Total hip replacement - College of Occupational Therapists

Introduction
Weight- bearing restrictions may also be in place. There is disparity in the length of time
to which it is recommended that precautions should be adhered, but this is usually
between six weeks and three months, as directed by the surgeon (this can vary from
surgeon to surgeon within the same department).
As more evidence becomes available to challenge the efficacy of hip precautions, this is
an area of practice likely to see ongoing change, and occupational therapists should,
therefore, take this into account when implementing the recommendations in this
practice guideline.
1.4 Practice requirement for the guideline
Occupational therapy is a key intervention for individuals receiving a total hip
replacement, as identified within the Musculoskeletal Services Framework (DH 2006),
National Audit Office report (NAO 2003), and good practice guidance (BOA 2006)
outlined in section 1.2.
The number of occupational therapists specifically working across the care pathway with
adults who have osteoarthritis or who receive a total hip replacement is not known.
However, given the number of hip replacements across the four UK countries, it is predicted
that a considerable proportion of the 32,454 occupational therapists registered with the
Health and Care Professions Council (HCPC 2012a), may come into contact with service users
receiving a hip replacement at some stage during their health or social care intervention. A
UK national survey of occupational therapists reported that the mean percentage of
department/service resources used to support service users receiving a total hip replacement
was 39 per cent. It also indicated that on average, an excess of two hours was spent in
face- to- face contact, and over one hour in non- direct contact (Drummond et al 2012).
To date there has been no formal national guidance for occupational therapists working
with service users who have received a total hip replacement. Known evidence from
both the literature (McMurray et al 2000, Drummond et al 2012), and from expert
practitioners involved in the College of Occupational Therapists Specialist Section –
Trauma and Orthopaedics, has, however, confirmed that differences exist in practice
across the UK in areas which include pre- operative assessment and education processes,
use of hip precautions and equipment provision.
The number of service users undergoing total hip replacement in the UK is high. This
demand for orthopaedic services, combined with the pressures of waiting list
management, means there is a constant drive for improved efficiency in service
provision. In this context, and with the significant variation in practice across the UK,
the publication of a practice guideline for occupational therapy and total hip
replacement is intended to assist clinicians and managers in achieving the best possible
outcomes for the service user, utilising resources in line with evidence and best practice.
1.5 Topic identification process
Total hip replacement, as a guideline development topic, was identified by the College
of Occupational Therapists Specialist Section for Trauma and Orthopaedics (COTSS –
Trauma and Orthopaedics).
A decision was made to focus the guideline on total hip replacement both as an elective
procedure and following trauma (i.e. fractured neck of femur). While it is recognised
that there are differences for the service user having elective compared to trauma
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Occupational therapy for adults undergoing total hip replacement