Fast Track Total Hip Replacement Surgery Effective and Safe

Healthy patients who undergo total hip replacement (THR) can be fast tracked to be discharged in two days compared with the standard three to six days, according to a new study.

Researchers at the Hospital for Special Surgery (HSS; New York, NY, USA) conducted a prospective study to compare the outcomes of patients undergoing THR between 2004 and 2008. One cohort of 149 patients underwent THR with a fast track protocol; the other cohort of 134 patients underwent THR followed by the hospital's traditional clinical pathway, which aimed to discharge patients at four days at that time. Patients in the two cohorts were matched for age, sex, body mass index (BMI), and comorbidities. Patients were excluded if they had inflammatory arthritis, complex THR, and medical comorbidities such as a history of a myocardial infarction (MI), pulmonary embolism (PE), or deep vein thrombosis (DVT), as all patients in the study were discharged with aspirin.

The results showed that 58% of the fast track cohort was discharged within two days of a THR, and 73% were discharged within three days; the average discharge time was 2.6 days in the fast track cohort and 4.1 in the traditional cohort. Although five patients were readmitted from the fast track group, compared with only one from the traditional group, no differences in the rates of overall complications between the two groups was found. Postoperative pain, nausea, and dizziness interfered with physical therapy and, as a result, were the main reasons for an unsuccessful two-day discharge. At one year, there were no differences in complications, readmissions, or reoperation between the two cohorts. The study was published early online on July 2, 2011, in HSS Journal.

“Before this study, we were uncertain how safe it would be to discharge patients within two days after a total hip replacement, but based on this study, we now know that it is safe,” said first author Lawrence Gulotta, MD, an orthopedic surgeon at HSS. “This is something that can help improve health care costs and provide better care for our patients by keeping them out of the hospital.”

The “Fast Track” protocol encourages patients to get up and move around earlier and more frequently. Hospital-based epidural pain relief is stopped earlier and patients are given aspirin to prevent blood clots. In addition, arrangements are made for a physical therapist to work with the patient at home after discharge.

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Hospital for Special Surgery