After undergoing hip replacement surgery, patients typically learn precautions to protect their hip from dislocation. A recent study suggests that avoiding these precautions may lead to shorter inpatient rehabilitation time and faster recovery.
In the study, “Comparative Inpatient Rehabilitation Outcomes of Anterior Total Hip Arthroplasty: With and Without Post-Operative Surgical Precautions,” researchers from Marianjoy Rehabilitation Hospital in Wheaton, Ill, compared inpatient rehabilitation outcomes between patients who learned and followed these precautions and those who did not.
Precautions include avoiding bending the hip past 90 degrees, turning the knee or foot inward, and crossing the leg past the middle of the body.
“We noticed postoperative hip precautions were being dictated by the surgeon’s preference rather than the operative technique,” explains Noel Rao, MD, FAAPM, lead investigator in the study, in a media release from the Association of Academic Physiatrists.
“Furthermore, surgeons using the same approach in the same surgical group varied on whether they placed patients under restrictions. Some did and some did not, which raised the question—what would be the impact of not having restrictions on hip dislocation rates and length of stay using the anterior surgical method? If reduced restrictions do not increase hip dislocation rates and patients have a shorter length of stay, they could be rehabilitated and reintegrated into the community sooner,” adds Rao, professor and chairman, Rosalind Franklin University of Medicine and Science, and former vice president of medical affairs and residency director at Marianjoy Rehabilitation Hospital.
The study included 68 patients (average age: 67) who underwent hip replacement surgery. Among the patients, 31 were admitted to inpatient rehabilitation without postoperative surgical precautions, and 37 were admitted with precautions.
Rao and his team looked at each participant’s medical records and noted each individual’s functional independence measures (FIM) at admission, daily during their stay and at discharge. The researchers also noted each person’s length of hospital stay and discharge disposition.
At the time of discharge, both groups had made similar progress in their overall FIM scores and their daily FIM improvements, but differed in length of hospital stay. The group who entered rehabilitation without post-operative precautions typically had a 3-day shorter stay than those who observed precautions (9 days and 12 days, respectively). Ultimately, this translated to improved FIM efficiency for the group that did not observe precautions, and this group did significantly better in daily motor FIM and overall FIM gains, the release explains.
“While both groups made similar overall progress during inpatient rehabilitation, the group that did not observe post-operative precautions made gains within a shorter time frame as they did not have restrictions to follow and therefore did not have to spend time learning and consistently demonstrating hip precautions, which takes some time to accomplish,” Rao states in the release.
“The absence of restrictions allowed these patients to improve their FIM scores quicker, resulting in a shorter length of hospital stay. Additionally, we anecdotally observed that reduced restrictions do not increase hip dislocation rates.”
Based on these findings, Rao suggests that physicians should not be overly concerned about using postoperative precautions, if the operating surgeon has made a clinical determination that the patient doesn’t need such precautions.
Additionally, per the release, Rao suggests patients considering hip replacement should discuss their surgeon’s preference for postoperative precautions and determine if they agree with their surgeon’s method or not.
“With newer surgical techniques and improved expertise of surgeons, more patients are being discharged home directly following this procedure. This is more evident in patients not requiring hip precautions than in patients who have restrictions. If this trend continues, we may want to look at expanding our existing outpatient therapy programs to accommodate more of these patients,” Rao concludes.
This study was presented recently at the Association of Academic Physiatrists Annual Meeting.
[Source(s): Association of Academic Physiatrists, Newswise]