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

PurposeMovement 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.MethodsA 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.ResultsHip 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.ConclusionThrough GRADE-adolopment approach new recommendations to provide an evidence-based guidance after THA have been formulated.