Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. A systematic review of psychological interventions in total hip and knee arthroplasty Reduced patient restrictions following total hip arthroplasty: study protocol for a randomized controlled trial Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Evaluation of reducing postoperative hip precautions in total hip replacement: a randomized prospective study. Can Dual Mobility Cups prevent Dislocation in All Situations After Revision Total Hip Arthroplasty? Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. Dislocation after total hip arthroplasty using Hueter anterior approach. Prevention of cervical cancer in HIV-seropositive women from developing countries: a systematic review protocol Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report. Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Quality of life after dislocation of hip arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up A comparison of total hip resurfacing and total hip arthroplasty - patients and outcomes. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. Resurfacing hip prostheses revisited: failure analysis during a 16-year follow-up. How to write an evidence-based clinical review article. Are modern dual mobility cups a valuable option in reducing instability after primary hip arthroplasty, even in younger patients? Dislocation of Primary Total Hip Arthroplasty with 36 and 40-mm Femoral Heads Hospital cost of dislocation after primary total hip arthroplasty. [Effectiveness of postoperative drainage after bipolar sealed endoprosthetic arthroplasty for femur neck fracture. Results of a prospective randomized study of 86 cases]. Midterm Survivorship of the Lefèvre Constrained Liner: A Consecutive Multisurgeon Series of 166 Cases. The effectiveness of yoga to prevent diabetes mellitus type 2
Purpose : Total hip arthroplasty ( THA ) is a common and effective treatment of hip osteoarthritis . Activity restrictions known as hip pre caution s are widely practice d in rehabilitation post THA , aim ing to foster healing and prevent hip dislocation . The focused clinical question was : Does the application of hip pre caution s in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation ? Methods : A comprehensive literature search was conducted for r and omized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up , with dislocation as an end point . Retrieved titles were assessed independently by 2 review ers for inclusion and underwent st and ardized data extraction . Results : Title search produced 80 potentially relevant articles . Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria . No eligible studies were found that concerned posterior approaches to hip arthroplasty , so the results of this review concern only anterolateral approaches . Neither included study showed any benefit of hip pre caution s in preventing dislocation . Conclusion : The rate of dislocation after anterolateral THA is low and is not improved by hip pre caution s. Hip pre caution s are associated with a slower return to activities , significant expense , and decreased patient satisfaction . Existing studies risk being compromised by a type II error , but a definitive study may be prohibitively large and expensive BACKGROUND It is currently unknown whether functional restrictions following total hip arthroplasty can reduce the prevalence of early postoperative dislocation . Our hypothesis was that dislocation was more likely to occur in patients who were not placed on these restrictions . METHODS We performed a prospect i ve , r and omized study to evaluate the role of postoperative functional restrictions on the prevalence of dislocation following uncemented total hip arthroplasty through an anterolateral approach . Of the 630 eligible consecutive patients , 265 patients ( 303 hips ) consented to be r and omized into one of two groups ( the " restricted " group or the " unrestricted " group ) . The patients in both groups were asked to limit the range of motion of the hip to < 90 degrees of flexion and 45 degrees of external and internal rotation and to avoid adduction for the first six weeks after the procedure . The patients in the restricted group were instructed to comply with additional hip pre caution s during the first six weeks postoperatively . Specifically , these patients were managed with the placement of an abduction pillow in the operating room before bed transfer and used pillows to maintain abduction while in bed ; used elevated toilet seats and elevated chairs in the hospital , in the rehabilitation facility , and at home ; and were prevented from sleeping on the side , from driving , and from being a passenger in an automobile . All patients were followed for a minimum of six months postoperatively . RESULTS There was one dislocation in the entire cohort ( prevalence , 0.33 % ) . This dislocation occurred in a patient in the restricted group during transfer from the operating table to a bed with an abduction pillow in place . Patients in the unrestricted group were found to return to side-sleeping sooner ( p < 0.001 ) , to ride in automobiles more often ( p < 0.026 ) , to drive automobiles more often ( p < 0.001 ) , to return to work sooner ( p < 0.001 ) , and to have a higher level of satisfaction with the pace of their recovery ( p < 0.001 ) than those in the restricted group . There was an additional expenditure of approximately $ 655 per patient in the restricted group . CONCLUSIONS Total hip arthroplasty through an anterolateral approach is likely to be associated with a low dislocation rate . Removal of several restrictions did not increase the prevalence of dislocation  following primary hip arthroplasty at our institution . However , it did promote substantially lower costs and was associated with a higher level of patient satisfaction as patients achieved a faster return to daily functions in the early postoperative period Background The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality , anxiety , depression and negative thinking styles can influence outcomes and recovery from surgery . The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip ( THA ) and knee arthroplasty ( TKA ) , in improving patient reported joint outcomes . Methods An extensive literature search was conducted according to Preferred Reporting Items for Systematic review s and Meta-Analyses guidelines . Search terms included psychology , interventions , and orthopaedics . Articles were included if they were r and omised controlled trials ( RCTs ) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty . Results A total of 19,489 titles were screened . Seven studies met the inclusion criteria and were included . Five of seven studies did not show improvements in patient reported outcomes after surgery . Specifically , psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies . Conclusion The current literature does not support routine psychological interventions for TKA and THA . However , it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy . This gap in the literature is surprising , considering the importance of the role of psychological factors in recovery . Further RCTs with long term follow ups , multidisciplinary involvement , and more comprehensive and focused interventions that go beyond educating patients are needed . Future studies should account for the dem and effect , include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others , and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA Background Total hip arthroplasty ( THA ) is a very common procedure in orthopedic surgery . In the Netherl and s , 25,642 primary THAs were performed in 2013 . Postoperative hip dislocation is one of the major complications and has been reported in 0.5 to 10.6 % of patients after primary THA.Several reports regarding the use of an anterolateral surgical approach have shown that a non-restriction or reduced restriction protocol does not increase the dislocation rate . For the posterolateral surgical approach it has been suggested that patient restrictions might be unnecessary but the amount of available literature is scarce . As such , r and omized controlled trials aim ed at investigating restrictions following THA using a posterior approach are strongly recommended . The aim of this prospect i ve r and omized controlled trial is to investigate the non-inferiority hypothesis concerning the early dislocation rate after THA in patients with and without the use of a reduced restriction protocol . Methods / Design After providing informed consent a group of 456 patients with symptomatic coxarthrosis will be r and omized to receive a THA either with care as usual , i.e. receiving postoperative restrictions including the advice to sleep in a supine position for the first 8 weeks postoperatively , or reduced restrictions with no recommendations regarding the position during sleeping . Primary outcome measure will be the percentage of early dislocations within the first 8 weeks after THA . Secondary outcome measures will be patient satisfaction , time to functional recovery , quality of sleep and patient ’s self-reported compliance with postoperative instructions . Discussion To our knowledge this will be the first r and omized controlled trial that compares a reduced restriction protocol with a restricted protocol following THA using a posterolateral surgical approach . Our hypothesis is that a reduced restriction protocol following THA with use of a posterolateral surgical approach has no influence on the early dislocation rate compared to a restricted protocol . Instead , embracing a reduced restriction protocol might even contribute to a higher quality of sleep , thereby facilitating a faster uptake and return to daily functions in patients after THA.Trial registration Clinical Trials.gov NCT02107248 , registration date 3 April 2014 INTRODUCTION Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty . The type of arthroplasty to be used , either hemi- or total hip arthroplasty , remains controversial as total hip replacements potentially have a higher rate of dislocation . HYPOTHESIS Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck . PATIENTS AND METHODS In a