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

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          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.


          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.


          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 16

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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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            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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              Sleep disturbances after fast-track hip and knee arthroplasty.

               L Krenk,  P Jennum,  H Kehlet (2012)
              Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement with length of stay (LOS) <3 days. The primary endpoint was REM sleep duration on the first postoperative night compared with before operation.

                Author and article information

                Acta Orthop
                Acta Orthop
                Acta Orthopaedica
                Taylor & Francis
                October 2017
                12 July 2017
                : 88
                : 5
                : 496-499
                [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
                © 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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