Recommendations on the use of restrictions and assistive devices after total hip arthroplasty: an adolopment of guidelines.

Abstract

Movement restrictions and assistive devices have traditionally been recommended to prevent hip dislocation after total hip arthroplasty (THA). Considering the advancements in THA surgery, a review of treatment recommendations is worthwhile. The aim of this study was to investigate whether unrestricted protocol (without movement restrictions and assistive devices) should be recommended for THA patients. A multiprofessional panel used the GRADE-Adolopment to develop the present recommendations, following the GIN-McMaster-Guideline-Development-Tool. We selected guideline topic and target audience, formulated clinical questions and prioritised outcomes. For the first question, a source guideline was identified and adoloped, whereas the second question required a de-novo recommendation. Therefore, the GRADE-Evidence-Profile and the Evidence-to-Decision framework were completed. Finally, the panel discussed and formulated the final recommendations. Hip dislocation was defined as critical outcome. No between-groups differences in the early dislocation rates were found: without movement restrictions, 1623 patients, RR 0.44 (CI₉₅ 0.16-1.20); without assistive devices, 4426 patients, RR 0.75 (CI₉₅ 0.52-1.08). Finally, considering small desirable health effects and trivial undesirable health effects of the intervention, we integrated two "conditional-recommendations" in favour of an unrestricted protocol. Through GRADE-adolopment approach new recommendations to provide an evidence-based guidance after THA have been formulated.