multicenter prospect i ve study conducted in France over an inclusion time of 3 months , all displaced fractures of the femoral neck treated with arthroplasty  were operated on with insertion of a dual mobility cup . Patients had clinical and radiological assessment at 3 , 6 , and 9 months postoperative . RESULTS Two hundred and fourteen hips in 214 patients with a mean age of 83 years ( range , 70 - 103 years ) were included . None of the patients was lost to follow-up . The mortality rate after 9 months was 19 % . Two patients ( 1 % ) had early postoperative infection successfully treated with lavage and antibiotics . Three patients ( 1.4 % ) , operated through a posterior approach , presented one postoperative dislocation , all of which were posterior . Reduction was performed through closed external manipulation under general anesthesia . There was no recurrence of dislocation . DISCUSSION This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemiarthroplasties . Dual mobility cups might therefore be considered a valuable option to prevent postoperative dislocation when treating displaced intracapsular fractures of the proximal femur in elderly patients if a total hip replacement is recommended . Further study is needed before extending the indications for total hip arthroplasty following a fracture of the femoral neck , to assess the potential cost and complications of a longer procedure with its potential acetabular complication , and weigh them against the potential benefits Currently , many rehabilitation protocol s for total hip replacements ( THRs ) include activity restrictions to prevent postoperative dislocation . There is increasing dem and for more efficient and safe rehabilitation protocol s. This r and omized prospect i ve study evaluates the need for hip restrictions following a modified anterolateral procedure . From 2004 to 2008 , 81 patients seeking elective THRs were r and omly assigned into a st and ard rehabilitation group or an early rehabilitation group . The st and ard group included restrictions to avoid hip flexion > 90 degrees and avoidance of riding in a car for the first postoperative month . The early group had no flexion or car riding restrictions . Forty-three patients were in the st and ard group and 38 patients were in the early group . There were no significant demographic differences between the 2 groups . All patients completed the Short Form 12- question Health Survey and Harris Hip Score preoperatively and at 4 weeks , 1 month , 3 months , and 1 year postoperatively . The time-points at which the patient first drove and ambulated with a cane , without a cane , and without a limp were also collected . No incidents of dislocation occurred . Patients in the early group were faster to ambulate with only a cane ( P=.03 ) , without a cane ( P<.001 ) , and without a limp ( P=.003 ) . They also drove earlier ( P=.02 ) . Pace of recovery was the only significant difference between the 2 groups . The early rehabilitation protocol increases the pace of recovery compared to a pathway with hip pre caution s without increasing complications UNLABELLED The outcome of a single design of dual mobility cup was prospect ively evaluated in a continuous series of 994 revision THAs with respect to dislocation and intra-prosthetic dislocation ( IPD ) . At a 7.3-year mean follow-up , the dislocation rate was 1.5 % and the IPD rate was 0.2 % . The 2 IPD occurred in acetabular-only revisions and were related to a poor head-to-neck ratio with early impingement and wear at the polyethylene mobile component chamfer . Dual mobility cups demonstrated a low dislocation rate in revision THA but did not compensate for potential perioperative technical errors . In addition , IPD did not appear to be a concern with respect to the benefit in term of instability prevention though caution is advised in acetabular-only revision associated with a poor head-to-neck ratio . LEVEL OF EVIDENCE Therapeutic study -Level IV OBJECTIVE Dislocation is a well-known complication after  total hip arthroplasty ( THA ) , and is the second-highest cause of revision surgery . Our objective was to assess the effect of preoperative patient education on the occurrence of  hip dislocation  within 6 months after primary THA . METHODS Between 1998 and 2007 , we conducted a prospect i ve cohort study at the Geneva University Hospital Department of Orthopaedic Surgery , including all primary THAs performed via an anterolateral transgluteal approach with the use of a 28-mm diameter head .  