The demand for hip replacements is on the rise; however, despite commonly employed post-operative positional and activity restrictions, limited evidence exists to substantiate such practices. Guidelines provide a means of assisting the healthcare team in decision-making; however, when a clinical decision has to be made in the absence of scientific evidence, guideline developers rely on consensus processes. A formal consensus process based on a nominal group technique was used to incorporate the scientific evidence and practitioner experience for the development of primary total hip replacement guidelines at a specialized orthopaedic tertiary care facility. Agreement was reached regarding a number of practice issues, which historically had varied among the surgeons. Given the lack of available guidance on how to synthesize research findings in conjunction with expert opinion, the process we employed has been described so that others may use, modify and refine it. Further scientific inquiry into safe activity resumption post-total hip replacement is warranted.

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