ Jr, Salvati EA (1980) Comparison of the transtrochanteric and posterior approaches for total hip replacement. Clin Orthop Relat Res 147:143–147

    PubMed  Google Scholar 

  6. Bottner F, Delgado S, Sculco TP (2006) Minimally invasive total hip replacement: the posterolateral approach. Am J Orthop 35(5):218–224

    PubMed  Google Scholar 

  7. Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ (2006) Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res 447:34–38. doi:10.1097/01.blo.0000218746.84494.df

    Article  PubMed  Google Scholar 

  8. Ali Khan MA, Brakenbury PH, Reynolds IS (1981) Dislocation following total hip replacement. J Bone Joint Surg Br 63-B(2):214–218

    CAS  PubMed  Google Scholar 

  9. Soong M, Rubash HE, Macaulay W (2004) Dislocation after total hip arthroplasty. J Am Acad Orthop Surg 12(5):314–321

    PubMed  Google Scholar 

  10. Suh KT, Park BG, Choi YJ (2004) A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res 418:162–167

    Article  PubMed  Google Scholar 

  11. Charnley J (1970) Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res 72:7–21

    CAS  PubMed  Google Scholar 

  12. Enloe LJ, Shields RK, Smith K, Leo K, Miller B (1996) Total hip and knee replacement treatment programs: a report using consensus. J Orthop Sports Phys Therapy 23(1):3–11. doi:10.2519/jospt.1996.23.1.3

    Article  CAS  Google Scholar 

  13. Peak EL, Parvizi J, Ciminiello M, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH (2005) The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. J Bone Joint Surg Am 87(2):247–253. doi:10.2106/JBJS.C.01513

    Article  PubMed  Google Scholar 

  14. Restrepo C, Mortazavi SM, Brothers J, Parvizi J, Rothman RH (2011) Hip dislocation: are hip precautions necessary in anterior approaches? Clin Orthop Relat Res 469(2):417–422. doi:10.1007/s11999-010-1668-y

    Article  PubMed Central  PubMed  Google Scholar 

  15. Talbot NJ, Brown JH, Treble NJ (2002) Early dislocation after total hip arthroplasty: are postoperative restrictions necessary? J Arthroplasty 17(8):1006–1008. doi:10.1054/arth.2002.34534

    Article  CAS  PubMed  Google Scholar 

  16. Tejwani NC, Immerman I (2008) Myths and legends in orthopaedic practice: are we all guilty? Clin Orthop Relat Res 466(11):2861–2872. doi:10.1007/s11999-008-0458-2

    Article  PubMed Central  PubMed  Google Scholar 

  17. Youm T, Maurer SG, Stuchin SA (2005) Postoperative management after total hip and knee arthroplasty. J Arthroplasty 20(3):322–324

    Article  PubMed  Google Scholar 

  18. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220

    CAS  PubMed  Google Scholar 

  19. Lu M, Zhou YX, Du H, Zhang J, Liu J (2013) Reliability and validity of measuring acetabular component orientation by plain anteroposterior radiographs. Clin Orthop Relat Res 471(9):2987–2994. doi:10.1007/s11999-013-3021-8

    Article  PubMed Central  PubMed  Google Scholar 

  20. Yao L, Yao J, Gold RH (1995) Measurement of acetabular version on the axiolateral radiograph. Clin Orthop Relat Res 316:106–111

    PubMed  Google Scholar 

  21. Ververeli PA, Lebby EB, Tyler C, Fouad C (2009) Evaluation of reducing postoperative hip precautions in total hip replacement: a randomized prospective study. Orthopedics 32(12):889. doi:10.3928/01477447-20091020-09

    Article  PubMed  Google Scholar 

  22. van Stralen GM, Struben PJ, van Loon CJ (2003) The incidence of dislocation after primary total hip arthroplasty using posterior approach with posterior soft-tissue repair. Arch Orthop Trauma Surg 123(5):219–222. doi:10.1007/s00402-003-0482-3

    PubMed  Google Scholar 

  23. Malkani AL, Ong KL, Lau E, Kurtz SM, Justice BJ, Manley MT (2010) Early- and late-term dislocation risk after primary hip arthroplasty in the Medicare population. J Arthroplasty 25(6 Suppl):21–25. doi:10.1016/j.arth.2010.04.014

    Article  PubMed  Google Scholar 

  24. Paterno SA, Lachiewicz PF, Kelley SS (1997) The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Joint Surg Am 79(8):1202–1210

    CAS  PubMed  Google Scholar 

  25. Woolson ST, Rahimtoola ZO (1999) Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplasty 14(6):662–668

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Tom Schmidt-Braekling, Wenzel Waldstein, Erol Akalin, Pablo Benavente, Brett Frykberg & Friedrich Boettner

Authors
  1. Tom Schmidt-Braekling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenzel Waldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erol Akalin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pablo Benavente
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brett Frykberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Friedrich Boettner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Friedrich Boettner.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schmidt-Braekling, T., Waldstein, W., Akalin, E. et al. Minimal invasive posterior total hip arthroplasty: are 6 weeks of hip precautions really necessary?. Arch Orthop Trauma Surg 135, 271–274 (2015). https://doi.org/10.1007/s00402-014-2146-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-2146-x

Keywords

Search

Navigation