The preoperative education session was introduced in June 2002 and included advice on muscle strengthening exercises and postoperative restrictions of range of motion as a means of preventing dislocation . The main outcome was the incidence of dislocation within 6 months of surgery . RESULTS A total of 597 patients who underwent 656 THAs between June 2002 and June 2007 participated in the education session , whereas 1,641 patients who underwent 1,945 procedures did not . Forty-six dislocations occurred over the study period , 5 ( 0.8 % ) in participants and 41 ( 2.1 % ) in non participants ( absolute risk reduction 1.3 % ; 95 % confidence interval [ 95 % CI ] 0.4 , 2.3 ) , with the time interval between surgery and dislocation being significantly shorter among participants ( 0.2 versus 1.2 months ) . Non participants had a 2.8 times higher risk of dislocation than participants ( unadjusted odds ratio [ OR ] 2.80 ; 95 % CI 1.10 , 7.13 ) . Adjustment for age , sex , comorbidities , and prior surgery did not change the results ( adjusted OR 2.79 ; 95 % CI 1.09 , 7.15 ) . CONCLUSION Our findings suggest that participation in a preoperative patient education session may reduce the risk of dislocation within 6 months after THA A prospect i ve study including 1764 hips has been carried out to evaluate the frequency of dislocation while using the Hueter anterior approach and the correlated factors . The dislocation group was compared with the patients without dislocation . We observed 27 dislocations ( 1.5 % ) . The dislocation rate when using 28 mm head diameter was 0.5 % . Two patients underwent a revision for recurrent dislocations . Correlated factors for dislocation were male sex , high body mass index , etiology of osteonecrosis , low head diameter , high bleeding , and low postoperative ROM . Dislocation risk while using Hueter approach is one of the lowest in the literature . The main disadvantages are the necessity for a specific orthopedic table and a more difficult exposure of the femur Background Over 85 % of cervical cancer cases and deaths occur in developing countries . HIV-seropositive women are more likely to develop precancerous lesions that lead to cervical cancer than HIV-negative women . However , the literature on cervical cancer prevention in seropositive women in developing countries has not been review ed . The aim of this study is to systematic ally review cervical cancer prevention modalities available for HIV-seropositive women in developing countries . Methods / design This protocol was developed by following the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) statement , and the systematic review will be reported in accordance with the PRISMA guidelines . Embase , MEDLINE , PubMed , CINAHL and Cochrane Library will be search ed from inception up to date of final search , and additional studies will be located through citation and reference list tracking . Eligible studies will be r and omised controlled trials , prospect i ve and retrospective cohort studies , case-control and cross-sectional studies carried out in developing countries . Studies will be included if they are published in English and examine cervical cancer prevention modalities in HIV-seropositive women . Results will be summarised in tables and , where appropriate , combined using meta- analysis . Discussion This review will address the gap in evidence by systematic ally review ing the published literature on the different prevention modalities being used to prevent  cervical cancer in HIV-seropositive women in developing countries . The findings may be used to inform evidence -based guidelines for prevention of cervical cancer in seropositive women as well as future research . Systematic review registration PROSPERO CRD42017054678 The purpose of the current study was to up date the results of a prospect i ve , single-surgeon series of primary Charnley total hip arthroplasties performed with cement . This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement  were followed for a minimum of thirty years . Twenty-seven patients ( thirty-four [ 10.3 % ] of the hips in the initial study group ) were alive at a minimum of thirty years postoperatively . These patients served as the focus of the present study .  Revision because of aseptic loosening of the acetabular component was performed in 7.3 % ( twenty-three ) of the hips from the original study group ( excluding those revised because of infection or dislocation ) and 26 % ( eight ) of the hips in the living cohort .  Revision  because of aseptic loosening of the femoral component was performed in 3.2 % ( ten ) of the hips from the original study group ( excluding those revised because of infection or dislocation ) and 10 % ( three ) of the hips in the living patients . Since the twenty-five-year review , three hips were revised ( one because of acetabular loosening , one because of femoral loosening , and one because of instability ) . This end- result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades , with 88 % of the original prostheses intact at the time of the final follow-up or at the patient 's death BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature Purpose A primary arthroplasty constitutes a st and ard procedure in the treatment of patients with displaced fractures of the femoral neck . Although dislocation of the prosthesis remains a significant clinical problem , there are no previous reports on its influence on health-related quality of life ( HRQoL ) . We analysed how a dislocation of the hip arthroplasty influenced the patients ’ HRQoL. Methods In total 319 consecutive patients with a displaced fracture of the femoral neck treated with a primary