title: Secure tracks device improves functional recovery and pain after total knee arthroplasty: a prospective, randomized, pilot study. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review Patterns of Rehabilitation After Hip Arthroplasty and the Association with Outcomes: An Episode of Care View Pre-surgical sensorimotor training for patients undergoing total hip replacement: a randomised controlled trial. Questionnaire on the perceptions of patients about total knee replacement. Reduced patient restrictions following total hip arthroplasty: study protocol for a randomized controlled trial Does preoperative hip rehabilitation advice improve recovery and patient satisfaction? Characterizing rehabilitation services for patients with knee and hip replacement in skilled nursing facilities and inpatient rehabilitation facilities. A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. Early discharge and home intervention reduces unit costs after total hip replacement: results of a cost analysis in a randomized study Environmental assessment and modification to prevent falls in older people. Effects of an experimental program on post-hospital adjustment of early discharged patients. The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. [Clinical effects of comprehensive rehabilitation after minimally invasive total hip arthroplasty]. Questionnaire on the perceptions of patients about total hip replacement. Evaluation of reducing postoperative hip precautions in total hip replacement: a randomized prospective study.
abstract: This prospect i ve , r and omized study compares functional outcomes between a novel support device ( Secure Tracks ™ ) and a st and ard walker  following unilateral total knee replacement . Thirty patients were r and omized for the study ; 15 walker patients ( 70.7±6.4 yrs ) and 15 Secure Track patients ( 68.2±6.7 yrs ) ( p=0.31 ) . Total distance walked during all therapy sessions was nearly two times greater in the Secure Track ( 2,332 ft ) than with the walker ( 1,241 ft)(p=.053 ) . This trend began on the day of surgery ( 275 ft vs. 176 ft , p<.069 ) and was statistically significant by the following morning ( 287 ft vs. 151 ft , p=.019 ) . Patients in the Secure Track spent a greater amount of time up and ambulating with the therapists in all sessions ( .006.30 ) . At the first clinical follow-up , patients that had walked in the Secure Track completed the timed up and go test ( TUG ) , a predictor of fall risk , 3 seconds faster than the st and ard rehabilitation group ( 9.6 vs. 12.9 seconds , p<.091 ) . The novel therapy patients demonstrated significantly greater pain relief following the TUG test ( p=.005 ) . This study demonstrates that the choice of support device can increase patient ambulation following surgery , which will in turn improve functional outcomes and pain relief Benefits of a direct anterior approach ( DAA ) versus a posterior-lateral ( PA ) approach to THA were assessed in a single-surgeon , IRB-approved , prospect i ve , r and omized clinical study . Subjects ( 43 DAA and 44 PA ) were evaluated at 6 weeks , and 3 , 6 and 12 months . The primary end point was ability to climb stairs normally and walk unlimited at each time point . Secondary end points included assessment by several outcome instruments . DAA subjects performed better during the immediate post-operative period ; they had lower VAS pain scores on the first post-operative day , more subjects climbing stairs normally and walking unlimited at 6 weeks , and higher HOOS Symptoms scores at 3 months . There were no significant differences between groups at later time points . Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases Purpose : Total hip arthroplasty ( THA ) is a common and effective treatment of hip osteoarthritis . Activity restrictions known as hip pre caution s are widely practice d in rehabilitation post THA , aim ing to foster healing and prevent hip dislocation . The focused clinical question was : Does the application of hip pre caution s in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation ? Methods : A comprehensive literature search was conducted for r and omized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up , with dislocation as an end point . Retrieved titles were assessed independently by 2 review ers for inclusion and underwent st and ardized data extraction . Results : Title search produced 80 potentially relevant articles . Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria . No eligible studies were found that concerned posterior approaches to hip arthroplasty , so the results of this review concern only anterolateral approaches . Neither included study showed any benefit of hip pre caution s in preventing dislocation . Conclusion : The rate of dislocation after anterolateral THA is low and is not improved by hip pre caution s. Hip pre caution s are associated with a slower return to activities , significant expense , and decreased patient satisfaction . Existing studies risk being compromised by a type II error , but a definitive study may be prohibitively large and expensive Tian W , DeJong G , Munin MC , Smout R : Patterns of  rehabilitation after hip arthroplasty and the association with outcomes : An episode of care view . Objectives : To examine the patterns of rehabilitation  after elective and nonelective hip arthroplasty  and its association with outcomes over an episode of postacute care . Design : Data were obtained from a multisite prospect i ve observational cohort study and its companion follow-up study . Patterns of care were measured by the combination of setting s of care where  hip arthroplasty patients received rehabilitation therapy . Main outcome measure was motor portion of the functional independence measure . Results : Approximately 90 % of hip arthroplasty patients received rehabilitation care from more than one setting . Eight patterns of care were identified in the follow-up period . Patterns of subsequent care were driven more by initial setting than by etiology . Nonelective hip arthroplasty patients had lower motor functional independence measure scores and used more rehabilitation services than did elective hip arthroplasty patients . Patterns of care were modest factors ( accounted for only 7 % of variance ) in predicting patient motor functional independence measure over an episode of postacute care . Conclusions : Etiology of hip arthroplasty is associated with amounts of rehabilitation care used and outcomes . After the initial postacute rehabilitation setting , patients continued to receive considerable amounts of therapy in various setting s. It is important to look beyond a single setting of care to an entire episode of care when examining clinical outcomes The aim of this study was to investigate whether pre-operative , sensorimotor training results in improved physical function , quality of life , sensorimotor function and reduced disability in total hip replacement patients . 80 subjects awaiting total hip replacement at a Swiss hospital were recruited for this r and omised controlled trial . The intervention group participated in a pre-operative home exercise sensorimotor training programme ; the control group received no therapy . Primary outcome measure was physical function , secondary outcome measures were quality of life , disability and sensorimotor function . Outcomes were measured using generic and disease-specific question naires as well as objective ly assessed balance ability . Measurements were taken one day before surgery and 10 days , 4 and 12 months after surgery . The intervention showed improved quality of life and sensorimotor function before surgery . These effects were lost following surgery . The intervention group experienced more disability at 4 months than the control group . At one year follow-up group-membership influenced quality of life scores depending on the measurement-time-point . It can be concluded that no useful effect was identified for a pre-operative sensory-motor training-programme . The psychological aspects following total hip replacement need to be considered in order to facilitate coping-strategies , reduce unrealistic expectations and increase satisfaction We have developed a 12-item question naire for patients having a total knee replacement ( TKR ) . We made a prospect i ve study of 117 patients before operation and at follow-up six months later , asking them to complete the new question naire and the form SF36 . Some also filled in the Stanford Health Assessment Question naire ( HAQ ) . An orthopaedic surgeon completed the American Knee Society ( AKS ) clinical score . The single score derived from the new question naire had high internal consistency , and its reproducibility , examined by test-retest reliability , was found to be satisfactory . Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up . We also compared change in scores with the patients ' retrospective judgement of change in their condition . The effect size for the new question naire compared favourably with those for the relevant parts of the SF36 . The change scores for the new knee question naire were significantly greater ( p < 0.0001 ) for patients who reported the most improvement in their condition . The new question naire provides a measure of outcome for TKR that is short , practical , reliable , valid and sensitive to clinical ly important changes over time Background Total hip arthroplasty ( THA ) is a very common procedure in orthopedic surgery . In the Netherl and s , 25,642 primary THAs were performed in 2013 . Postoperative hip dislocation is one of the major complications and has been reported in 0.5 to 10.6 % of patients after primary THA.Several reports regarding the use of an anterolateral surgical approach have shown that a non-restriction or reduced restriction protocol does not increase the dislocation rate . For the posterolateral surgical approach it has been suggested that patient restrictions might be unnecessary but the amount of available literature