Better early outcome with enhanced recovery total hip arthroplasty (ERAS-THA) versus conventional setup in randomized clinical trial (RCT)

Abstract

Introduction Numbers of total hip arthroplasty (THA) are steadily rising and patients expect faster mobility without pain postoperatively. The aim of enhanced recovery after Surgery (ERAS) programs in a multidisciplinary setup was to keep pace with the needs of quality and quantity of surgical THA-interventions and patients’ expectations. Methods 194 patients undergoing THA procedures were investigated after single-blinded randomization to ERAS (98) or conventional setup group (96). Primary outcome variable was mobilization measured with the Timed Up and Go Test (TUG) in seconds. Secondary outcome variables were floor count and walking distance in meters as well as rest, mobilization and night pain on a numerous rating scale (NRS). All variables were recorded preoperatively and daily until the sixth postoperative day. To assess and compare clinical outcome and patient satisfaction, the PPP33-Score and PROMs were used. Results No complications such as thromboembolic complications, fractures or revisions were recorded within the first week postoperatively in either study group. Compared to the conventional group, the ERAS group showed significantly better TUG (p < 0.050) and walking distance results after surgery up to the sixth, and floor count up to the third postoperative day. On the first and second postoperative day, ERAS patients showed superior results (p < 0.001) in all independent activity subitems. Regarding the evaluation of pain (NRS), PPP33 and PROMS, no significant difference was shown (p > 0.050). Conclusion This prospective single-blinded randomized controlled clinical trial was able to demonstrate excellent outcome with comparable pain after ERAS THA versus a conventional setup. Therefore, ERAS could be used in daily clinical practice.

Total Hip Arthroplasty Combined with Proximal Femoral Reconstruction Effectively Treats Severe Hip Deformities: A Novel Osteotomy Technique

“…Postoperatively, an immediate accelerated rehabilitation plan, implemented by a multidisciplinary team, was initiated. 12 Rehabilitation exercises, including ankle pump exercises, isometric quadriceps contractions, and moderate active hip flexion and extension exercises, commenced immediately after surgery. On the first postoperative day, the patient was instructed to walk without weight‐bearing.…”

SOG—Special Orthopedic Geriatrics

“…Die Datenlage unter Einbeziehung alternativer Mobilitätsassessments (Timed-Up-And-Go-Test, Gait Speed) nach elektivem Gelenkersatz ist etwas besser, jedoch kontrovers. In mehreren prospektiv-randomisierten Studien wurde die Mobilität nach Hüft-TEP-Implantation im Fast-Track-Schema gegenüber einer Kontrollgruppe mit Standardversorgung verglichen, wobei sich insbesondere in der frühen postoperativen Phase eine deutlich bessere Mobilität in den Fast-Track-Gruppen zeigte [ 6 , 17 ]. Eine weitere prospektiv-randomisierte Studie und eine Metaanalyse kamen zu dem Ergebnis, dass die Mobilität ab 4 Wochen postoperativ zwischen Fast-Track-Gruppen und Kontrollgruppen vergleichbar ist [ 1 , 3 ].…”

“…Das Verbesserungsausmaß der PROM war in der Interventionsgruppe, trotz objektiv besserer Mobilität und geringerer Komplikationsrate, vergleichbar zur Kontrollgruppe. In der Literatur finden sich mehrere Hinweise, dass sich eine objektive Funktionsverbesserung und/oder Komplikationsreduktion nach Gelenkersatz nicht unbedingt in verbesserten PROM widerspiegelt [ 6 , 20 ]. Möglicherweise sind die verwendeten Fragebögen zu unscharf, um den klinisch evidenten Vorteil der Intervention hier herauszuarbeiten.…”