Reinventing Hip Precautions

Project completed as part of the 2025 Hampshire Hospitals Green Team Competition. 

Project Team Members: 

• Katie Thornton, physiotherapist
• Yaron Haziza, physiotherapist

Setting / Patient Group: Patients undergoing elective total hip replacement at Hampshire Hospitals.

Issue: 

Traditional hip precautions after Total Hip Replacement (THR) which avoid flexion >90°, internal rotation, and adduction are outdated and do not reduce dislocation risk. They increase anxiety, delay recovery, and require costly equipment provision. Current practice also limits efficiency of pre-assessment processes.

Aim: 

Stop recommending traditional hip precautions and introduce a more efficient pre-assessment system for THR patients.

Intervention: 

Literature review confirmed precautions do not affect dislocation rates. Proposed alignment with evidence-based practice by coaching patients to avoid extremes of movement and listen to their bodies. Planned adoption of text message triage system used successfully for TKR patients. Collected data on equipment costs, therapist time, and environmental impact.

Outcomes:

• Clinical: Evidence shows no increase in dislocation rates when precautions are removed. Patients without precautions demonstrate better functional outcomes and faster recovery. Surveys indicate reduced anxiety and improved confidence in movement.
• Environmental: Estimated annual saving of 3,301 kgCO2e (equipment, cleaning, delivery), equivalent to driving 9,712 miles. 
• Economic: Predicted savings of £33,757 per year from reduced equipment provision and staff time. 
• Social: Patient surveys showed 100% want evidence-based guidance, 75% value sustainability, and many reported anxiety about movement. Staff surveys indicated strong support for reducing time spent on equipment provision.

Key Learning: 

Removing hip precautions improves sustainability, reduces costs, and aligns care with evidence. Barriers include historic attitudes, consultant consensus, and small sample size. Risks of dislocation remain low and unchanged according to research. Change requires board-level approval, updated SOPs, and staff education. Wider adoption could standardise care nationally and improve patient experience while reducing environmental impact.