Evaluation of hip precautions following total hip replacement: a before and after study.

PURPOSE: To evaluate the effect of hip precautions following total hip replacement (THR) by comparing outcomes of patients who received hip precautions with those who did not. METHODS: Before (phase 1) and after (phase 2) study with two consecutive cohorts of patients. In phase 1, patients were strictly educated about hip precautions. In phase 2, patients were not advised about precautions but encouraged to move as able. The primary outcome was the Oxford Hip Score (measuring pain and function) at three months. Secondary outcomes included Oxford Hip Score, activities of daily living (ADLs) (Nottingham Extended Activities of Daily Living), sleep (Pittsburgh Sleep Quality Index), mood (Hospital Anxiety and Depression Scale), and quality of life (QoL) (EQ-5 D). RESULTS: A total 237 participants successfully underwent THR surgery, 118 participants in phase 1 and 119 in phase 2. At three months postoperatively, participants had significantly equivalent Oxford Hip Scores (MD= -0.82, 95% CI: -2.64 to 1.00). No significant differences between the groups were observed at six weeks and three months postoperatively for secondary outcomes. CONCLUSIONS: Patients recovered at a similar rate regardless of whether they received hip precautions or not, with no increase in complications observed. The findings lend evidence to support decision-making around the removal of precautions.Implications for rehabilitationThe use of no hip precautions resulted in no additional benefit following primary total hip replacement surgery in terms of functional recovery.Patients who were not prescribed precautions had significantly less pain and greater function during the first week after surgery.Total hip replacement patients had similar outcomes at six weeks and three months postoperatively regardless of whether they received hip precautions or not.The study provides evidence to suggest that hip precautions may not be needed routinely following elective primary total hip replacement.

Improving resource utilisation and outcomes after total knee arthroplasty through technology-enabled patient engagement.

BACKGROUND: A multi-modal, technology-enabled, patient engagement and pathway management solution (PES) for patients undergoing primary total knee arthroplasty (TKA) was evaluated. The primary outcome measure was length of stay (LoS). The secondary outcome measures were clinical and patient-reported outcomes (PROMs). METHODS: Retrospective analysis of a consecutive series of 1256 TKA patients before (n = 783) and after (n = 473) implementation of the PES. LoS, PROMs, complications, readmissions, and return to theatre were measured. Results were analysed using bivariate and multivariable regression using general linear models, and a sensitivity analysis on LoS was conducted using interrupted time series (ITS) methods. RESULTS: Patients in the PES cohort had a significantly shorter mean LoS of two days (mean 4.7 days) versus the Pre-PES patients (mean 6.7 days; p < 0.001) in multivariate analysis. PES was also associated with a significant reduction in rates of reoperation within 60 days compared with Pre-PES (adjusted rate 2.2% versus 5.0%, p = 0.031). There were no statistically significant differences in the 60-day complication rate and 30-day readmission rate. All PROMs in the PES cohort demonstrated significant improvement (change from baseline to six months postoperative) compared with Pre-PES (Oxford Knee Score, 20.1 versus 15.5, p < 0.001; EQ-5D Index, 0.40 versus 0.32, p = 0.005; and EQ VAS, 22.9 versus 8.3, p < 0.001). CONCLUSIONS: Outcomes following TKA performed in enhanced recovery programs may be improved using technology to more effectively engage patients and streamline their surgical pathway. Integration of such solutions may significantly reduce LoS and improve PROMs without negatively impacting clinical outcomes.