Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients

Background and purpose — Hip precautions are rou-tinely prescribed to patients with osteoarthritis to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach. However, recommendations have been based on very low certainty of evidence. We updated the evidence on the influence of hip precautions on early recovery following THA by this systematic review. Materials and methods — We performed systematic searches for randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL published from 2016 to July 2022. 2 review-ers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analy-ses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was the risk of hip dislocations within 3 months of surgery. Other outcomes were long-term risk of dislocation and reop-eration, self-reported and performance-based assessment of function, quality of life, pain, and time to return to work. Results — 4 RCTs and 5 NRSs, including 8,835 partici-pants, were included. There may be no or negligible differ- ence in early hip dislocations (RCTs: risk ratio [RR] 1.8, 95% confidence interval [CI] 0.6–5.2; NRS: RR 0.9, CI 0.3–2.5)Certainty in the evidence was low for RCTs and very low for NRSs. Finally, precautions may reduce the performance-based assessment of function slightly, but the evidence wavery uncertain. For all other outcomes, no differences werfound (moderate to very low certainty evidence). Conclusion — The current evidence does not supporroutinely prescribing hip precautions post-surgically fopatients undergoing THA to prevent hip dislocations. How-ever, the results might change with high-quality studies.