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The first 6 weeks of recovery after primary total hip arthroplasty with fast track.

ABSTRACT: Background and purpose - Fast-track protocols have been introduced worldwide to improve the recovery after total hip arthroplasty (THA). These protocols have reduced the length of hospital stay (LOS), and THA in an outpatient setting is also feasible. However, less is known regarding the first weeks after THA with fast track. We examined patients' experiences of the first 6 weeks after hospital discharge following inpatient and outpatient THA with fast track. Patients and methods - In a prospective cohort study, 100 consecutive patients who underwent THA surgery in a fast-track setting between February 2015 and October 2015 received a diary for 6 weeks. This diary contained various internationally validated questionnaires including HOOS-PS, OHS, EQ-5D, SF-12, and ICOAP. In addition, there were general questions regarding pain, the wound, physiotherapy, and thrombosis prophylaxis injections. Results - 94 patients completed the diary, 42 of whom were operated in an outpatient setting. Pain and use of pain medication had gradually decreased during the 6 weeks. Function and quality of life gradually improved. After 6 weeks, 91% of all patients reported better functioning and less pain than preoperatively. Interpretation - Fast track improves early functional outcome, and the PROMs reported during the first 6 weeks in this study showed continued improvement. They can be used as a baseline for future studies. The PROMs reported could also serve as a guide for staff and patients alike to modify expectations and therefore possibly improve patient satisfaction.

SUBMITTER: Klapwijk LC

PROVIDER: S-EPMC5385107 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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The first 6 weeks of recovery after primary total hip arthroplasty with fast track.

Klapwijk Lisette C M LC Mathijssen Nina M C NM Van Egmond Jeroen C JC Verbeek Bianca M BM Vehmeijer Stephan B W SB

Acta orthopaedica 20170112 2

Background and purpose - Fast-track protocols have been introduced worldwide to improve the recovery after total hip arthroplasty (THA). These protocols have reduced the length of hospital stay (LOS), and THA in an outpatient setting is also feasible. However, less is known regarding the first weeks after THA with fast track. We examined patients' experiences of the first 6 weeks after hospital discharge following inpatient and outpatient THA with fast track. Patients and methods - In a prospect ...[more]

PMID: 28079428

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Project description:Total hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after these procedures, but early mobilization and short hospitalization length of stay (LOS) could potentially increase the risk of falls after discharge. We investigated injuries, circumstances, and the timing of fall-related hospital admissions 90 days after fasttrack THA and TKA.This was a prospective, descriptive multicenter study on fall-related hospital admissions, in 5145 elective fast-track THA and TKA patients, with complete 90-day follow up through the Danish National Patient registry and medical charts.Of 83 (1.6%) fall-related hospital admissions, 43 (51.8%) were treated in the Emergency Room and 40 (48.2%) were admitted to a regular ward. The median LOS after surgery was 3 days (interquartile range [IQR]: 2-3) in fallers versus (vs) 2 days (IQR: 2-3) (P=0.022) in patients without falls. Injuries were classified as "none" or minor in 39.8%, moderate in 9.6%, and major in 50.6%. Most falls (54.8%) occurred within 1 month of discharge. Falls due to physical activity (12.0%) and extrinsic factors (14.5%) occurred later than did surgery-related falls (73.5%), contributing to 40% of all falls >30 days after discharge. In multivariate analysis, age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.0-1.08) (P=0.001), living alone (OR: 2.09; 95% CI: 1.20-3.62) (P=0.009), and psychiatric disease (OR: 2.80; 95% CI: 1.42-5.50) (P=0.001) were associated with surgery-related falls, whereas the use of a walking aid (OR: 1.20; 95% CI: 0.67-2.16) (P=0.544) and LOS ?4 days (OR:1.19; 95% CI: 0.52-1.28) (P=0.680) was not.Hospital admissions due to falls are most frequent within the first month after fast-track THA and TKA. The overall incidence of surgery-related falls amongst these patients is low, declines after the first month, and is related to patient characteristics rather than short LOS. The effect of interventions aimed at surgery-related falls should focus on the first 30 days after surgery and differentiate between the causes of falling.

Dataset Information

The first 6 weeks of recovery after primary total hip arthroplasty with fast track.

Publications

The first 6 weeks of recovery after primary total hip arthroplasty with fast track.

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