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 .
Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study.
BACKGROUND Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement ( THR ) . AIM To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR . DESIGN Non-r and omized , controlled study . SETTING Inpatient . POPULATION 365 consecutively included THR patients . METHODS Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a st and ard package of assistive devices ( restricted group ) . This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs ( unrestricted group ) . Question naires on function , pain , quality of life ( HOOS ) , anxiety ( HADS ) , working status and patient satisfaction were completed before THR , 3 and 6 weeks after . RESULTS The HOOS function score at the 3 measurement times was ( mean ± SD ) ; unrestricted group : 46 ± 17 - 76 ± 9 - 83 ± 14 compared to restricted group : 43 ± 16 - 81 ± 14 - 83 ± 13 . Changes over time was significantly higher in the restricted group ( P=0.004 ) . Return to work 6 weeks after THR for the unrestricted group compared to restricted group was : 53 % versus 32 % ( P=0.045 ) . No significant differences between groups in pain , symptoms , quality of life , anxiety/depression , hip dislocations and patient satisfaction . CONCLUSION This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices , but the difference was eliminated after 6 weeks . Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work . CLINICAL REHABILITATION IMPACT It is possible to reduce movement restrictions and use of assistive devices considerably . More research on safety issues is needed to eluci date the effect of unrestricted rehabilitation on hip dislocation
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 .