is scarce . As such , r and omized controlled trials aim ed at investigating restrictions following THA using a posterior approach are strongly recommended . The aim of this prospect i ve r and omized controlled trial is to investigate the non-inferiority hypothesis concerning the early dislocation rate after THA in patients with and without the use of a reduced restriction protocol . Methods / Design After providing informed consent a group of 456 patients with symptomatic coxarthrosis will be r and omized to receive a THA either with care as usual , i.e. receiving postoperative restrictions including the advice to sleep in a supine position for the first 8 weeks postoperatively , or reduced restrictions with no recommendations regarding the position during sleeping . Primary outcome measure will be the percentage of early dislocations within the first 8 weeks after THA . Secondary outcome measures will be patient satisfaction , time to functional recovery , quality of sleep and patient ’s self-reported compliance with postoperative instructions . Discussion To our knowledge this will be the first r and omized controlled trial that compares a reduced restriction protocol with a restricted protocol following THA using a posterolateral surgical approach . Our hypothesis is that a reduced restriction protocol following THA with use of a posterolateral surgical approach has no influence on the early dislocation rate compared to a restricted protocol . Instead , embracing a reduced restriction protocol might even contribute to a higher quality of sleep , thereby facilitating a faster uptake and return to daily functions in patients after THA.Trial registration Clinical Trials.gov NCT02107248 , registration date 3 April 2014 The goal of the current study was to investigate whether preoperative rehabilitation advice reinforced by a patient information booklet can aid recovery after total hip arthroplasty in terms of pain , function , satisfaction , and quality of life .  Thirty-five patients awaiting primary total hip arthroplasty were recruited into this study and r and omly allocated before admission to receive either the st and ard pathway of care or the rehabilitation program and booklet . All patients showed increases in function and psychological variables with time . The preoperative class and booklet , however , seemed to have the greatest impact on length of hospital stay , reducing the hospital stay by 3 days , and therapy input required , significantly influencing the cost of the procedure ( the rehabilitation class led to a cost saving of 587 British pounds ; approximately 810 dollars , per patient ) . In addition , patients attending the class reported higher levels of satisfaction ( 99 % satisfied in the preoperative rehabilitation class compared with 80 % in the control group 3 months postoperatively ) and had more realistic expectations of surgery OBJECTIVE To characterize rehabilitation services for patients with knee and hip replacement in 3 types of postacute facilities in the U.S. DESIGN Multi-site prospect i ve observational cohort study . SETTING Eight freest and ing skilled nursing facilities ( SNFs ) , 1 hospital-based SNF , and 11 inpatient rehabilitation facilities ( IRFs ) . PARTICIPANTS Patients ( N=2158 ) with knee or hip replacement . INTERVENTIONS No new interventions . MAIN OUTCOME MEASURES Length of stay ( LOS ) , amount and intensity of physical therapy ( PT ) and occupational therapy ( OT ) , types of therapy activities . RESULTS Average LOS was about 15 days for freest and ing SNF patients , and 9 to 10 days for hospital-based SNF and IRF patients . Freest and ing SNFs and IRFs provide about the same number of hours of PT and OT ; the hospital-based SNF provided 27 % fewer hours . Freest and ing SNFs and the hospital-based SNF provided fewer hours a day than did IRFs . Joint replacement patients across all 3 types of facilities spent , on average , 70 % to 75 % of their PT time in just 2 activities -- exercise and gait and spent 56 % to 66 % of their OT time in 3 activities -- exercise , functional mobility , and dressing lower body . CONCLUSIONS Both freest and ing SNFs and IRFs provided similar amounts of PT with a similar emphasis on exercise and gait activities . IRFs , however , provided more OT than freest and ing SNFs . IRFs had shorter LOSs and more intensive therapy services than freest and ing SNFs . Study freest and ing SNFs exhibited greater variation in LOS and intensity of therapy than IRFs Objective : To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement . Design : Single blinded feasibility r and omised controlled trial , with data collection prior to the intervention , and at 4 , 12 , and 26 weeks following surgery . Setting : Recruitment from two NHS orthopaedic outpatient centres in the West Midl and s , UK . Subjects : Patients awaiting primary total hip replacement due to osteoarthritis were recruited . Following pre-operative assessment , patients were individually r and omised to