Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

Abstract

Background An inpatient hospital stay of up to 10 days after total hip arthroplasty (THA) is still common in Germany, mostly followed by inpatient rehabilitation. Internationally already widespread concepts for enhanced recovery are increasingly gaining popularity in Germany. Objectives The presentation of content and results of a newly implemented enhanced recovery concept in THA. Materials and Methods In this single-center, prospective observational study of a consecutive patient collective of a single surgeon, between January 2016 and July 2016, 103 short-stem THA patients were enrolled and treated using a newly introduced enhanced recovery concept. After 6 weeks and 6 months clinical examination was performed regarding function, pain, satisfaction and possible complications. Results The goal of discharge on day 4 after operation was reached in 61.2% of the patients with a mean postoperative inpatient stay of 4.9 days. After 6 weeks and 6 months respectively, excellent clinical results were achieved with high patient satisfaction. The complication rate was found to be low. Mean hemoglobin concentration decreased by 2.1 g/dl. A fissure of the femur below the implant healed conservatively applying no weight bearing for a total of 6 weeks. A pulmonary embolism that occurred during rehabilitation was also successfully treated. After 6 months one case showed a bursitis trochanterica. Conclusions Inpatient length of stay can be reduced by enhanced recovery concepts without increasing the risks to patients. Thus, in Germany these concepts will be applied increasingly.

Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

“…Larsen et al stated an HHS of 45.7 (±15.1) preoperatively, an HHS of 82.9 (± 13.1) 3 months after surgery and an HHS of 88.0 (± 15.1) 12 months after fast track hip arthroplasty. The study by Kutzner et al [25], where the outcome of an enhanced recovery concept after THA was prospectively investigated, showed an HHS of 93.8 (± 8.0) 6 weeks after surgery and of 98.4. (± 3.0) 6 months after surgery.…”

Sedentary Behavior in Older Patients before and after Total Hip Arthroplasty: A Prospective Cohort Study

“…Following conservative treatment, total hip arthroplasty (THA) is indicated in end-stage OA [ 4 ]. THA followed by rehabilitation usually leads to complete freedom from pain, a significant improvement of patient health related quality of life, the restoration of joint function and significant improvements in physical functioning [ 5 , 6 , 7 ]. In addition to these effects of surgery, most OA patients also expect an improvement of their physical activity (PA) [ 8 , 9 ].…”

Entlassbarkeit versus Entlassung – Ergebnisse der PROMISE-Studie

“…Für eine ausgewählte Patientengruppe im Bereich der Hüftendoprothetik wird hier ebenfalls von stationären Aufenthaltszeiten < 24 h berichtet [12]. Für unselektionierte Kohorten werden in Deutschland 5-7 Tage bis zur Entlassung aus dem Krankenhaus angegeben [13,14].…”

“…Sind Entlasskriterien angegeben, unterscheiden sich diese nicht grundsätzlich. Gefordert werden ein Mindestmaß an selbstständiger Aktivität (Lagewechsel, Essen am Tisch, Anziehen, Waschen, Mindestgehstrecke, Treppensteigen), tolerierbarer Schmerz und trockene Wundverhältnisse [8, [13][14][15][16]. Bei "hip in a day" sind die Entlasskriterien noch um die Abwesenheit von Schwindel, Übelkeit, Erbrechen oder Schwäche und keine Einwände durch Operateur, Anästhesist oder Pflege erweitert.…”

“…Wie beschrieben, gibt es zwar grundsätzliche Übereinstimmungen, aber in Detail und im Differenzierungsgrad bestehen Unterschiede. So wird in [17] zusätzlich zum selbstständigen Anund Entkleiden speziell das Anziehen der Schuhe gefordert, in [15][16][17] das Treppen steigen und in [14] das Gehen zur Toilette. Auch die geforderte Gehstrecke differiert mit 45 m [15], 100 m [16] oder 200 m [12].…”