Total hip replacement - College of Occupational Therapists

Appendix 5: Evidence- based review tables
Source Design and participants Intervention Outcomes Results Quality and comment
Malik et al (2002) Case description
Describes three service users
who, in the immediate postoperative
period, dislocated
their THRs
All three service users, two
female and one male (aged 77,
40 and 64), underwent
Charnley THR via the Hardinge
approach. All had no cerebral
dysfunction, no radiological
evidence of component
malposition and leg length
discrepancies of less than
1 centimetre
Total hip replacement. Dislocation. Service users dislocated at 14, 19
and 23 days post- operatively, when
turning to answer the telephone. It
was assumed that the dislocation
was due to postural reasons
The authors recommend that when
discussing hip precautions and
performance of activities of daily
living post- operatively, specific
mention should be made regarding
the need to place the telephone in
an easily accessible location, and
think of safe limb positioning prior
to automatically using the
telephone without prior thought.
Grade D – Very Low
Limitations:
• Descriptive only
• Case series but very limited
information provided.
United Kingdom.
Mancuso
et al (2003)
Cross- sectional design
Aim: measure service user preoperative
expectations of THR,
and to assess whether
expectations vary by
demographic characteristics
and functional status
n=1103
Primary unilateral or bilateral
THR
Mean age 65 ± 13 years
Male: female ratio = 43%:57%
United States of America.
Total hip replacement
– unilateral or bilateral.
Self- reported preoperatively:
• Hospital for special
surgery total hip
replacement
expectations survey
• American Academy of
orthopaedic surgeons
hip/knee module
• SF- 36® – general health
scale.
Significant evidence that decreased
status pre- operatively results in
greater expectation of THR surgery
and greater importance on postoperative
achievement of goals
Pain relief and improvement in
walking were most prevalent
expectations
• Service users with worse hip
function had more expectations
compared with patients who had
better hip function (p=0.0001)
• Similarly, service users who had
worse overall physical health had
more expectations compared with
service users who had better
physical health (p=0.0001)
• Service users with worse function
were particularly more likely to
expect relief of night pain and to
not need medications compared
with service users who had better
function (p=0.001).
Grade C – Low
Limitations
• Allocation unclear
• Possible bias through selfreporting
• Co- morbidities not included
in analysis
• Single setting
• Not controlled for severity
of pre- operative condition
• Unclear if differences
existed in pre- operative
discussion about
expectations between
surgeons and service users.
College of Occupational Therapists
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