Implementing fast-track in total hip arthroplasty: rapid mobilization with low need for pain medication and low pain values

Abstract

Introduction Total hip arthroplasty (THA) is reported to be one of the most painful surgical procedures. Perioperative management and rehabilitation patterns are of great importance for the success of the procedure. The aim of this cohort study was the evaluation of function, mobilization and pain scores during the inpatient stay (6 days postoperatively) and 4 weeks after fast-track THA. Materials and methods A total of 102 consecutive patients were included in this retrospective cohort trial after minimally invasive cementless total hip arthroplasty under spinal anesthesia in a fast-track setup. The extent of mobilization under full-weight-bearing with crutches (walking distance in meters and necessity of nurse aid) and pain values using a numerical rating scale (NRS) were measured. Function was evaluated measuring the range of motion (ROM) and the ability of sitting on a chair, walking and personal hygiene. Furthermore, circumferences of thighs were measured to evaluate the extent of postoperative swelling. The widespread Harris Hip Score (HHS) was used to compare results pre- and 4 weeks postoperatively. Results Evaluation of pain scores in the postoperative course showed a constant decrease in the first postoperative week (days 1–6 postoperatively). The pain scores before surgery were significantly higher than surgery (day 6), during mobilization (p < 0.001), at rest (p < 0.001) and at night (p < 0.001). All patients were able to mobilize on the day of surgery. In addition, there was a significant improvement in independent activities within the first 6 days postoperatively: sitting on a chair (p < 0.001), walking (p < 0.001) and personal hygiene (p < 0.001). There was no significant difference between the measured preoperative and postoperative (day 6 after surgery) thigh circumferences above the knee joint. Compared to preoperatively, there was a significant (p < 0.001) improvement of the HHS 4 weeks after surgery. In 100% of the cases, the operation was reported to be successful and all of the treated patients would choose a fast-track setup again. Conclusion Application of a fast-track scheme is effective regarding function and mobilization of patients. Low pain values and rapid improvement of walking distance confirms the success of the fast-track concept in the immediate postoperative course. Future prospective studies have to confirm the results comparing a conventional and a fast-track pathway.

Educational Intervention in Rehabilitation to Improve Functional Capacity after Hip Arthroplasty: A Scoping Review

“…The articles in the literature sample indicate that educational interventions may also help with pain control [ 16 , 18 , 23 ], which corroborates the results of other studies that confirm an approach focused on educational interventions, patient-centred care, and their fears and anxieties contribute to an effective pain control [ 8 , 9 , 32 ]. After surgery, effective pain control is one of the most important issues, and it is necessary to optimise pain control, whether through preoperative analgesia as a preventive measure [ 16 , 17 , 18 , 23 ], infiltration of local anaesthetic into the wound [ 18 ], intra-articular injection of local anaesthetic [ 16 , 17 ], or the use of self-controlled intravenous analgesia (PCA) [ 17 ]. All these alternatives had a significant influence on adequate pain control and the possibility of mobilisation on the day of surgery.…”

“…The 13 studies included in the present scoping review were published between 2003 and 2021, with one of the articles published in 2003 [ 14 ], one in 2005 [ 7 ], one in 2008 [ 15 ], two in 2011 [ 16 , 17 ], one in 2012 [ 18 ], one in 2018 [ 19 ], one in 2019 [ 20 ], and five in 2020 [ 21 , 22 , 23 , 24 , 25 ].…”

“…Eleven articles are in English, although with various countries of origin, such as Canada [ 17 ], Sweden [ 14 ], Taiwan [ 7 ], Germany [ 16 ], Italy [ 19 ], the United Kingdom [ 18 ], China [ 21 , 23 ], Thailand [ 20 ], Denmark [ 22 ], the United States of America [ 24 ], and Portugal [ 25 ]. The French article originated in France [ 15 ], and the Portuguese article originated in Portugal [ 25 ] ( Table 2 ).…”

“…Of these articles, 11 are primary sources: cohort study [ 16 , 17 , 20 ], quasi-experimental study [ 7 , 18 , 19 ], randomised controlled study [ 21 , 22 , 23 , 24 ]; two are systematic reviews [ 14 , 15 ]; and one is a quantitative descriptive study [ 25 ].…”

“…Educational interventions were carried out in sessions and the themes usually approached were the surgery, the risks and complications, breathing exercises before surgery, isometric exercises of the quadriceps, dorsiflexion and plantar flexion of the ankle, postoperative care, thromboembolic prophylaxis, first standing up, gait training with the aid of devices, and care to prevent dislocation of the prosthesis [ 7 , 16 , 17 , 18 , 19 , 23 , 25 ].…”