Self-reported functional outcome after primary total hip replacement treated with two different periopera-tive regimes: A follow-up study involving 61 patients

Abstract

Background and purpose Fast-track surgery has been reported to improve rehabilitation outcome after major surgery, with length of hospitalization and muscle strength as outcome measures. We assessed the effect of optimization of perioperative care during admission on self-reported functional outcome, and compared patient status 6 months after THR with an age-matched healthy cohort.Patients and methods 79 THR patients were randomized to optimized perioperative care (OPC) or conventional perioperative care (CPC). 61 patients fulfilled the requirements of the study protocol. Endpoint outcome was measured by SF-36 and WOMAC. To compare functional outcome in the THR group with that in healthy controls, we used data from a representative sample of 4,098 non-institutionalized Danish adults collected by the Danish National Institute of Public Health.Results We found similar improvements in SF-36 and WOMAC scores for the OPC and CPC groups postoperatively, except for the total WOMAC score and the WOMAC subscore "function"-in which the CPC group did statistically significantly better. The OPC and CPS groups had similar score levels. 6 months after surgery, THR patients scored higher overall in the general health subscale and lower in three physical subscales of SF-36 compared to age-matched healthy controls.Interpretation We found no evidence for the effect of optimization strategies during admission on selfreported functional outcome after THR. Although THR patients improved considerably after treatment, their

Quality of life and hip function during the first month after total hip arthroplasty

“…Conventional perioperative care regimes have not been shown to be superior to fast-track setup in improvement of patient activity or QoL after 6 mo or longer. 12,13 Some results might suggest a need for more preoperative or early postoperative physical intervention during the first 3 mo. 13 Besides oral analgesics, patients were offered local infiltration analgesia during the first 24 h after surgery.…”

“…Previous studies have demonstrated the benefit of THA on both QoL and function of the hip with follow-ups of more than 6 mo. 12,13,21 Very few authors have discussed how patients perform and cope with the principles of fast-track surgery. Conventional perioperative care regimes have not been shown to be superior to fast-track setup in improvement of patient activity or QoL after 6 mo or longer.…”

“…11 Little attention, however, has been given to how patients cope with the principles of fast-track surgery. 12,13 Some results might suggest a need for more preoperative or early postoperative (3 mo) physical intervention. 13 Subacute postoperative comfort, quality of life, pain, and functional ability after discharge from the hospital remains incompletely described in relation to fast-track hip arthroplasty.…”

Initiatives to reduce length of stay in acute hospital settings: a rapid synthesis of evidence relating to enhanced recovery programmes

“…Of these, 12 RCTs (21 articles due to multiple publications) were included in published systematic reviews discussed in the systematic reviews section above and will not be discussed here further. 36,[38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54][55][56][57]61 Another 12 RCTs (13 articles) that were not included in the systematic reviews are discussed here separately. [58][59][60][62][63][64][65][66][67][68][69][70][71] Two foreign-language articles were identified: one Russian 72 and one Chinese.…”

A Multimodal Clinical Pathway Can Reduce Length of Stay After Total Knee Arthroplasty

“…Pre-emptive pain management programs using NSAIDS or COX-2 medications and dexamethasone can shorten hospital stay and decrease the likelihood of discharge to a skilled nursing facility but not all studies confirm these findings [2,3,5,6,9,17]. Several reports have reached conflicting conclusions regarding the efficacy of earlier physical therapy on discharge [7,8,10,[12][13][14]16]. Similarly, pre-operative patient education programs have demonstrated a varying contribution to decreased LOS [12-15, 18, 19].…”