Hi guys – I have had a lot of conversations with my surgeon about this (I had a right, then left posterior approach THR in 2014). First, I think there is some incentive to decrease precautions and limitations if they are not indicated because these are the main ‘con’s’ to the posterior approach when competing with the anterior approach. I have a great deal of respect for my surgeon. He is nationally known and all about the evidence, great ethics and best outcomes. He is strongly contemplating changing the precautions at VCU (He is head of the department). He says these precautions were created in the 60’s and the THR has changed significantly since that time. The hospital pre-op class, the PT’s in the hospital and the home health PT’s continue to follow the precautions, but he believes they are much too conservative. He came into my room on day 1 after the surgery and adducted my leg well past midline. From my experience, I believe (i.e., no evidence, just personal experience!) it is the combined position of flexion/add/IR that puts the posterior approach pt. at greatest risk, not any of the motions in isolation. When I am working on improving flexion, I have patients rock in quadriped in relative hip ER to decrease risk. I also believe it is helpful to teach patients the concept of end-feel and educate them to avoid pushing into resistance in combined movements. In addition, I think having a surgeon who repairs the deep hip rotators and comprehensive PT to strengthen all layers of hip musculature likely significantly decreases risk for dislocation. My surgeon agrees. Unfortunately, one study shows that, with the anterior approach, 25% of patients end up with a torn deep external rotator during dislocation for surgery which is not repaired. This was one of the main reasons I chose the posterior approach.
Another opinion: Many surgeons and PT’s tend to take away assistive devices when the patient does not have adequate strength to ambulate in normal biomechanics. I would rather keep them on the AD a little longer if using the AD helps to facilitate normal dynamic strength in normal biomechanics.
Would love to see some research on dislocation incidence in those with less conservative precautions…..