Article Review:
The First 6 Weeks of Recovery After Primary Total Hip Arthroplasty With Fast Track; a diary study of 94 patients
Background:
Fast track protocols have been introduced to help speed up the recovery after total hip arthroplasties (THA), or hip replacements. A faster recovery means less time spent in the hospital and a quicker return to function for the individual. Fast track protocols have shown to reduce the length of stay in hospitals while still being safe as they did not show to cause any increase in complications, re-admission rates, or re-operations. Most studies have researched fast track within the hospital setting, however this study looked more into patient’s recovery for the first 6 weeks after discharge from the hospital in an outpatient or inpatient rehab setting.
Methods:
This study looked at 100 individuals who underwent a primary THA using an anterior supine intermuscular (ASI) approach (refer to article for complete inclusion and exclusion criteria). The fast track protocol was used for all patients. Here is a summary of what the fast track protocol entails:
Discharge criteria from hospital included: walk 30 meters with crutches/ rollator, climb stairs, dress independently, toilet independently, pain below 3/10 at rest, and proper healing of wound.
Outcome measures: Five questionnaires were used that each patient filled out themselves. The questionnaires were a measurement of function and pain.
Results:
94 patients were accepted for final analysis with 42 operated in outpatient and 52 operated in inpatient settings.
Pain and use of pain medications gradually decreased over first 6 weeks
Function and quality of life gradually improved based on questionnaires. 91% of all patients reported better functioning and less pain than pre-operatively.
Discussion:
Using the fast track protocol, patients had an overall decrease in hip pain and had greater functional capabilities within their first 6 weeks after hospital discharge. Most patients were pleased they were able to leave the hospital early and perform their rehab at home. Unfortunately, the demographics of patients between the inpatient rehab groups and outpatient rehab groups were different, therefore these groups are unable to be compared. Another major limitation of this study is that all outcome measures are based on patient reported questionnaires. There were no objective physical exam function measurements used.
Take Home Message:
From this study, it suggests a fast track protocol following hip replacement surgery is beneficial not only for the first couple days following surgery, but also safe and effective for the next 6 weeks. Despite some limitations of this study, the research still suggests less pain and improved functional outcomes when undergoing early mobility following a hip replacement. This is consistent with what I see clinically and I have worked with multiple patients have excellent results with even same day discharge following hip replacements. A common complaint patients have when undergoing hip replacement is hesitation and extra caution to get up and move around. This is totally understandable and I respect people feeling this way. Even though it is smart and necessary to be cautious, I hope this article can re-assure people how beneficial it is to get up and walk around early on and within each person’s tolerance levels. If you are planning on undergoing a hip replacement, the physical therapists here at Physical Therapy First can provide you complete 1 on 1 care to help get you back moving around safely and with confidence!
Article Reference:
Lisette C M Klapwijk, Nina M C Mathijssen, Jeroen C Van Egmond, Bianca M Verbeek & Stephan B W Vehmeijer (2017) The first 6 weeks of recovery after primary total hip arthroplasty with fast track, Acta Orthopaedica, 88:2, 140-144, DOI: 10.1080/17453674.2016.1274865