Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

Abstract

Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consectutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices.

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

“…Prior work that has examined outpatient discharge protocols after THA is in highly selected patient groups without control subjects [5,8]. Also, many studies have used the term ''outpatient'' loosely and often refer to the ''23-hour stay'' patient as an ''outpatient,'' although the patient stayed overnight in the hospital.…”

“…With the goal of decreasing LOS, modern surgical techniques, advances in regional anesthesia, improved postoperative pain management with multimodal and preemptive analgesia, and rapid rehabilitation protocols have allowed patients undergoing THA to be discharged from the hospital as early as the day of surgery with high patient satisfaction and infrequent complications in appropriately selected patients [1,5,6,8]. However, the published studies that have examined same-day and ''early'' discharge protocols after THA are in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects [5,8].…”

“…However, the published studies that have examined same-day and ''early'' discharge protocols after THA are in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects [5,8].…”

Total hip arthroplasty in an outpatient setting in 27 selected patients

“…In the USA, THA in an outpatient setting for selected patients has already been described (Berger et al 2009a, Aynardi et al 2014). Moreover, US centers have also reported on hemi- and total knee replacement in an outpatient setting (Berger et al 2009b, Cross and Berger 2014).…”

“…Traditionally, the length of hospital stay (LOS) after primary joint replacement has been more than several weeks (Berger et al 2009a). In the past few years, fast-track protocols have been introduced worldwide.…”