arthroplasty were included in a prospect i ve cohort study . We used a mixed-effects model regression analysis to evaluate factors of importance for HRQoL ( EQ-5Dindex score ) during the first 12 months following surgery . Results A dislocation of the arthroplasty occurred in 21 of the 319 patients ( 7 % ) , 8 of whom had a single dislocation and 13 recurrent dislocations . At 4 months , the EQ-5Dindex score displayed a significantly worse outcome for patients with recurrent dislocations compared to patients with no dislocation ( P = 0.001 ) , and a trend towards a worse outcome for patients with a single dislocation ( P = 0.08 ) . At 12 months , the mean EQ-5Dindex score of patients with recurrent dislocations was still substantially lower ( P = 0.001 ) , while the EQ-5Dindex score for patients with a single dislocation had returned to a level similar to that of patients with no dislocation . Our analysis of the EQ-5D dimensions indicates that the difference was mainly due to perceived difficulties in self-care and usual activities and increased problems with anxiety/depression . Conclusions A recurrent dislocation of the hip arthroplasty in the treatment of patients with femoral neck fractures seems to result in a persisting deterioration in the HRQoL , while patients with a single dislocation seem to experience only a temporary deterioration A comparison of pertinent preoperative and postoperative data relative to total hip resurfacing versus total hip arthroplasty ( THA ) would assist in evaluating current perceptions in outcome . We compared 50 consecutive metal-metal resurfacing replacements in 50 patients with 44 consecutive conventional total hip arthroplasties in 35 patients , who were implanted during the same time period , by the same surgeon , and followed prospect ively for 2 to 4 years . The patients undergoing hip resurfacing were 62 % male , 9 years younger , and 3.2 inches taller , with a lower mean body mass index and American Society of Anesthesiologists ( ASA ) grade than patients undergoing total hip arthroplasty .  Preoperatively , patients undergoing resurfacing had a lower Harris hip score ( 46 vs 52 points ) , more pain , higher UCLA ( University of California at Los Angeles ) activity scores ( 4.2 vs 3.6 ) , and better range of motion . Surgical time for resurfacing was 18 % longer , but there was less total blood loss and fewer transfusions . Postoperatively , there was no difference in Harris hip score ( 97 vs 96 ) . Patients undergoing resurfacing had higher function , Short Form-12 physical activity scores , and UCLA activity scores , but also a higher incidence of slight or mild pain . There were no differences in postoperative range of motion or dislocation ( one each ) . The preoperative characteristics and general health status of the average patient undergoing resurfacing are more favorable than that of the average patient undergoing conventional total hip arthroplasty . Caution should be applied in attributing differences in outcomes directly to the arthroplasty technology BACKGROUND The use of larger femoral heads has been proposed to reduce the risk of dislocation after total hip arthroplasty , but there is a lack of evidence to support this proposal . The aim of this multicenter r and omized controlled trial was to determine whether the incidence of dislocation one year after total hip arthroplasty is significantly lower in association with the use of a 36-mm femoral head articulation as compared with a 28-mm articulation . METHODS Six hundred and forty-four middle-aged and elderly patients undergoing primary or revision arthroplasty were r and omized intraoperatively to receive either a 36 or 28-mm metal femoral head on highly cross-linked polyethylene .  Patients who were at high risk of dislocation ( including those with dementia and neuromuscular disease ) and those undergoing revision for the treatment of recurrent hip dislocation or infection were excluded . Patients were stratified according to other potential risk factors for dislocation , including diagnosis and age . Diagnosis of hip dislocation required confirmation by a physician and radiographic evidence of a dislocation . RESULTS Overall , at one year of follow-up , hips with a 36-mm femoral head articulation had a significantly lower incidence of dislocation than did those with a 28-mm articulation ( 1.3 % [ four of 299 ] compared with 5.4 % [ seventeen of 316 ] ; difference , 4.1 % [ 95 % confidence interval , 1.2 % to 7.2 % ] ) when controlling for the type of procedure ( primary or revision ) ( p = 0.012 ) . The incidence of dislocation following primary arthroplasty was also significantly lower for hips with a 36-mm femoral head articulation than for those with a 28-mm articulation ( 0.8 % [ two of 258 ] compared with 4.4 % [ twelve of 275 ] ; difference , 3.6 % [ 95 % confidence interval , 0.9 % to 6.8 % ] ) ( p = 0.024 ) . The incidence of dislocation following revision arthroplasty was 4.9 % ( two of forty-one ) for hips with a 36-mm articulation and 12.2 % ( five of forty-one ) for hips with a 28-mm articulation ; this difference was not