How necessary are hip restrictions for avoiding dislocation following hemiarthroplasty or total hip arthroplasty in older patients with a hip fracture?

Purpose: It is common practice for health care professionals to encourage hip fracture patients to adhere to a set of guidelines to prevent potential hip dislocation, so-called 'hip restrictions', following either hemiarthroplasty (partial) or total hip arthroplasty. The purpose of this critical review was to investigate the factors influencing dislocation for hip fracture patients who had undergone hemiarthroplasty or total hip arthroplasty and whether there was evidence to support compliance with hip restrictions following surgery. Method: A search of published literature was carried out to collect the most relevant and highest level evidence available. It was considered important to determine what previous research had accomplished and which studies might have an indirect or implied relationship to the topic. This critical review investigates the literature available and whether studies carried out can inform current clinical practice. Findings: The evidence indicates that, for hemiarthroplasty, the surgical approach has a strong influence on the dislocation rate and the recommendation is that, if using an anterolateral approach, restricting hip movement following surgery is unnecessary. For total hip arthroplasty, the dislocation rate is higher in those requiring total hip arthroplasty following a hip fracture (trauma) than for those undergoing an elective, planned procedure. Conclusion: The limited body of research regarding compliance with hip restrictions and influence on the dislocation rate refers to elective, planned surgery only. Because the traumatic hip fracture population is entirely different from the elective population, the outcomes for the elective population cannot be generalised to those with a hip fracture in a trauma setting.