ATOCP conference: Trauma and orthopaedic physios vote for the abolishment of hip precautions after surgery

The keynote debate at the Association of Trauma and Orthopaedic Chartered Physiotherapists annual conference in Oxford on 26 November had speakers for and against the abolishment of hip precautions.

Jane Harrison, lead physiotherapist for the South West London Elective Orthopaedic Centre in Epsom, Surrey, which has largely abolished precautions on movement for patients with new hips, said her trust had also saved 65 per cent on the cost of props needed to help post-operative hip replacement patients who were previously limited by precautions.

But Ms Harrison said ending official precautions did not mean patients should be given carte blanche to do what they wanted after surgery.

‘Patients should be cautious and listen to their pain,’ she said.

‘When they are initially numb immediately after their operation they should be particularly careful.’

Patients should not sit on the floor or engage in extreme movement, but the key was to assess each patient as an individual and use clinical reasoning, rather than introduce hard and fast rules for all patients Ms Harrison said.

Anthony Gilbert, clinical research physiotherapist at the Royal National Orthopaedic Hospital in Stanmore, arguing against the abolition of hip precautions, accepted that dislocation was most likely if patients ‘pushed things’, but he said issuing parameters for movement meant patients were less likely to go to extremes.

It was also important to consider the quality of orthopaedic surgery around the country, he said. And Giles Stafford, consultant orthopaedic surgeon at South West London Elective Orthopaedic Centre, said the quality of surgery was vital, and precautions would make no difference if the hip replacement was not done well.

Mr Stafford, arguing in favour of ending precautions, said his trust audited the dislocation rates for surgeons who used precautions and those who didn’t and they found that those who didn’t use precautions had a lower dislocation rate in the short and long term.

His department agreed to modify precautions by removing the requirement to use raised toilet seats, and for patients not to sleep on their sides, amongst others,  and a further audit showed there was no increase in dislocation rates.

Geoff Stranks, consultant trauma and orthopaedic surgeon at Hampshire Hospitals Foundation Trust, speaking against the proposal, said some patients needed parameters on their movement to prevent them going beyond their limits, and other patients needed parameters to feel safe to move at all.

A vote taken before the debate showed almost universal support among delegates for abolishing precautions. A vote taken after the debate produced the same result.