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Meta-Analysis
. 2023 Apr 5:94:141-151.
doi: 10.2340/17453674.2023.11958.

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

Christoffer B Korfitsen  1 , Lone R Mikkelsen  2 , Marie-Louise Mikkelsen  3 , Jeanett F Rohde  4 , Pætur M Holm  5 , Simon Tarp  3 , Holger-Henning F Carlsen  6 , Kirsten Birkefoss  3 , Thomas Jakobsen  7 , Erik Poulsen  8 , Jane S Leonhardt  9 , Søren Overgaard  10 , Inger Mechlenburg  11
Affiliations
Meta-Analysis

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

Christoffer B Korfitsen et al. Acta Orthop. .

Abstract

Background and purpose: Hip precautions are routinely prescribed to patients with osteoarthritis to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach. However, recommendations have been based on very low certainty of evidence. We updated the evidence on the influence of hip precautions on early recovery following THA by this systematic review.

Materials and methods: We performed systematic searches for randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL published from 2016 to July 2022. 2 reviewers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analyses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was the risk of hip dislocations within 3 months of surgery. Other outcomes were long-term risk of dislocation and reoperation, self-reported and performance-based assessment of function, quality of life, pain, and time to return to work.

Results: 4 RCTs and 5 NRSs, including 8,835 participants, were included. There may be no or negligible difference in early hip dislocations (RCTs: risk ratio [RR] 1.8, 95% confidence interval [CI] 0.6-5.2; NRS: RR 0.9, CI 0.3-2.5). Certainty in the evidence was low for RCTs and very low for NRSs. Finally, precautions may reduce the performance-based assessment of function slightly, but the evidence was very uncertain. For all other outcomes, no differences were found (moderate to very low certainty evidence).

Conclusion: The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA to prevent hip dislocations. However, the results might change with high-quality studies.

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Figures

Figure 1
Figure 1
PRISMA flow diagram illustrating selection of studies.
Figure 2
Figure 2
Random-effects meta-analysis on the effect of precautions on the risk of early dislocations after total hip arthroplasty. Abbreviations: M-H = Mantel-Haenszel, CI = confidence interval, RCT = randomized controlled trial NRS = non-randomized study.
See this image and copyright information in PMC

References

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