After studying 84 hip revision treatments, the following protocol is recommended. First, the team approach should be employed because it provides consistent patient training. Many patients in this study were in their 70s, and a few were in their 80s. Patients in this age group often have physical and cognitive deficits preventing them from learning easily.
When all staff use the hip orthosis during the patient's hospital stay, there is a greater chance for patient compliance at home. This was verified by the 90 percent compliance rate. No data exist to prove the compliance rate is higher than it would be without the team approach, but experience using the hip orthosis without the team benefits has been less successful.
Second, the orthosis should be used on all revision patients to lessen the chance of dislocation, allow soft tissue to tighten and create the optimal environment for bone graft incorporation. If a decision is made not to use the orthosis on all revision patients, the orthosis should at least be used on patients most at risk to dislocate.
Third, patients at risk for anterior dislocation should be identified during surgery if possible so that they can be managed immediately to block external rotation and extension with a hip-knee-ankle-foot orthosis. Other high-risk patients should wear the orthosis for four to six months rather than the customary eight-week period.