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      Recall and patient perceptions of hip precautions 6 weeks after total hip arthroplasty

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          Abstract

          Background and purpose

          There is a lack of evidence to support the role of hip precautions in preventing dislocation following total hip arthroplasty (THA). We report an exploratory study which assesses recall, adherence, and the impact of precautions on activities of daily living in the first 6 weeks postoperatively.

          Patients and methods

          We designed a new questionnaire based on the education patients receive and refined by professionals within our multidisciplinary team. 129 patients underwent primary elective THA during the study period and received the questionnaire at 6 weeks postoperatively.

          Results

          97 (75%) patients responded before the 8th week postoperatively. Most of these (83 patients) could remember all the precautions. Of the 97 who responded only 22 claimed to adhere to all of the precautions. 48 admitted to putting their own underwear on without the use of aids or assistance, and 38 had started walking without an aid. Due to the precautions 67 avoided leaving the house at some point and 63 were unable to perform desired activities. 84 stated that their sleep was affected. There were no dislocations among the 97 patients who responded; however, there was 1 dislocation among the 32 non-responders.

          Interpretation

          We found that most patients did not adhere to hip precaution advice. Precautions have a detrimental effect on patient activity and sleep. In view of the limited efficacy in reducing dislocation rate, we question the use of precautions in the primary arthroplasty setting.

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          Most cited references 17

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          Posterior approach to total hip replacement using enhanced posterior soft tissue repair.

          The two senior authors (PMP, RP) independently began using an identical enhanced posterior soft tissue repair after total hip replacement through a posterior approach. In the first author's experience, a dislocation rate of 4% in 395 patients before using the enhanced closure was reduced to 0% in 395 patients in whom the enhanced closure was performed. In the second author's experience, 160 total hip replacements had a dislocation rate of 6.2% before the enhanced closure whereas 124 total hip replacements had a dislocation rate of 0.8% after the enhanced closure. These results are highly statistically significant.
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            Prevalence of sleep problems and quality of life in an older population.

            To determine the prevalence of insomnia traits in a population and the effect of these traits on health-related quality of life. The Epidemiology of Hearing Loss Study is a population-based study in Beaver Dam, Wisconsin. Participants were interviewed as part of the 5-year follow-up examination (1998-2000) of the Epidemiology of Hearing Loss Study. Participants were interviewed at the study office in Beaver Dam, WI, by telephone, or at their residence. 2800 adults aged 53-97 years. N/A. Participants were asked to what extent they experienced difficulty getting to sleep, waking up at night and having a hard time getting back to sleep, and waking up repeatedly during the night for any reason. A response of "often" or "almost always" was coded as positive for an insomnia trait. The SF-36 was administered to assess mental and physical function. Twenty-six percent of the population reported one insomnia trait, 13% reported two, and 10% reported three. All eight domains and the Mental and Physical Component Summary scores of the SF-36 decreased significantly (F-test for linear trend statistically significant at p<0.0001) as the number of reported insomnia traits increased. These results indicate that symptoms of insomnia are common among older adults and are associated with a decrease in health related quality of life.
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              The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability.

              Ensuring the accuracy of the intra-operative orientation of the acetabular component during a total hip replacement can be difficult. In this paper we introduce a reproducible technique using the transverse acetabular ligament to determine the anteversion of the acetabular component. We have found that this ligament can be identified in virtually every hip undergoing primary surgery. We describe an intra-operative grading system for the appearance of the ligament. This technique has been used in 1000 consecutive cases. During a minimum follow-up of eight months the dislocation rate was 0.6%. This confirms our hypothesis that the transverse acetabular ligament can be used to determine the position of the acetabular component. The method has been used in both conventional and minimally-invasive approaches.
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                Author and article information

                Journal
                Acta Orthop
                Acta Orthop
                IORT
                Acta Orthopaedica
                Taylor & Francis
                1745-3674
                1745-3682
                October 2017
                12 July 2017
                : 88
                : 5
                : 496-499
                Affiliations
                [1 ]Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK;
                [2 ]Avon Orthopaedic Centre, Brunel Building, Southmead Hospital, Bristol, UK
                Author notes
                Article
                iort-88-496
                10.1080/17453674.2017.1350008
                5560211
                28699373
                © 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License ( https://creativecommons.org/licenses/by-nc/3.0)

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                Hip

                Orthopedics

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