Are hip movement precautions effective in preventing prosthesis dislocation post hip arthroplasty using a posterior surgical approach? A systematic review and meta-analysis

Purpose To determine if hip movement precautions reduce hip prosthesis dislocation rates post hip arthroplasty using a posterior surgical approach compared to minimal or no movement restrictions. Materials and methods This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. CINAHL, MEDLINE and Embase were searched from inception until September 2020 supplemented by citation tracking. Studies were included if patients had a hip arthroplasty using a posterior surgical approach with comparative data on hip movement precautions or minimal to no movement restrictions. Methodological quality was evaluated using the Downs and Black checklist. Results From a yield of 8 studies, meta-analysis of 7 studies and 9599 total hip arthroplasties, there was low quality evidence of no increased risk of dislocation (RR = 0.98, 95%CI 0.58 to 1.67) for patients prescribed minimal or no hip movement restrictions compared with patients prescribed hip movement precautions. There were 121/5440 dislocations (2.2%) in the movement precaution group and 90/4159 dislocations in the minimally restricted group (2.2%). Conclusions Dislocation rates after total hip arthroplasty are low irrespective of movement precaution allocation. Resources allocated to implementing hip movement precautions may be better directed towards other clinical areas.

Automated summary

This study aimed to determine if hip movement precautions reduce the risk of dislocation after hip arthroplasty using a posterior surgical approach. The meta-analysis of multiple studies found that there was no increased risk of dislocation in the group with minimal or no movement restrictions compared to the group with hip movement precautions. Therefore, allocating resources to implementing hip movement precautions may not be necessary.