The impact of unrestricted rehabilitation following THR (ReHip2).

• Research type

  Research Study

• Full title

  A Randomised Controlled Trial of the impact on function of an unrestricted rehabilitation pathway of no precautions following total hip replacement (THR) (ReHip2).

• IRAS ID

  192077

• Contact name

  JUSTINE THEAKER

• Contact email

  justine.theaker@manchester.ac.uk

• Sponsor organisation

  The University of Manchester

• Clinicaltrials.gov Identifier

  NCT03833258

• Clinicaltrials.gov Identifier

  IRAS ID 195796. REC Reference; 16/WM/0282, The ReHip1 study, 'Do patients adhere to post-operative restrictions following total hip replacement?' was carried out in preparation for ReHip2 to explore the necessity to carry out a trial.

• Duration of Study in the UK

  1 years, 1 months, 24 days

• Research summary

  The study aims to explore the impact on function of a rehabilitation pathway with no restrictions in patients following total hip replacement (THR).

  Following THR, patients are advised to follow a restricted rehabilitation pathway. This involves avoidance of movements increasing the risk of hip dislocation, commonly known as ‘precautions.’ These are;

  • No bending past 90 degrees at the hip
  • Use raised chair
  • No twisting in either standing or sitting
  • No crossing legs
  • Sleep on their back
  • Use elbow-crutches / mobility aid

  However, emerging evidence casts doubt on the impact of precautions on dislocation. Previous research has explored factors influencing dislocation, such as surgical technique, type of hip replacement and precautions. The evidence is mixed in terms of what exactly constitutes an unrestricted pathway with many studies being selective regarding which of the precautions were omitted.

  In existing research there is no consideration that patients find adherence to precautions challenging with potential non-adherence. However in patient forums they report difficulties managing activities of daily living due to the imposed precautions. A shift away from precautions will have the potential to improve patient function, pain and quality of life.

  Present research suggests further work is required due to a lack of evidence enabling traditional precautions to be excluded following THR.

  The proposed research plans to explore the differences in two randomised groups of patients using questionnaires and patient diaries for 12 weeks after surgery.
  One group will follow usual care of a restricted pathway following precautions, and the second an unrestricted pathway with no precautions.

  The study sites are two specialist Elective Orthopaedic Centres in Greater Manchester. The study will involve patients admitted for THR in the care of a surgeon agreeing to participate.

  The study is unfunded however is endorsed by the British Orthopaedic Society and The Association of Trauma and Orthopaedic Chartered Physiotherapists.

• REC name

  North West - Preston Research Ethics Committee

• REC reference

  19/NW/0250

• Date of REC Opinion

  10 Jun 2019

• REC opinion

  Further Information Favourable Opinion