Do hip precautions after posterior approach total hip arthroplasty reduce the incidence of early postoperative dislocation or influence other patient-important outcomes: A systematic review and meta-analysis from a Danish Clinical Practice Guideline

Background: Hip precautions are routinely prescribed to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach.
Aim: The purpose of this systematic review was to determine whether hip precautions influence early recovery after THA.
Materials and Methods: Randomised and non-randomised controlled trials comparing postoperative precautions after THA with minimal or no precautions were included. MEDLINE, EMBASE, PEDRO and Cinahl were searched in March 2016 and updated in June 2020. Screening of eligible studies, data extraction and risk of bias assessment were conducted by two reviewers. Critical outcome were hip dislocations three months post-THA. Important outcomes included late hip dislocation, patient-reported function, functional performance, reoperation, pain, health-related quality of life, and return to work. Inverse variance random effects and Mantel- Haenszel fixed-effects meta-analyses were performed to synthesise the results. A guideline panel used the Grading of Recommendations Assessment and Evaluation (GRADE) approach to rate the certainty of evidence. The Protocol was registered at the Danish Health Authority website.
Results: Two randomised and four non-randomised trials, including 3,778 participants, were included. There was low certainty of evidence for no difference in risk of dislocation within three months after THA following hip precautions compared to no or minimal precautions (risk ratio: 1.38, 95% CI: 0.73-2.59), low certainty of evidence for a small effect on patient-reported function favouring no or minimal precautions (risk ratio: 1.54, 95% CI: 1.18-2.02), and very low certainty of evidence for a small effect on functional performance favouring no or minimal precautions (risk ratio: 0.64, 95% CI: 0.48-0.85). Moderate, low, and very low certainty of evidence was found for no difference on any other important outcomes.
Interpretation / Conclusion: Precautions will possibly not reduce the risk of dislocation. Both patient-reported function and functional performance were slightly better with no or minimal precautions. Recommendation: Do not routinely instruct patients in hip precautions after posterior approach THA because there is possibly no effect on the risk of hip dislocations.