Does the use of hip precautions influence post-operative physiotherapy outcomes in patients who have undergone hip surgery? A service evaluation

Purpose: Dislocations, whilst rare, are a serious post-operative complication associated with hip surgery. This complication, which occurs in between 1-11% of cases is more common in the first three-months post-operatively and is often multifactorial in nature. To reduce this risk, hip precautions, a series of movements to be avoided, have been implemented following hip surgery on a global scale. However, there is conflicting evidence of their effect in reducing dislocation rates. There is evidence to suggest that implementing hip precautions has no impact on patient-reported outcomes. This service evaluation (SE) aims to compare post-operative outcomes of patients who were and were not prescribed hip precautions who were seen by the Community Therapy Service (CTS), to inform decisions regarding patient care.
Methods: A quantitative experimental design, using retrospective data collected from physiotherapy records of patients who completed their treatment with CTS at Oxford Health NHS Foundation Trust, following hip surgery between November 2024 and April 2024, was conducted. CTS provides a short-term, domiciliary rehabilitation service typically spanning 6-8 weeks. This SE examined the pre- and post-physiotherapy musculoskeletal Therapy Outcome Measure Score 2019 (TOMS) and the number of appointments for patients seen by CTS. TOMS has been validated as a reliable measure of patient outcome across a range of impairments and therapies and has a meaningful clinically important difference of +/- 0.5 points at repeated measures.
Data, including whether the patient was prescribed hip precautions post-operatively, was extracted from the physiotherapy records by BK, and analysed using independent samples t-tests where two-tailed p values <0.05 were considered statistically significant.
Results: Twenty-six patient records were included in this SE with equal numbers of patients prescribed hip precautions (n=13) and those that were not (n=13).
There was no statistically significant difference in the number of physiotherapy sessions received between the hip precaution and no hip precaution groups (mean difference 1.61; p=0.0611)
There was no statistically significant difference in pre- to post-treatment TOMS between the hip precaution and no hip precaution group (mean difference -1.08; 95% CI -0.61 - +2.77; p=0.199). Both groups achieved MCID thresholds for TOMS with mean improvements of 5.38 (SD = 2.50) and 6.46 (SD=1.51) for the hip precaution and no hip precaution groups respectively.
Conclusion(s): This SE concluded that there was no statistically significant difference in post-physiotherapy outcomes, or the number of physiotherapy sessions required, for patients prescribed hip precautions, compared to those without. MCID thresholds for the TOMS were met by both groups, although in favour of those who did not have hip precautions, who on average required at least one less session compared to those prescribed hip precautions. The results of this SE are comparable with previous research, which highlights the equivalent results of functional restoration, with and without hip precautions. These results, however, are founded upon a small sample size. Future SEs should examine a larger patient group to detect significant differences, accounting for the wider complexity of patient outcomes.
Impact: These results could infer that the Trust continue to be guided by surgical expertise in the prescription of hip precautions.