Evaluation of reducing postoperative hip precautions in total hip replacement: a randomized prospective study

Currently, many rehabilitation protocols for total hip replacements (THRs) include activity restrictions to prevent postoperative dislocation. There is increasing demand for more efficient and safe rehabilitation protocols. This randomized prospective study evaluates the need for hip restrictions following a modified anterolateral procedure. From 2004 to 2008, 81 patients seeking elective THRs were randomly assigned into a standard rehabilitation group or an early rehabilitation group. The standard group included restrictions to avoid hip flexion >90 degrees and avoidance of riding in a car for the first postoperative month. The early group had no flexion or car riding restrictions. Forty-three patients were in the standard group and 38 patients were in the early group. There were no significant demographic differences between the 2 groups. All patients completed the Short Form 12-question Health Survey and Harris Hip Score preoperatively and at 4 weeks, 1 month, 3 months, and 1 year postoperatively. The time-points at which the patient first drove and ambulated with a cane, without a cane, and without a limp were also collected. No incidents of dislocation occurred. Patients in the early group were faster to ambulate with only a cane (P=.03), without a cane (P<.001), and without a limp (P=.003). They also drove earlier (P=.02). Pace of recovery was the only significant difference between the 2 groups. The early rehabilitation protocol increases the pace of recovery compared to a pathway with hip precautions without increasing complications.