Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): a randomized double blinded clinical trial

Marchisio, A. E.; Ribeiro, Tiango Aguiar; Umpierres, Carolina Sant Anna; Galvão, Lívia Carvalho; Rosito, Ricardo; Macedo, Carlos Alberto de Souza; Gália, Carlos Roberto

doi:10.1590/0100-6991e-20202548

Cited by 14 publications

(8 citation statements)

References 47 publications

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“…In this research, we used a controlled group to assess the outcomes of two kinds of hip arthroplasty, THA and HA, on patients with femoral neck fracture. The findings indicated that the THA group had substantially greater operating time, intraoperative blood loss, and total drainage than the HA group, indicating that THA is more stressful and detrimental to patients than HA, as previous research [20] has shown. The results showed that at the 6-month postoperative time point, patients in the HA group had significantly higher hip Harris scores than those in the THA group, and there was no difference in the Harris scores at the 1-year and 2-year postoperative time points.…”

Section: Discussionsupporting

confidence: 50%

Analysis of Clinical Effect after Treatment of Patients with Femoral Neck Fracture Using Total or Hemihip Arthroplasty

Zhao

Zhang²,

Chen

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. To investigate the difference in clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fracture. Method. To retrospectively analyze 96 patients (96 hips) with femoral neck fracture treated in our hospital and distinguish them into THA group (50 patients with 50 hips) and HA group (46 patients with 46 hips) according to the difference of their chosen surgical procedure, and to compare the difference in perioperative indexes, postoperative hip function, occurrence of near and long-term complications, long-term imaging performance, and revision rate between the two groups. Result. The operating time, intraoperative blood loss, and total drainage were greater in the THA group than in the HA group ( P < 0.05 ). At 6 months after surgery, the Harris score of the hip joint was higher in the HA group than in the THA group. At 3 years after surgery, the Harris score was higher in the THA group than in the HA group ( P < 0.05 ). At 3 years after surgery, the excellent hip function rates were 86.00% and 67.39% in the THA and HA groups, respectively, with statistically significant difference between the groups. The incidence of long-term complications was significantly lower in the THA group than in the HA group ( P < 0.05 ). The anteversion and abduction angles of patients in the HA group were smaller than those in the THA group at 6 months after surgery ( P < 0.05 ). The WOMAC scores of the THA group were better than those of the HA group at 3 years after surgery ( P < 0.05 ). Conclusion. Compared with hemiarthroplasty, total hip arthroplasty has a longer operative time and more postoperative bleeding, but the complication rate is relatively lower in the long term, and the patients have better long-term hip function recovery, so total hip arthroplasty is recommended for patients with femoral neck fracture with an expected survival time longer than 3 years.

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Section: Discussionsupporting

confidence: 50%

Analysis of Clinical Effect after Treatment of Patients with Femoral Neck Fracture Using Total or Hemihip Arthroplasty

Zhao

Zhang²,

Chen

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Of these studies, 14 studies 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 retrospectively compared the ERAS pathway with historical or standard controls, and eight 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 prospectively described ERAS pathways with associated controls. The remaining two 35 , 36 studies were conducted as RCTs. Details are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“… 47 , 48 A total of 41.7% (10/24) of the studies highlighted the importance of perioperative surgical factors in their ERAS protocols. Sixty percent (6/10) of studies 13 , 14 , 16 , 33 , 35 , 36 reported the use of specific surgical approaches; 50% (4/8) of studies 13 , 20 , 30 , 36 with knee replacement highlighted the reduced or abandoned use of tourniquets; and 60% (6/10) of studies 13 , 14 , 18 , 20 , 22 , 36 did not support the routine use of drains. Furthermore, only two studies 13 , 36 supported the use of specific surgical approaches and reduced or abandoned the use of tourniquets and drains.…”

Section: Resultsmentioning

confidence: 99%

Enhanced Recovery after Total Joint Arthroplasty (TJA): A Contemporary Systematic Review of Clinical Outcomes and Usage of Key Elements

