JBJS - 2026-07-01 - Journal Article; Multicenter Study
Minimal Movement Restrictions Do Not Increase Hip Dislocations Following Total Hip Arthroplasty: A Before-and-After Study of 10,357 Patients.
Klaassen AD, Willigenburg NW, Musters JWQ, Jager J, Poolman RW, the Santeon Hip Osteoarthritis Group
Topics
Key Takeaway
Minimal movement restrictions after THA produced a 90-day dislocation rate of 1.93% versus 1.46% with strict restrictions — a non-significant difference (p=0.093) across 10,357 hips.
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Summary
This multicenter before-and-after study asked whether eliminating strict postoperative movement restrictions increases 90-day dislocation rates after THA. Patients operated between 2015–2020 were divided into strict-restriction (n=7,661) and minimal-restriction (n=2,691) cohorts based on institutional protocol change. Dislocation rates were 1.46% vs 1.93% respectively, with no statistically significant difference (p=0.093).
Key Limitation
The before-and-after design cannot control for unmeasured secular trends — particularly shifts in surgical approach distribution or bearing surface use — that occurred concurrently with the protocol change and independently affect dislocation rates.
Original Abstract
BACKGROUND
Hip dislocation is the most common reason for early revision after total hip arthroplasty (THA). To prevent dislocation, patients are often prescribed movement restrictions following THA; however, these restrictions can be uncomfortable and limiting for patients and may delay a return to daily activities. The present study aimed to investigate whether a protocol with reduced movement restrictions following THA would lead to an increased incidence of early hip dislocations.
METHODS
In this uncontrolled, multicenter, before-and-after study, 2 groups were retrospectively compared. Patients who underwent a THA between January 1, 2015, and March 31, 2020, were included. Patients in the first group (n = 7,666) were prescribed strict movement restrictions following THA, and patients in the second group (n = 2,691) were prescribed minimal movement restrictions. Patient and prosthesis characteristics were collected, as well as data regarding hip dislocations within 90 days postoperatively as the primary outcome.
RESULTS
The incidence of early hip dislocations was not significantly different between movement groups, with 112 (1.46%) of 7,661 hips in the restricted group and 52 (1.93%) of 2,691 hips in the minimally restricted group experiencing a dislocation (p = 0.093).
CONCLUSIONS
The use of a protocol with minimal movement restrictions following THA did not increase the incidence of early hip dislocations.
LEVEL OF EVIDENCE
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.