Hip precautions not meaningful after hemiarthroplasty due to hip fracture. Cluster-randomized study of 394 patients operated with direct anterolateral approach

Aims: We aimed to compare two treatment regimes, one with and one without postoperative precautions in hemiarthroplasty patients, in terms of dislocation rate and patient-reported outcome. Direct lateral approach was used. Patients and Methods: 394 patients were included in a cluster-randomized study 2010−2014. Depending on which ward they were admitted to, they were allotted to free rehabilitation (non-precaution group, NPG, n = 226)or our conventional regime with precautions and mandatory assistive equipment (precaution group, PG, n = 168). Patients were followed during hospital stay, at 6 weeks (postal questionnaire), 3 month (visit)and 6 months (reading of medical records)by means of function tests, health-related quality of life (EQ-5D)and other patient-reported outcome measures (PROM). Results: One patient in each group had dislocation(s). We found no statistically significant differences regarding in-hospital-mortality, severe adverse events, EQ5D index or other PROM. In the NPG, rehabilitation personnel had significantly shorter work effort during hospital stay (p < 0.001). 7 in the NPG and 13 of the PG had reoperations (p = 0.038), 4 and 8 had deep infections, 3 and 5 periprosthetic fractures. Conclusion: Rehabilitation precautions are not needed for preventing dislocation when direct lateral approach is used. Without precautions, rehabilitation personnel implement significantly shorter work effort during hospital. We found no statistically significant differences regarding PROM and complications except for somewhat more reoperations in total in the precaution group.