intervention or control by a computer-generated block r and omisation algorithm stratified by age and centre . Interventions : The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations , assessed home safety , and provided appropriate adaptive equipment . The control group received treatment as usual . Outcomes : The study assessed the feasibility of recruitment procedures , delivery of the intervention , appropriateness of outcome measures and data collection methods . Health related quality of life and re source use were recorded at 4 , 12 and 26 weeks . Results : Forty-four participants were recruited , 21 were r and omised to the  occupational therapy  intervention and 23 to usual care . Analysis of 26 week data included 18 participants in the intervention group and 21 in the control . The intervention was delivered successfully with no withdrawals or crossovers ; 5/44 were lost to follow-up with further missing data for participation and re source use . Conclusions : The feasibility study provided the information required to conduct a definitive trial . Burden of assessment would need to be addressed . A total of 219 patients would be required in an efficacy trial Within the context of a double blind r and omized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs , we vali date d WOMAC , a new multidimensional , self-administered health status instrument for patients with osteoarthritis of the hip or knee . The pain , stiffness and physical function subscales fulfil conventional criteria for face , content and construct validity , reliability , responsiveness and relative efficiency . WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials Total hip replacement ( THR ) is a common and costly procedure . The number of THR is expected to increase over the coming years . Two pathways of postoperative treatment were compared in a r and omized study . Fifty patients from two hospitals were r and omized into a study group ( SG ) of 27 patients receiving preoperative and postoperative education programs , as well as home visits from an outpatient team . A control group ( CG ) of 23 patients received “ conventional ” rehabilitation augmented by a stay at a rehabilitation center if needed . All costs for the two groups both in hospitals and after discharge were collected and analyzed . On average total costs for the SG were $ 8,550 and $ 11,952 for the CG , a 28 % cost reduction . Total inpatient costs were $ 5,225 for the SG and $ 6,515 for the CG . In a regression analysis the group difference is statistically significant . Adjusting for changes in the Oxford Hip Score gives effective costs ( C/E ) . The ratio of the SGs C/E to the CGs is 0.60 . That is a cost-effectiveness gain of 40 % . A shorter hospital stay augmented with better preoperative education and home treatment appears to be more effective and costs less than the traditional in hospital pathway of treatment UNLABELLED To assess the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors . DESIGN A pilot three-armed r and omized controlled trial . SETTING Airedale National Health Service Trust catchment , North and West Yorkshire , Engl and . PARTICIPANTS Two hundred thirty-eight community-dwelling adults aged 70 and older with a history of falls in the previous year . INTERVENTION Assessment and modification of the home environment of people at greater risk of falls .  MEASUREMENTS Fear of falling was the primary outcome measure , and an analysis of covariance was conducted on the area under the curve at 12 months . As a secondary outcome , falls were analysed using negative binomial regression . Quality of life and independence in activities of daily living ( ADLs ) were also measured . RESULTS The intervention had no effect on fear of falling ( P=.63 ) . The occupational therapy group had significantly fewer falls than controls 12 months after the assessment ( incidence rate ratio (IRR)=0.54 , 95 % confidence interval (CI)=0.36 - 0.83 , P=.005 ) . There was no significant effect on falls in the trained assessor group ( IRR=0.78 , 95 % CI=0.51 - 1.21 , P=.34 ) . CONCLUSION Environmental assessment had no effect on fear of falling . Environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high-risk individuals whereas that prescribed by a trained assessor did not . Further research in other setting s is needed to confirm this , to explore the mechanisms , and to estimate cost-effectiveness This paper reports the results of a study evaluating the effects of an experimental program on post-hospital adjustment of early discharged patients after total hip arthroplasties . This experimental program consisted of patient teaching by means of a pamphlet and videotape , and regular home visits by a community health nurse . A significant difference was found between the experimental and control patients in perceived preparedness for discharge and post-hospital exercise compliance . The early discharged experimental patients demonstrated post-hospital objective and subjective functional