Orthopaedic References

Question 1

NICE (2011) hip fracture management (physio focused)

Answer 1

1. Pts to be assessed and mobilised 1 day post op if not contraindicated and ensure regular review if proceeding days a
2. Goals of rehab is to restore pt to previous baseline of function and independence.

3.

Question 2

Fox et al. 2011- hip precautions after surgery following a hemiarthoplasty: what’s happening in the UK and at what cost? (Prospective audit)

Answer 2

• common hip precautions (don’t bend hip past 90 degrees, don’t cross legs, don’t twist on that leg)
• this was adopted by 78% of nhs centres in the UK in 2011. Prospectively, this costs per patient £12 more in equipment, 1.5 hrs therapy, and delayed d/c 0-4 days range, average 1/4 day.
• these precautions encourage physical limitations and limit functional tasks unnecessarily
• overall this costs more money, more therapy time for no reduction in incidence rates. Bonkers!

Question 3

Restrepo et al. 2011 hip dislocation: are hip precautions necessary? (prospective audit)

Answer 3

-2543 patients underwent THR. Trust agreed to abandon hip precaution protocol- no limitations on hip range/ no specialised equipment such as raised seats/ abduction pillows/ riser recliners.

• 4 dislocations. Reported no increase in incidence rate and the trust continued no precaution hip protocol from there on in.