To reduce dislocation after hip replacement surgery, precautions were originally introduced with the first hip replacements . Despite developments in surgical management, precautions appeared to remained unchanged, although the true extent of their use was unknown, and the benefits to patients questioned. Methods To answer the research question of whether precautions affected patient outcomes, the work in this thesis explored several issues. The extent of current endorsement of precautions by healthcare professionals was essential to establish if precaution use was widespread. If precautions endorsement was extensive, it was important to evaluate the willingness of healthcare practitioners (HCPs) and patients, to participate in a randomised controlled trial (RCT). A combination of postal, telephone and conference surveys were carried out with patients and HCPs to answer these questions and establish if a trial was necessary. The survey studies confirmed the need for further investigation, and a non-inferiority RCT, evaluating the impact of precautions on function and pain, sleep, quality of Life, patient satisfaction with walking and anxiety, was subsequently conducted. Results 87% of surgeons and 89% of physiotherapists continued to endorse precautions after surgery. 76% of patients adhered to post-operative precautions whilst in hospital, although this reduced to 68% adherence when patients went home. Only 40% of surgeons surveyed were willing to participate in an RCT, compared with 94% of physiotherapists and 97% of patients. The subsequent RCT compared outcomes of patients following precautions, and not following precautions. It was revealed that although anxiety was significantly worse in the treatment group at 6 weeks, it was no worse at 12 weeks. There was no worsening of other outcomes in patients following rehabilitation without precautions, therefore the primary hypotheses held true. Conclusion Except for anxiety at 6 weeks, patients recovering from hip replacement without precautions, were no worse in outcomes than those following precautions.
- hip replacement