Total Hip Arthroplasty for Posttraumatic Conditions

Min Lu, MD; Dayna Phillips, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(8):275-285. 

In This Article

Postoperative Care

Antibiotic prophylaxis is continued postoperatively until intraoperative cultures are negative. Pharmacologic deep vein thromboprophylaxis is administered per institutional protocol.

For prior acetabular trauma, weight bearing should be restricted postoperatively if notable bone grafting is performed or if initial implant stability relies markedly on screw fixation. Patients are instructed on toe-touch weight bearing for 6 to 12 weeks until stable bone ingrowth is observed.

For prior femoral trauma, weight bearing status is determined by the presence of a trochanteric osteotomy or bone defects. In the absence of an osteotomy or notable defects, weight bearing as tolerated may be initiated. Conversely, if a trochanteric osteotomy is used, toe-touch weight bearing is initiated for 6 weeks. At that time, weight bearing can be progressed if no migration of the trochanteric fragment or implants is found. A hip abduction brace is used for patients with a trochanteric osteotomy or abductor deficiency. Because all cases of complex hip arthroplasty are at higher risk of instability, we are conservative in instituting hip precautions for most patients. The exact degree of activity restriction and duration of precautions vary depending on the complexity of prior injury, abductor mechanism integrity, and the surgical approach used.

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