exercise-diagram

Hip Advisor – Dislocated Hip Precautions

The risk of dislocation after a total hip replacement is thought overall to be 2 in 100 operations.  This number changes for patient age and surgeon’s skill.

By the time I was sent home from hospital after my hip replacement, I had amassed enough information leaflets and letters to fill a ring binder. I wanted to follow all the guidance so that I get back to an active life as fast as possible; however, the advice I read about ‘Hip Precautions’ was unclear and in some places contradictory.

This made me fearful of doing something ‘wrong’ and jeopardising my hip through dislocation.

On the NHS website I found these ‘hip precautions’ that someone is advised to take after an operation:

  • avoid bending your hip more than 90° (a right angle) during any activity
  • avoid twisting your hip
  • don’t swivel on the ball of your foot
  • when you turn around, take small steps
  • don’t apply pressure to the wound in the early stages (so try to avoid lying on your side)
  • don’t cross your legs over each other
  • don’t force the hip or do anything that makes your hip feel uncomfortable
  • avoid low chairs and toilet seats (raised toilet seats are available)

Google also threw up a leaflet: Guy’s and St Thomas Taking Precautions Following Hip Surgery

Mixed messages

In my piles of take home paperwork was a booklet of exercises, one of which needed me to bend my hip past 90°.

So, do I do this exercise as I want to get better and my NHS hospital gave the booklet to me. Or do I not do the exercises as the NHS website advises against it, and I don’t want to jeopardise my hip.  Or if I don’t do the exercise as instructed am I jeopardising my recovery in the long term?

As I am young in hip replacement terms (how glorious, being called young in my 50’s) I qualified for NHS physiotherapy.

So I took the booklet to the NHS physiotherapist for my first appointment two weeks after surgery. They told me NOT to do the exercise (until I checked with the surgeon).

At my six week check up, I asked the surgeon, who said I SHOULD be doing the exercise.

The hospital had, therefore been consistent with the advice, the physio deferred to the surgeon, so in a way they were consistent, but the NHS overall seems muddled about ‘hip precautions’.  The NHS site says that the ‘Recovery’ page is due for review this autumn, I’ll keep a watch to see if things are clearer after.

Research

An internet search found this interesting piece of research from 2015 (click on the title below to open the link):

In patients who have had a THA (‘hip replacement’) does the application of hip precautions versus unrestricted activities significantly decrease the risk of prosthetic dislocation?

If you don’t like scientific papers, the conclusion is simply put:

‘The available evidence would suggest that the rate of dislocation … is low and is not improved by hip precautions. At the same time, hip precautions are associated with a slower return to activities of daily living, significant expense, and less patient satisfaction. …but a definitive study would be prohibitively large and expensive.’

What next?

I’ve been told this week that I need my other hip replaced sometime soon.  I wonder if there will be enough evidence available by then for the NHS, as well as my surgeon, to give conclusive advice about hip precautions?

I have used the exercise as an example, but I was given contradictory advice for several of the hip precautions.

I understand that it is a difficult area, as every person operated on is different, and every surgeon is different and there are many many hips available on the market to put into someone, so coming to a definitive answer is difficult, and the research is ‘prohibitively large and expensive’.

The USA, however, carries out 300 000 hip replacements a year (interestingly the UK carries out approximately 120 000 per year – despite having a population five times smaller).  Would it be worth the time and cost to the American insurance companies to do the research?

I’d feel more confident if there were either clarity of guidance (clarity gives reassurance even if the research is not yet clear) or an explanation of the merits and drawbacks of the hip precautions, so that I could make an informed choice.

Encouragingly, what is clear is that, the risk of displacement seems to decrease the more time that has elapsed from the operation.  Six weeks now and counting.

Thank you to NHS

I have written before about my disquiet over the unexpected pain I experienced immediately after the operation. This piece also examines what I perceive to be a fault.

But.

What I completely get is that I received all this fabulous, life-changing treatment for no charge.  The professionalism, support and care I experienced were absolutely brilliant.  The two issues of precautions and pain are matters of, in a large organisation, tweaking systems – but in an overstretched organisation with no wriggle room, what seems to be a simple matter viewed from the outside, can cost more in terms of time and organisation than can simply be achieved.

Further reading

I found this interesting video: dislocation after total hip replacement

Also this article discussing research about dislocation rates: dislocation following total hip replacement

 

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>