Hip surgery has come a long way

Historically total hip replacement precautions have been strictly advised to prevent the risk of hip dislocation. Patients are told not to flex their hips beyond 90 degrees, to sleep supine, to avoid situations where the hip is crossed or twists; all to prevent the hip from coming out.

Traditionally new hip patients are discharged with a trailer load of expensive equipment;  chair raisers, commodes to go over the toilet and grabbers to avoid leaning forwards when sitting. This policy is so long standing it has become entrenched in physio vocabulary. We have been reciting the hip post-op protocol for years with little thought or audit of the validity of this threat.

As such, the site of a low toilet seat strikes fear in the heart of many a new hip owner. A whole population has diligently laid coffin-like in their beds for months. Patients are slow to return to driving, avoid car journeys altogether or visiting friends/relatives due to the inevitable low seats. Imagine getting dressed or emptying the dishwasher without bending your hip beyond 90 degrees for fear of it popping out. In my experience this can result in patients avoiding movements and activities for far longer than the prescribed three months. This often leads to a stiffer hip or less physically active person than could otherwise have been achieved.

Total hip replacements are a common and successful surgery. Advances in surgical expertise, innovations in hip prosthetic technology and a better understanding of when and who do best with this type of surgery have all contributed to its impressive outcomes and the remarkably low dislocation rates.

There is a growing body of research supporting a less strict and more individualised approach to post total hip replacement advice, precautions and needs assessed provision of equipment. As yet the overwhelming message appears to show that the incidence of dislocations is no different with this approach. To be clear, the previous advice has not been abandoned. Instead patients are advised based on their individualised needs. Should they require chair raisers and adaptions for safety and comfort then they are provided. Often the requirements of a 55-year-old’s new hip differ from that of a 90-year-old’s; lifting the ban enables some to return to normal activity sooner. Most people would not contemplate sleeping on their newly operated hip due to pain; however, as comfort and common sense allow they can sleep, dress and move about the house more freely without such rigid restrictions placed upon them.

This change in practice has been advocated by the physiotherapy governing body the CSP and ATOP. It is a view that many NHS trusts are starting to roll out and audit individually within their departments. Many London based hip surgeons are championing this approach and heading up the research groups bolstering the evidence in support of a more individualised approach to the provision of hip advice and rehabilitation.

If you would like to know more then please don’t hesitate to get in touch or discuss with your orthopaedic team.

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