title: The rate of dislocation is not increased when minimal precautions are used after total hip arthroplasty using the posterolateral approach: a prospective, comparative safety study.
abstract: OBJECTIVE
  In order to prevent dislocation of the hip after total hip arthroplasty (THA), patients have to adhere to precautions in the early post-operative period. The hypothesis of this study was that a protocol with minimal precautions after primary THA using the posterolateral approach would not increase the short-term (less than three months) risk of dislocation.
  
  
  METHODS
  We prospectively monitored a group of unselected patients undergoing primary THA managed with standard precautions (n = 109, median age 68.9 years; interquartile range (IQR) 61.2 to 77.3) and a group who were managed with fewer precautions (n = 108, median age 67.2 years; IQR 59.8 to 73.2). There were no significant differences between the groups in relation to predisposing risk factors. The diameter of the femoral head ranged from 28 mm to 36 mm; meticulous soft-tissue repair was undertaken in all patients. The medical records were reviewed and all patients were contacted three months post-operatively to confirm whether they had experienced a dislocation.
  
  
  RESULTS
  There were no dislocations in the less restricted group and one in the more restricted group (p = 0.32).
  
  
  CONCLUSIONS
  For experienced surgeons using the posterolateral approach at THA and femoral heads of diameter ≥ 28 mm, it appears safe to manage patients in the immediate post-operative period with minimal precautions to protect against dislocation. Larger studies with adequate statistical power are needed to verify this conclusion.
  
  
  CONCLUSIONS
  Experienced orthopaedic surgeons using the posterolateral approach for THA should not fear an increased dislocation rate if they manage their patients with a minimal precautions protocol. Cite this article: Bone Joint J 2016;98-B:589-94.
authors.affiliation: St. Anna Hospital, Bogardeind 2, 5664EH, Geldrop, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Kornuijt
authors.affiliation: St. Anna Hospital, Bogardeind 2, 5664EH, Geldrop, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Das
authors.affiliation: St. Anna Hospital, Bogardeind 2, 5664EH, Geldrop, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Sijbesma
authors.affiliation: St. Anna Hospital, Bogardeind 2, 5664EH, Geldrop, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: van der Weegen
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002985:Clinical Protocols; D005260:Female; D005270:Femur Head / Q000033:anatomy & histology / Q000601:surgery; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies
keywords: Dislocation; Posterolateral Approach; Precautions.; Primary Hip Arthroplasty