capabilities equal to those of the control patients . This study is seen to have implication s for nursing service and nursing education BACKGROUND It is currently unknown whether functional restrictions following total hip arthroplasty can reduce the prevalence of early postoperative dislocation . Our hypothesis was that dislocation was more likely to occur in patients who were not placed on these restrictions . METHODS We performed a prospect i ve , r and omized study to evaluate the role of postoperative functional restrictions on the prevalence of dislocation following uncemented total hip arthroplasty through an anterolateral approach . Of the 630 eligible consecutive patients , 265 patients ( 303 hips ) consented to be r and omized into one of two groups ( the " restricted " group or the " unrestricted " group ) . The patients in both groups were asked to limit the range of motion of the hip to < 90 degrees of flexion and 45 degrees of external and internal rotation and to avoid adduction for the first six weeks after the procedure . The patients in the restricted group were instructed to comply with additional hip pre caution s during the first six weeks postoperatively . Specifically , these patients were managed with the placement of an abduction pillow in the operating room before bed transfer and used pillows to maintain abduction while in bed ; used elevated toilet seats and elevated chairs in the hospital , in the rehabilitation facility , and at home ; and were prevented from sleeping on the side , from driving , and from being a passenger in an automobile . All patients were followed for a minimum of six months postoperatively . RESULTS There was one dislocation in the entire cohort ( prevalence , 0.33 % ) . This dislocation occurred in a patient in the restricted group during transfer from the operating table to a bed with an abduction pillow in place . Patients in the unrestricted group were found to return to side-sleeping sooner ( p < 0.001 ) , to ride in automobiles more often ( p < 0.026 ) , to drive automobiles more often ( p < 0.001 ) , to return to work sooner ( p < 0.001 ) , and to have a higher level of satisfaction with the pace of their recovery ( p < 0.001 ) than those in the restricted group . There was an additional expenditure of approximately $ 655 per patient in the restricted group . CONCLUSIONS Total hip arthroplasty through an anterolateral approach is likely to be associated with a low dislocation rate . Removal of several restrictions did not increase the prevalence of dislocation  following primary hip arthroplasty at our institution . However , it did promote substantially lower costs and was associated with a higher level of patient satisfaction as patients achieved a faster return to daily functions in the early postoperative period BACKGROUND Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement ( THR ) . AIM To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR . DESIGN Non-r and omized , controlled study . SETTING Inpatient . POPULATION 365 consecutively included THR patients . METHODS Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a st and ard package of assistive devices ( restricted group ) . This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs ( unrestricted group ) . Question naires on function , pain , quality of life ( HOOS ) , anxiety ( HADS ) , working status and patient satisfaction were completed before THR , 3 and 6 weeks after . RESULTS The HOOS function score at the 3 measurement times was ( mean ± SD ) ; unrestricted group : 46 ± 17 - 76 ± 9 - 83 ± 14 compared to restricted group : 43 ± 16 - 81 ± 14 - 83 ± 13 . Changes over time was significantly higher in the restricted group ( P=0.004 ) . Return to work 6 weeks after THR for the unrestricted group compared to restricted group was : 53 % versus 32 % ( P=0.045 ) . No significant differences between groups in pain , symptoms , quality of life , anxiety/depression , hip dislocations and patient satisfaction . CONCLUSION This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices , but the difference was eliminated after 6 weeks . Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work . CLINICAL REHABILITATION IMPACT It is possible to reduce movement restrictions and use of assistive devices considerably . More research on safety issues is needed to eluci date the effect of unrestricted rehabilitation on hip dislocation OBJECTIVE To explore clinical effects of comprehensive rehabilitation therapy for function restore of hip joint after minimally invasive total hip arthroplasty . METHODS From March 2006 to February 2008 , 100 patients were r and omly divided into the treatment group and the control group . Fifty patients in the treatment group , including 21 males and 29 females , ranging in age from 56 to 78 years , with an average of ( 67.2 + /- 11.0 ) years . Fifty patients in the control group , including 26 males and 24 females , ranging in age from 54 to 79 years , with an average of ( 65.5 + /- 11.5 ) years . The