The need for supine position advise in the first period (first 8 weeks) after a total hip replacement to prevent hip dislocation of the hip replacement.

In 2012, 592 primary total hip replacement were performed by the Orhopedisch
Centrum Oost Nederland. In the Netherlands 31.840 primary total hip replacement
are placed in 2009. One of the complications after a total hip replacement is
hip dislocation. Especially, in the first 8 weeks after the surgery there is a
risk for this complication. To reduces this risk patients receive during these
8 weeks precepts. In the Netherlands there is no consensus about these precepts
and the Nederlandse Orthopedische Vereniging (NOV) gives no advices. One of
these precepts is the supine position for 8 weeks after the surgery. It appears
that this precepts is experienced by patients as very stressful and the
adherence to this precepts decreases over time (Tijink, 2012).
For the replacement of a hip the OCON uses the posterolateral approach. No
literature is known about the added value of precepts after a total hip
replacement. However, for the anterolateral approach Peak et al., 2005
conducted a randomized clinical trial to precepts after surgery. The percentage
of hip dislocation in the total cohort was less than 1%. There were no
difference between with or without precepts concerning supine position.
Concerning the low risk of hip dislocation, the diversity of national advises
for precepts after surgery, the decrease of adherence over time and the burden
on the patient for supine position during sleep the OCON doubts the added value
of the precepts supine position after a total hip replacement.

The primary objective of this study is the to prove that there is no difference
in hip dislocation percentage to 8 weeks after total hip replacement in patient
with or without the precepts of supine position when lying, in the first 8
weeks after surgery.

A blocked stratified surgeon blinded randomized clinical trial.

patients in the intervention group will be exempted from sleeping on the back
during the first 8 weeks after total hip replacement surgery. The remaining
anti-luxation instructions (for example, bend forward) remain applicable.

This study is based on the hypothesis that there is no difference in percentage
of hip dislocations between groups with and without supine position as precept.
Participants are not burden with extra visits to the clinic. However,
participants are asked to fill out questionnaires pre-operative, 8 weeks
post-operative and 6 months post-operative. For the patient of the intervention
group there is the advantage of no precept concerning supine position during
the first 8 weeks after surgery.