I have a few friends who have had hip replacements without any of the restrictions I had when I got my new hip. They drive in the first month. They don't even have to use a raised toilet seat. Is it really safe to do all this? I thought the big scare was the risk of dislocating the new hip.
Anyone who has had a hip replacement knows that there are certain precautions that must be followed to avoid dislocating the new hip. But there is some suggestion that maybe those precautions aren't really necessary after all.
With today's updated surgical techniques and less invasive procedures, perhaps the risk of a hip dislocation just isn't as real as it once was. Surgeons from Lehigh Valley Hospital in Allentown, Pennsylvania conducted a recent study that showed the restrictions placed on some patients getting a total hip replacement might not be necessary.
Half their patients were placed in the standard restrictions group. They had to avoid bending the hip past 90 degrees and couldn't ride in a car for the first month following surgery. The other half were in the early group. There were no hip flexion or car riding restrictions placed on these patients. They were told not to cross the legs but could bend at the waist or from the hip as long as they were comfortable doing so. They could even sleep in any position they wanted without even a pillow between the legs. Sitting on a toilet could be done without the special raised toilet seat required in the standard precautions (restricted) group.
All patients in both groups had the same hip replacement operation (a modified anterolateral procedure). A single surgeon who specializes in total hip replacements performed all the operations. The patients were matched between the two groups for age, socioeconomic background, and size (body mass index).
The early group did better in all ways and with no more complications than the standard restrictions group. There were no hip dislocations reported in either group. The early group switched from a walker to a cane sooner than the restricted group. The early group got rid of the cane sooner. They stopped walking with a limp significantly before the restricted group. They were back behind the wheel driving much sooner, too. All-in-all the early group was so successful, the authors ended the study and switched all of their appropriate patients to an early rehab protocol.
The key here is the careful selection of patients and using a minimally invasive surgical procedure that doesn't cut through all the muscles around the hip. It is best to follow whatever guidelines the surgeon provides on a patient-by-patient basis. With younger, healthier adults getting hip replacements with minimally invasive techniques, it's likely that the extreme restrictions of the past will be replaced with a more accelerated rehab process. That includes fewer restrictions and means a faster pace of recovery.
Prodromos A. Ververeli, MD, et al. Evaluation of Reducing Postoperative Hip Precautions in Total Hip Replacement: A Randomized Prospective Study. In Orthopedics. December 2009. Vol. 32. No. 12. Pp. 889-893.
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