Chen

Yang

et al. 2023

Orthopaedic Surgery

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Background Enhanced recovery after surgery (ERAS) is a pathway designed to improve the care of surgical patients and achieve early recovery. The clinical outcomes and usage of key elements of ERAS pathways in total joint arthroplasty (TJA) need further reanalysis. This article aims to provide an overview of the latest clinical outcomes and current usage of key elements of ERAS pathways in TJA. Methods We undertook a systematic review of the PubMed, OVID, and EMBASE databases in February 2022. Studies investigating the clinical outcomes and usage of key elements of ERAS in TJA were included. The components of successful ERAS programs and their usage were further determined and discussed. Results Twenty‐four studies involving 216,708 patients assessed ERAS pathways for TJA. A total of 95.8% (23/24) of studies reported a reduced length of stay (LOS), followed by reduce overall opioid consumption or pain (87.5% [7/8]), save costs (85.7% [6/7]), improvements in patient‐reported outcomes or functional recovery (60% [6/10]), and reduced incidence of complications (50% [5/10]). In addition, preoperative patient education (79.2% [19/24]), anesthetic protocol (54.2% [13/24]), use of local anesthetics for infiltration analgesia or nerve blocks (79.2% [19/24]), perioperative oral analgesia (66.7% [16/24]), perioperative surgical factors including reduced use of tourniquets and drains (41.7% [10/24]), use of tranexamic acid (41.7% [10/24]) and early mobilization (100% [24/24]) were contemporary comparatively “active” components of ERAS. Conclusions ERAS for TJA has favorable clinical outcomes in terms of reducing LOS and overall pain, saving costs, accelerating functional recovery, and reducing complications, although the evidence is still low in quality. In the current clinical scenario, only some “active” components of the ERAS program are widely used.

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“…If a postoperative complication occurs, recovery length may increase up to 10 days [ 7 ]. As soon as the patient is stable in regard to general status, and pain is controlled, he or she can be discharged to a rehabilitation ward or facility [ 8 , 9 ]. Alternatively, if functional status is definitely good, the rehabilitation protocol can be continued with supervised exercises either at patient’s home or as an outpatient [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative and Perioperative Predictors of Length of Hospital Stay after Primary Total Hip Arthroplasty—Our Experience on 743 Cases

Papalia

Zampogna

Torre

et al. 2021

JCM

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The aim of this retrospective investigation is to evaluate the correlation between several preoperative and perioperative factors and the length of hospital stay in patients that underwent elective total hip arthroplasty with overnight admission. Medical records of patients that underwent THA from the beginning of 2016 to the end of 2018 were retrospectively screened. Demographics, comorbidities, whole blood count, intraoperative details, and length of postoperative stay were retrieved. The association between clinical, laboratory and surgical factors and the length of hospital stay was explored by means of negative binomial and logistic regression models. The median length of postoperative hospital stay was four days (Inter Quartile Range, IQR 3, 5). After univariate regression a stepwise multivariate regression showed that operative time (p = 0.001), the preoperative serum creatinine (p < 0.001), the intraoperative blood loss (p = 0.04) and the use of an anterolateral approach (p < 0.001) were found to correlate significantly with the increase of the hospitalization length, while no significant correlation was found for all the other features. Multivariable model fitted through logistic regression (LOS below or over the median value of four days) had an Area Under the Curve (AUC) of 0.748. Our analysis suggests a significant role played by different preoperative and perioperative variables in influencing the length of hospital stay.

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Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): a randomized double blinded clinical trial

Cited by 14 publications

References 47 publications

Analysis of Clinical Effect after Treatment of Patients with Femoral Neck Fracture Using Total or Hemihip Arthroplasty

Analysis of Clinical Effect after Treatment of Patients with Femoral Neck Fracture Using Total or Hemihip Arthroplasty

Enhanced Recovery after Total Joint Arthroplasty (TJA): A Contemporary Systematic Review of Clinical Outcomes and Usage of Key Elements

Preoperative and Perioperative Predictors of Length of Hospital Stay after Primary Total Hip Arthroplasty—Our Experience on 743 Cases

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