Discontinuing the recommendation of hip precautions does not increase the risk of early dislocation after primary total hip arthroplasty using 36-mm heads: a population-based study from the Danish Hip Arthroplasty Register

• Published in: Acta orthopaedica Vol. 95; pp. 407 - 414
• Main Authors: Iljazi, Afrim, Sørensen, Michala Skovlund, Winther-Jensen, Matilde, Overgaard, Søren, Petersen, Michael Mørk
• Format: Journal Article
• Language: English
• Published: Sweden MJS Publishing, on behalf of the Nordic Orthopedic Federation 18.07.2024; Medical Journals Sweden
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Cohort Studies; Denmark - epidemiology; Female; Hip Dislocation - epidemiology; Hip Dislocation - etiology; Hip Dislocation - prevention & control; Hip Prosthesis - adverse effects; Humans; Incidence; Male; Middle Aged; Osteoarthritis, Hip - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Registries; Risk Factors; Denmark
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.2340/17453674.2024.41168

Dislocation is a severe complication following total hip arthroplasty (THA). Hip precautions have been recommended in the initial postoperative period but evidence supporting this practice is limited. We therefore conducted a population-based study to evaluate the association between discontinuing recommending postoperative hip precautions and the risk of early dislocation. This is a cohort study with data from the Danish Hip Arthroplasty Register and the Danish National Patient Register. We included patients who underwent primary THA for osteoarthritis in 2004-2019 in public hospitals in the Capital Region of Denmark. The cohort was divided into the hip precautions group, comprising patients operated on between 2004 and 2009, and the no-precautions group operated on between 2014 and 2019. The primary outcome was the difference in the absolute risk of dislocation within 3 months post-surgery. The secondary outcome assessed the same risk within 2 years. We evaluated the difference in absolute risk using absolute risk regression (ARR). The cumulative incidence of dislocation within 3 months was 2.9% (confidence interval [CI] 2.5-3.3) in the hip precautions group and 3.5% (CI 3.1-3.9) in the no-precautions group. The risk of dislocation was higher in the no-precautions group but failed to reach statistical significance in the crude (ARR 1.2, CI 0.9-1.6) and multivariate model (ARR 1.4, CI 0.9-2.2). We found a higher but statistically insignificant increase in the risk of early dislocation in the no-precautions group. The lack of significance in the association may be explained by the increased use of 36-mm femoral heads after the guideline revision.