AUTHORS ' CONCLUSIONS Very low quality evidence is available from single trials , thus we are uncertain if hip pre caution s with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA .
BACKGROUND Total hip arthroplasty ( THA ) is one of the most common orthopaedic operations performed worldwide .
Painful osteoarthritis of the hip is the primary indication for THA .
Following THA , people have conventionally been provided with equipment , such as raised toilet seats and chairs , and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees , or adduction or rotation past the midline .
These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation .
However , the appropriateness of these recommendations has been question ed .
OBJECTIVES To assess the effects of provision of assistive devices , education on hip pre caution s , environmental modifications and training in activities of daily living ( ADL ) and extended ADL ( EADL ) for people undergoing THA .
The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study.
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
AUTHORS ' CONCLUSIONS Very low quality evidence is available from single trials , thus we are uncertain if hip pre caution s with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA .
BACKGROUND Total hip arthroplasty ( THA ) is one of the most common orthopaedic operations performed worldwide .
Painful osteoarthritis of the hip is the primary indication for THA .
Following THA , people have conventionally been provided with equipment , such as raised toilet seats and chairs , and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees , or adduction or rotation past the midline .
These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation .
However , the appropriateness of these recommendations has been question ed .
OBJECTIVES To assess the effects of provision of assistive devices , education on hip pre caution s , environmental modifications and training in activities of daily living ( ADL ) and extended ADL ( EADL ) for people undergoing THA .