Dislocation of a new hip joint is one of the things that patients are usually most concerned about and is something that surgeons will be very careful to warn about when advising patients about how to approach their post-operative recovery.
Interestingly, according to the results of a new study, depending on the type of surgery they have had, low-risk patients do not need to be as concerned about the risk of dislocation as their level of risk to this group is extremely low. The research, carried out by the Hospital for Special Surgery (HSS) in New York, reports that “low-risk patients undergoing a total hip replacement with a posterior approach can skip the standard hip precautions currently recommended for post-surgical recovery.”
Firstly, it is important to understand that there are two fundamentally different approaches to carrying out a total hip replacement: the posterior approach and the anterior approach. The differences between these two approaches are as follows:
- Posterior approach: This involves surgeons making an incision through the side or the buttocks. The incision is small; the main gluteal muscle is split and small muscles are taken off the back of the hip and repaired at the end of the surgery.
- Anterior approach: By comparison, surgeons using this approach will make their incision through the front of the hip. The incision starts at the top of the pelvic bone and continues down towards the top of the thigh. The surgery is done by opening the space between different muscle groups.
Both approaches have a very low chance of their new joint dislocating.
What this means for hip replacement patients
The relatively low risk for patients should be taken into consideration when advising patients what to expect from their recovery and what precautions to take, and indeed that is the way that Mr Simon Bridle approaches post-operative planning.
Authors of the new report suggest that if the guidance is not adapted to reflect the nature of the surgery, then low-risk patients could be scared unnecessarily about their risk of dislocation, when in fact they are at very low risk of this occurring. Peter Sculco, one of the report authors, says that if not handled properly “the precautions can be limiting and cause fear in patients.”
By way of an example, for patients who have had traditional posterior approach surgery, the “standard precautions include not flexing your hip past 90 degrees, not internally rotating your hip more than 10 degrees, using an elevated seat cushion at all times, and sleeping on your back for six weeks.”
This level of precaution is not required if the muscles are repaired with a posterior approach, or with an anterior approach, as the muscles have not been affected in the same way. The important take away from this new research is that a ‘one size for all approach’ is not appropriate for designing a recovery plan for the two different kinds of surgery, and that guidance for the post-operative days, weeks and months should be designed and tailored according to the nature of the surgery. The traditional ‘hip precautions’ are just not required in most patients having hip replacements and patients are allowed to use the hip as comfort allows from the very early post-operative stages.