New Study: THR Surgeons Should Ease UP on Restrictions

Surgeons, after performing hip replacement surgery, typically give their patients a list of precautions—movements to avoid—during their recovery. Typical of these precautions is the advice to avoid bending the hip past 90 degrees, not turning the knee or foot inward or crossing the leg past the middle of the body.

Research presented at the February 2017 annual meeting of the Association of Academic Physiatrists has given a big “Oops” to the advice in the precautions. It turns out that patients who fail to follow their doctors’ post-surgery advice have shorter inpatient rehabilitation time and faster overall recovery than do the more compliant patients.

“We noticed postoperative hip precautions were being dictated by the surgeon’s preference rather than the operative technique,” explained Noel Rao, M.D., FAAPM, professor and chairman, Rosalind Franklin University of Medicine and Science, and former vice president of medical affairs and residency director at Marianjoy Rehabilitation Hospital, and lead investigator in the study.

“Furthermore, surgeons using the same approach in the same surgical group varied on whether they placed patients under restrictions. Some did and some did not, which raised the question—what would be the impact of not having restrictions on hip dislocation rates and length of stay using the anterior surgical method? If reduced restrictions do not increase hip dislocation rates and patients have a shorter length of stay, they could be rehabilitated and reintegrated into the community sooner.”

Rao’s team looked at the medical records of 68 people who underwent hip replacement surgery and noted each individual’s functional independence measure (FIM score). Study members checked the participants’ FIM scores on admission, daily during their hospital stay and at discharge.

Thirty-one patients were admitted to inpatient rehabilitation without post-operative surgical precautions, and 37 were admitted with precautions. The two groups were similar in age and both groups had similar FIM scores when admitted.

At the time of discharge, both groups had made similar progress in their overall FIM scores and their daily FIM improvements. However, the groups differed in their length of hospital stay. The group who entered rehabilitation without the surgeon’s post-operative precautions typically had a three-day shorter stay than did those who observed precautions. Ultimately, this translated to improved FIM efficiency for the group that did not observe precautions. According to Rao, this group did significantly better in daily motor FIM and overall FIM gains.

“While both groups made similar overall progress during inpatient rehabilitation, the group that did not observe post-operative precautions made gains within a shorter time frame as they did not have restrictions to follow and therefore did not have to spend time learning and consistently demonstrating hip precautions, which takes some time to accomplish,” explained Rao of the findings. “The absence of restrictions allowed these patients to improve their FIM scores quicker resulting in a shorter length of hospital stay. Additionally, we observed that reduced restrictions do not increase hip dislocation rates.”

Rao suggests patients considering hip replacement should discuss their surgeon’s preference for post-operative precautions and determine, in advance, if they agree with their surgeon’s method.