|Beitragstitel||Early mobilization program after primary THA, a prospective case series in a swiss regional hospital.|
Introduction: In recent years, a trend towards early rehabilitation program (EMP) after elective primary total hip arthroplasty (THA) was noted. Recent studies suggest that it could reduce length of stay (LOS) at hospital and decrease the rate of post operative complications (deep venous thrombosis, pulmonary and urinary track infections). The aim of the study was to evaluate this multimodal approach combining patient education, surgical and anesthetic technique, post operative analgesia and rehabilitation in a swiss regional hospital.
Methods: We prospectively collected the data of 20 consecutive patients undergoing primary THA in the early rehabilitation program. Exclusion criteria were patient not amenable for home discharge at pre-surgical visit. All surgeries were performed by a direct anterior approach, by a single surgeon, at a regional hospital in Swizterland. All patients received local anesthetic infiltration during surgical closure. After surgery all patient had an early mobilization with physiotherapist assistance. The two main outcomes were readiness for discharge (RFD) and effective LOS. Criteria’s of RFD were independence with bed mobility, standing transfers, ambulation with or without a walking aid, negotiation of 3 steps, personal care, performing the home exercise regime and were evaluated by the physiotherapist. LOS was determined by the time between the end of surgery and the time the patient was discharged from the ward. We reviewed the charts for post-operatives complication or readmission within a 3 months’ time frame.
Results: Male/female ratio was 7/13. The median age was 74 (min 53; max 83) and the median BMI was 26 kg/m² (+3.8SD). General anesthesia was performed for 15 patients and spinal anesthesia in 5 patients. Comorbidities were: diabetes type II (1), hypertension (10), dyslipidemia (5), there was no active smoker. The median time for RFD was 69.8 hours (+26.8 SD) and for LOS was 125 hours (+39.7 SD). The median delta between both was 28 (+26 SD). We noticed only one postoperative complication, urinary retention treated by urinary catheterization. No blood transfusions or readmissions were noted within the 3 postoperative months.
Conclusion: Our study showed similar results regarding RFD compared to the current international literature. Nonetheless our median LOS was two days longer. Due to the absence of major complications in our series we have no explanation other than patient convenience.