significant with the relatively small sample size of the revision group ( difference , 7.3 % [ 95 % confidence interval , -5.9 % to 21.1 % ] ) ( p = 0.273 ) . CONCLUSIONS Compared with a 28-mm femoral head articulation , a larger 36-mm articulation result ed in a significantly decreased incidence of dislocation in the first year following primary total hip arthroplasty . However , before a 36-mm metal-on-highly cross-linked polyethylene articulation is widely recommended , the incidence of late dislocation , wear , periprosthetic osteolysis , and liner fracture should be established We conducted a prospect i ve study of the clinical and radiographic variables related to the survival of 114 cementless resurfacing double-cup hip replacements ( RHR ) with a mean follow-up of 9 ( range : 1 - -16 ) years . Three patients died , and 22 were unavailable for the final review in 2003 . Sixty-one RHRs had to be revised to a total hip replacement . Failure analysis of these revised RHRs showed femoral head and neck resorption under the prosthesis in 33 , acetabular protrusion in seven , both femoral and acetabular resorption in 14 and a femoral-neck fracture in three . One hip had dislocated , and there were three hips with unexplained pain . The Kaplan-Meier 5-year mean survival was 92 % , the 10-year survival was 47 % ( 95 % CI 37 - -57 % ) and the 15-year survival was 30 % ( 95 % CI 20 - -40 % ) . Pre-operative joint destruction ( grade 1 ) , a high degree of radiological osteoporosis , a body mass index > 25 and prosthesis mismatch were significantly related to failure of the RHR . We believe that in young , non-obese patients with pre-operative radiological central destruction but without severe proximal femoral osteoporosis , a resurfacing arthroplasty may have some value . Our failures were mainly due to femoral resorption under the prosthetic femoral component Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points Hip instability after total hip replacement has been shown to be a critical cause of failure . The use of dual mobility has been classically restricted to patients " at risk " , over 70 years of age . The question rises up about extended indications of so-called " modern " second generation dual mobility cups . This prospect i ve multicenter study reports on first results at 2 - 5 years of the HA anatomical ADM cup  upon two comparative groups of patients under 70 years ( 112 hips ) vs. over 70 years of age ( 325 hips ) . No dislocation , migration , tilting , wear , or intra-prosthetic dislocation was recorded within each of the two cohorts . Survivorship for cup failures at this 4-year period was ideal at 100 % in the younger patients , and 99.7 % in the older group of patients Some authors suggest the use of larger ( 36 and 40 mm ) femoral heads against highly cross-linked polyethylene acetabular liners will reduce the prevalence of early dislocation after primary total hip arthroplasty ( THA ) . We prospect ively followed 61 consecutive patients at high risk for dislocation to determine the prevalence of early dislocation after primary THA with 36 and 40 mm femoral heads .  We established specific indications for the use of these larger heads in primary arthroplasty . There were 65 hips in 61 patients with a minimum followup of 1 year ( mean 2 years , range 1 - 4 years ) . There were 55 36 mm heads and 10 40 mm heads . All arthroplasties were performed by the posterior approach with capsular repair . The prevalence of early dislocation was 4.6 % ( 3 of 65 ) . There was one patient with an anterior dislocation and two with posterior dislocation . No patient underwent reoperation for dislocation . There was no dislocation in the 10 hips that had a 40 mm head . We identified no complications related to the larger femoral heads . The use of larger femoral heads did not notably reduce the prevalence of early dislocation after primary THA in high risk patients compared to historical controls . Therapeutic study : Level IV , case series . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND The treatment of dislocation following primary total hip arthroplasty usually requires the use of expensive hospital re sources and sometimes requires revision surgery . The hospital costs associated with treating this complication have not been previously analyzed , to our knowledge . The purpose of this study was to assess the financial impact of treating dislocations at our institution . METHODS Between 1997 and 2001 , 3671 patients underwent a total of 4054 consecutive primary total hip arthroplasties at our institution . The patients were prospect ively followed at regular intervals , and their follow-up data were recorded in an institutional total joint registry . Ninety-nine hips ( 2.4 % ) in ninety-nine patients dislocated . The costs to our institution to treat these dislocations were evaluated by determining the cost of each treatment episode required to reestablish hip stability and were expressed as the percent increase in cost compared with that of an uncomplicated primary total hip replacement . RESULTS Of the ninety-nine hips that dislocated , sixty-two ( 63 % ) remained stable after one or more closed reductions and thirty-seven ( 37 % ) ultimately required revision surgery . The hospital cost of each closed reduction episode represented 19 % of the hospital cost of an uncomplicated total hip replacement . When revision surgery was eventually needed , the average hospital costs of one or more closed reductions and the subsequent revisions represented 148 % of the hospital cost of an uncomplicated primary total hip replacement . CONCLUSIONS Dislocation after primary hip replacement continues to be a prevalent and costly complication that diminishes the cost-effectiveness of an otherwise very successful surgical procedure Purpose of the study Suction drainage in bipolar arthroplasty for hip fracture is st and ard procedure despite the lack of a solid scienfific basis . No study is reported in the literature demonstrating an advantage of systematic drainage . The aim of this work was to search for reasons why this conventional practice should be continued , Material and method es A prospect i ve r and omized stydt in a homogeneous consecutive group of patients hospitalized in our unit for hip fracture were included in the study from January 1995 through January 1999 . Among the 183 patients , 97 were excluded ( hemostasis disorders or anticoagulant treatment , multiple fractures , preoperative anemia with Hg < 9.5 g/dl , postponed operation ) . For the 86 included patients , the posterolateral Moore access was used to implant a sealed intermediary prosthesis . According to r and om selection , drainage was then installed or not . Outcome criteria were number of reoperations , hemoglobin level on DO , D1 , D2 , D5 , and D10 , number of patients requiring transfusion and number of packed red cell units in each group , and finally , temperature as reflecting presence of possible hematome ( DO , D2 , D5 , D10 ) . Results The two groups were similar for age and sex . There were no reoperations for hematoma or superficial infection and only one patient was reoperated for early dislocation in the group without drainage . Twenty-seven patients had transfusions , 14 in the drainage group and 13 in the no drainage group ; mean number of packed red cell units was 2 . Hemoglobin level fell similarly in the two groups in DO ( 2.1 versus 1.9 ) , D2 ( 2.5 versus 2.4 ) , D ( 2.7 versus 2.7 ) , D10 ( 2.4 versus 2.6 ) as did mean temperatures . Discussion We were thus unable to demonstrate any advantage of using suction drainage in bipolar arthroplasty for hip fracture when using more access . This is in agreement with reports in the literature . Exception the simplification of nursing care by not using drains , the cost savings can be considerable in light of the number of patients treated . We recommend that systematic use of suction drainage be discontinued in bipolar arhtroplasty for hip fracture BACKGROUND Constrained liners are used as part of a salvage procedure to provide stability for patients at high risk for dislocation after a total hip arthroplasty . However , no recent studies exist highlighting their effectiveness and /or limitations . METHOD This prospect i ve review included 166 consecutive hip arthroplasties , either primary ( 27 % ) or revision ( 73 % ) , with a unique design of a constrained liner : Lefèvre retentive cup . There were 113 females ( 69 % ) , and the average age at index surgery was 75.9 years ( range , 35 - 94 ) . The mean follow-up was 6.2 years ( range , 0.3 - 11 ) . RESULTS Twenty patients had a reoperation ; 10 for infection ( 4 acute and 6 chronic joint infection ) and 10 for cup failure ( 5 fixation failure , 3 aseptic loosening , and 2 dislocation ) . Ten-year survivals for cup revision were 89 % ( CI , 83 - 94 ) and 92 % ( CI , 89 - 97 ) for all revision and revision for noninfectious reasons , respectively . When solely evaluating for dislocation , the survival at 10 years was 99 % ( CI , 97 - 100 ) . Considering primary and revision cases , 10-year survivals cup revision for aseptic reasons were 92.4 % ( CI , 84 - 100 ) and 92.5 % ( CI , 87 - 98 ) , respectively . CONCLUSIONS The Lefèvre retentive cup demonstrated excellent 10-year 's survivorship . With the rate of aseptic loosening around 2 % and a dislocation rate around 1 % , the cup is as effective as other available devices and is therefore a cost-effective tool to reduce the risk of dislocation in at-risk patients undergoing hip arthroplasty Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD
Patients in the unrestricted group resumed activities significantly faster and were more satisfied with their pace of recovery .
Conclusion : A more liberal lifestyle restrictions and pre caution s protocol will not lead to worse dislocation rates after total hip arthroplasty , but will lead to earlier and better resumption of activities and higher patient satisfaction .
These results appear to hold up for various surgical approaches
Objective : A systematic literature review and meta- analysis on the effectiveness of lifestyle restrictions and pre caution s to prevent dislocation after total hip arthroplasty .