course of disease of the two groups were 10 to 15 years . The comprehensive rehabilitations such as joint range of motion , the activities of daily living and restoring muscle strength were performed step-by-step in the treatment group under the guidance of the therapist at the 2nd day after hip arthroplasty . Above rehabilitations were not performed in the control group . The postoperative functional recovery of hip joint , the Harris scores and X-ray were analyzed and compared between the two groups . RESULTS All the patients were followed and the duration averaged 13 months ( 12 to 14 months ) . The therapeutic effects of the two groups had statistical differences , Zc = 12.72 , P<0.001 . In the treatment group , the average Harris score was ( 94.50 + /- 29.87 ) , 32 patients got an excellent result , 12 good , 4 poor and 2 bad . While in the control group , above data were ( 63.50 + /- 19.97 ) , 12 , 15 , 7 and 16 respectively . The therapeutic effects of treatment group were better than those of control group . The X-ray showed that there were no hip prosthesis loosening , femoral neck fractures and other complications . CONCLUSION The early comprehensive rehabilitation after minimally invasive total hip replacement is the key to decrease postoperative complications and to decide the success or failure of surgery We developed a 12-item question naire for completion by patients having total hip replacement ( THR ) . A prospect i ve study of 220 patients was undertaken before operation and at follow-up six months later . Each completed the new question naire as well as the SF36 , and some the  Arthritis Impact Measurement Scales ( AIMS ) . An orthopaedic surgeon assessed the Charnley hip score . The single score derived from the question naire had a high internal consistency . Reproducibility was examined by test-retest reliability and was found to be satisfactory . The validity of the question naire was established by obtaining significant correlation in the expected direction with the Charnley scores and relevant scales of the SF36 and the AIMS . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at the follow-up . The st and ardised effect size for the new question naire compared favourably with that for the SF36 and the AIMS . The new question naire provides a measure of outcome for THR which is short , practical , reliable , valid and sensitive to clinical ly important changes Currently , many rehabilitation protocol s for total hip replacements ( THRs ) include activity restrictions to prevent postoperative dislocation . There is increasing dem and for more efficient and safe rehabilitation protocol s. This r and omized prospect i ve study evaluates the need for hip restrictions following a modified anterolateral procedure . From 2004 to 2008 , 81 patients seeking elective THRs were r and omly assigned into a st and ard rehabilitation group or an early rehabilitation group . The st and ard group included restrictions to avoid hip flexion > 90 degrees and avoidance of riding in a car for the first postoperative month . The early group had no flexion or car riding restrictions . Forty-three patients were in the st and ard group and 38 patients were in the early group . There were no significant demographic differences between the 2 groups . All patients completed the Short Form 12- question Health Survey and Harris Hip Score preoperatively and at 4 weeks , 1 month , 3 months , and 1 year postoperatively . The time-points at which the patient first drove and ambulated with a cane , without a cane , and without a limp were also collected . No incidents of dislocation occurred . Patients in the early group were faster to ambulate with only a cane ( P=.03 ) , without a cane ( P<.001 ) , and without a limp ( P=.003 ) . They also drove earlier ( P=.02 ) . Pace of recovery was the only significant difference between the 2 groups . The early rehabilitation protocol increases the pace of recovery compared to a pathway with hip pre caution s without increasing complications
target: AUTHORS ' CONCLUSIONS Very low quality evidence is available from single trials , thus we are uncertain if hip pre caution s with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA .
background: BACKGROUND Total hip arthroplasty ( THA ) is one of the most common orthopaedic operations performed worldwide .
  Painful osteoarthritis of the hip is the primary indication for THA .
  Following THA , people have conventionally been provided with equipment , such as raised toilet seats and chairs , and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees , or adduction or rotation past the midline .
  These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation .
  However , the appropriateness of these recommendations has been question ed .
  OBJECTIVES To assess the effects of provision of assistive devices , education on hip pre caution s , environmental modifications and training in activities of daily living ( ADL ) and extended ADL ( EADL ) for people undergoing THA .