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Fast track total hip replacement effective and safe, according to study

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Lawrence Gulotta

Patients who undergo total hip replacement and are considered generally healthy can be fast tracked to be discharged within 2 days instead of the standard 3 days to 6 days, according to researchers at Hospital for Special Surgery.

The study and its findings were published online in the HSS Journal.

“Before this study, we were uncertain how safe it would be to discharge patients within 2 days after a total hip replacement (THR), but based on this study, we now know that it’s safe,” first author Lawrence Gulotta, MD, stated in a Hospital for Special Surgery press release.

The study compared the outcomes of two cohorts of patients undergoing THR at Hospital for Special Surgery between 2004 and 2008. One 149-patient cohort underwent THR with a fast track protocol, while a 134-patient cohort underwent THR followed by the hospital’s traditional clinical pathway – a 4-day wait until discharge.

Patients were excluded from the study if they reported inflammatory arthritis, has a complex THR or medical comorbidities, such as a history of myocardial infarction, pulmonary embolism or deep vein thrombosis.

Patients undergoing the fast track protocol were given a physical therapy session on the day of their surgery. The main difference between the two protocols, the study noted, was the fast track cohort’s discontinuation of pain medication on postoperative day one as opposed to the traditional cohort’s 2-day discontinuation.

Bryan J. Nestor

Both cohorts were sent home with aspirin, physical therapy arrangements, a patient management plan including daily goals, and control plans for pain and nausea. A study coordinator screened for complications 1 day and 1 week after discharge.

Fifty-eight percent of the fast track cohort was discharged within 2 days of a THR, with 73% of patients discharged within 3 days. Fast track patients were discharged at an average of 2.6 days, while the traditional cohort discharged in an average of 4.1 days.

At 1 year, there were no differences between the cohorts for complications, re-admissions or reoperations.

“For a select group of patients, we have shown that a 2-day discharge is safe and feasible for patients undergoing a total hip replacement,” principal investigator Bryan Nestor, MD, stated in the release.

Reference:

• Gulotta LV, Padgett DE, Sculco TP, et al. Fast track THR: One hospital’s experience with a 2-day length of stay protocol for total hip replacement. HSS J. 2011. doi: 10.1007/s11420-011-9207-2.
• www.hss.edu

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