Purpose: Movement restrictions and assistive devices have traditionally been recommended to prevent hip dislocation after total hip arthroplasty (THA). Considering the advancements in THA surgery, a review of treatment recommendations is worthwhile. The aim of this study was to investigate whether unrestricted protocol (without movement restrictions and assistive devices) should be recommended for THA patients.
Methods: A multiprofessional panel used the GRADE-Adolopment to develop the present recommendations, following the GIN-McMaster-Guideline-Development-Tool. We selected guideline topic and target audience, formulated clinical questions and prioritised outcomes. For the first question, a source guideline was identified and adoloped, whereas the second question required a de-novo recommendation. Therefore, the GRADE-Evidence-Profile and the Evidence-to-Decision framework were completed. Finally, the panel discussed and formulated the final recommendations.
Results: Hip dislocation was defined as critical outcome. No between-groups differences in the early dislocation rates were found: without movement restrictions, 1623 patients, RR 0.44 (CI95 0.16-1.20); without assistive devices, 4426 patients, RR 0.75 (CI95 0.52-1.08). Finally, considering small desirable health effects and trivial undesirable health effects of the intervention, we integrated two "conditional-recommendations" in favour of an unrestricted protocol.
Conclusion: Through GRADE-adolopment approach new recommendations to provide an evidence-based guidance after THA have been formulated.
Keywords: GRADE approach; Total hip arthroplasty; assistive devices; movement restrictions; rehabilitation.
For patients undergoing total hip arthroplasty (THA), unless otherwise indicated by the surgeon, the removal of movement restrictions and assistive devices early after THA does not affect hip dislocation rate, regardless of surgical approach.On the other hand, unrestricted protocols may enhance a more rapid recovery process, shorter length of stay and less caregiver assistance.A more liberal lifestyle early after THA surgery (e.g., no mandatory sleeping posture) is associated with higher patient’s satisfaction.The non-routine adoption of movement restriction and assistive devices allows a costs reduction for both patients and the healthcare system after THA.