Do Hip Precautions Matter After Posterior Approach Total Hip Arthroplasty With Capsular Repair? A Randomized Control
Aditya S Yadav1, Ajay Potluri1, Siddhartha Dandamudi1
1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Background:
The clinical efficacy of posterior hip precautions in preventing dislocation after primary posterior approach total hip arthroplasty (THA) remains uncertain. Such mobility restrictions may delay patients' return to daily activities and functional recovery. The aim of this study was to determine whether THA hip precautions impact hip dislocation rates.
Methods:
We conducted a prospective, randomized study evaluating the effect of hip precautions on the risk of dislocation after primary THA. A total of 1,133 patients were enrolled and underwent posterior approach primary THA by multiple fellowship-trained surgeons at a single academic center between January 2016 and June 2025. Patients were randomized to either a restricted group, instructed to avoid hip flexion beyond 90°, adduction past midline, and internal rotation for six weeks postoperatively, or an unrestricted group without restraint to motion or activity. Demographics, surgical indications, and prosthesis data were recorded. The minimum follow-up for analysis was 6 weeks. The primary outcome was dislocation; secondary outcomes included perioperative complications and patient-reported outcomes. The unrestricted and restricted groups included 567 and 566 patients, respectively, with no significant demographic or surgical differences (all P > 0.245). Follow-up was similar between groups (mean, 1.3 ± 1.4 years; range, 0.1 to 8.6 years; P = 0.645). Statistical analyses used Fisher's exact test and t-tests using P < 0.05 for significance.
Results:
Overall, 10 dislocations (0.88%) were reported at 9.1 ± 10.5 months postoperatively, with six in restricted and four in unrestricted patients (odds ratio: 0.60; 95% confidence interval: 0.17 to 2.17; P = 0.547). Hip Disability and Osteoarthritis Outcome Scores Joint Replacement were statistically higher in the unrestricted group at six weeks (76.78 versus 74.48, P = 0.028) and three to six months (84.60 versus 81.54, P = 0.015), with no significant difference in baseline scores (51.98 versus 50.44, P = 0.130). There were no differences observed in 90-day complications or revisions (all P > 0.209).
Conclusions:
We could not detect any difference in dislocation risk following routine use of strict hip precautions following posterior approach THA with capsular repair. These precautions may unnecessarily limit early functional recovery, increase patient anxiety, and negatively impact patient-reported outcomes.
