by Sean Phillips, PT, DPT, OCS

Total hip arthroplasty (THA) is one of the most common joint replacement surgeries performed around the world. In the past, it was common for patients to stay in the hospital for up to 2-3 weeks post-op and were typically forced to bedrest. Recently, however, there has been a shifting sentiment towards a “fast track” approach that greatly reduces the length of stay (LOS) in the hospital and leads to a quicker recovery overall.

In a study by Klapwijk et al, the first 6 weeks after a patient’s discharge from the hospital following a THA with fast track were observed. This prospective cohort study was performed in the Netherlands in 2015, and involved 94 patients who received a THA with an anterior approach. Each patient was provided a diary to document their pain and function on a daily basis for 6 weeks following their discharge from the hospital or outpatient center. These forms included…

  • Hip injury and osteoarthritis outcome score physical function short form (HOOS-PS)
  • Oxford hip score (OHS)
  • EuroQol quality of life (EQ-5D)
  • NRS pain score
  • 12-item short-form health survey (SF-12)
  • Intermittent and constant osteoarthritis pain score (ICOAP)

Out of the 94 patients who participated, 52 received an inpatient surgery and 42 were in an outpatient setting. The average LOS was one night for inpatient and released the same day for outpatient. Overall, the study found that over the first 6 weeks, patients reported gradual and significant improvements in a variety of factors including pain, sleep quality, walking ability, and functioning for daily activities (OHS, HOOS-PS, SF-12 PCS). Another result this study identified was that patients reported an improvement in a variety of these surveys within the first week post-op relative to their scores pre-op.

Although the study did have some limitations including limited sample size and only utilizing self-reported subjective values, it did shine a light on the efficacy of a fast-track approach following THA. They found that 97% of the participants reported that the were satisfied with their shorter LOS, and over the first 6 weeks patients’ pain gradually decreased as their function gradually increased.


Klapwijk LCM, Mathijssen NMC, Van Egmond JC, Verbeek VM, Vehmeijer SBW. The first 6 weeks of recovery after primary total hip arthroplasty with fast track: A diary study of 94 patients; Acta Orthopaedica 2017; 88 (2): 140–144