Rapid mobilisation following total hip and knee arthroplasty

Abstract

IntroductionTotal joint arthroplasty has become established as a very successful method of treating end-stage arthritis of the hip and knee with excellent long-term outcomes. 1,2 With an ageing population, there is an increased demand for services relating to joint arthroplasty. Individual patient's demands and expectations are also increasing, with patients desiring a quicker return to normal functioning with minimal discomfort after their joint replacement surgery.In today's climate of limited resources and global financial strain we need to investigate ways of containing cost while enabling and maintaining safe effective treatment with optimised results. Any alteration to the surgical management of hip and knee arthroplasty should never compromise patient safety and outcomes. AbstractIntroduction: A rapid recovery protocol for hip and knee replacement surgery is a multidisciplinary, standardised pathway to meet the increasing demands for surgery and enhancement of recovery. This is the idea behind the recent global push by funders for cost effective, elective primary hip and knee arthroplasty. We report on a pilot study to assess the implementation and feasibility of a standardised care pathway in a South African private hospital setting. Materials and methods:Eligible patients presenting for primary hip or knee arthroplasty were enrolled in a rapid recovery programme. The protocol that was implemented was based on current literature and international best practices. It involved members of a multidisciplinary team and the standardisation of the treatment of patients undergoing elective hip and knee arthroplasty.Results: Forty-six patients were enrolled in the pilot study and 43 patients were successfully discharged by the third post-operative day. There were no major complications and high patient satisfaction was recorded. Conclusion:This pilot study successfully implemented a multidisciplinary and standardised treatment protocol for hip and knee arthroplasty in a South African setting. The rapid recovery protocol proved to be safe and effective for the management of hip and knee replacements.

Incidence and risk factors for extended post-operative length of stay following primary hip arthroplasty in a South African setting

“…25 In order to cope with the higher demand for hip arthroplasty, some hospitals are beginning to implement fast-track protocols which are aimed at reducing post-operative length of stay while minimising the rate of post-discharge complications in suitable patients who undergo the surgical procedure. 26 This might possibly explain the difference in median post-operative length of stay following primary hip arthroplasty between South African and overseas populations. 10,[14][15][16] With regard to EPLoS following hip arthroplasty, the literature is scant.…”

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

“…On the other hand, over the last decades there have been many advances in the elds of biomechanics, tribology, prosthetic design and surgical technique (5,6), that have contributed to minimize the patient discomfort after arthroplasty favoring the reduction of the hospital recovery (7). Moreover, in a climate of limited resources and global nancial strain, ways of containing costs and pressure from third party payers, maintaining at the same time highly e cient care pathways, better patient satisfaction and improved patient-reported outcomes are needed (2,8).…”

“…ClinicalTrials.gov, NCT03875976, registered on 15 March 2019 -'Retrospectively registered', https://clinicaltrials.gov/ct2/show/NCT03875976 Background Total hip replacement (THR) is one of the most successful surgeries, with more than 1 million procedures undertaken annually worldwide (1). THR has become established as an elective method of treating end-stage arthritis of the hip with excellent long-term outcomes (2). The average ageing of the population, the increase in the life expectancy, the arthrosis conditions secondary to sport injuries or any other source of physical trauma are the basis for the increasingly growing demand of arthroplasty (3,4).…”

Comparison of a fast track protocol and standard care after hip arthroplasty in the reduction of the length of stay and the early weight-bearing resumption: study protocol for a randomized controlled trial

“…Total hip replacement (THR) is one of the most successful surgeries, with more than 1 million procedures undertaken annually worldwide [ 1 ]. THR has become established as an elective method of treating end-stage arthritis of the hip with excellent long-term outcomes [ 2 ]. The average aging of the population, the increase in life expectancy, the arthrosis conditions secondary to sports injuries or any other source of physical trauma are the basis for the increasingly growing demand for arthroplasty [ 3 , 4 ].…”

“…On the other hand, over the last decades, there have been many advances in the fields of biomechanics, tribology, prosthetic design, and surgical technique [ 5 , 6 ] that have contributed to minimize the patient discomfort after arthroplasty favoring the reduction of the hospital recovery [ 7 ]. Moreover, in a climate of limited resources and global financial strain, ways of containing costs and pressure from third-party payers, maintaining at the same time highly efficient care pathways, better patient satisfaction, and improved patient-reported outcomes are needed [ 2 , 8 ].…”