Description
In this enlightening session, Sebastian Dawson-Bowling discusses critical practices in orthopedic surgery, particularly after hip replacements. He begins by addressing hip precautions, raising the issue of their necessity post-surgery. Historically, patients have been advised to follow specific protocols—such as avoiding crossing legs or bending past 90 degrees—to mitigate the risk of dislocation. However, Dawson-Bowling highlights emerging evidence suggesting that these precautions may not significantly influence recovery outcomes. In fact, adhering to such restrictions might hinder functional improvements and prolong patients' anxieties about their hip mobility, even after the precautionary period has expired.
He presents a systematic review from Scandinavia involving over 1,500 patients, which concludes that there is no statistically significant difference in dislocation rates between those who did or did not follow hip precautions. This finding strongly advocates for a shift away from these protocols, suggesting that allowing patients more freedom post-surgery could lead to better recovery rates.
Shifting the focus, Dawson-Bowling then explores the use of aspirin as an effective and safe option for venous thromboembolism (VTE) prophylaxis in patients with a history of DVT, citing a robust study comparing its efficacy against other anticoagulants. Further, he addresses the topic of urinary catheterization in joint replacement surgeries, questioning its necessity—particularly as studies show no significant difference in outcomes between patients with and without catheters.
Finally, the talk transitions to discussions on femoral head size and the implications of long waiting lists for joint surgery. Dawson-Bowling advocates for the use of larger femoral heads for enhanced stability while reassuring that modern materials mitigate previous concerns regarding wear. He emphasizes that waiting for surgery is a considerable public health issue, noting a decline in patients' quality of life and increased frailty in those awaiting joint replacements.
The session closes with an emphatic conclusion: abandoning hip precautions, embracing aspirin for VTE prevention, avoiding unnecessary catheterizations, and maintaining optimal patient care amidst ongoing healthcare challenges.