Comparison of a fast track protocol and standard care after hip arthroplasty in the reduction of the length of stay and the early weight-bearing resumption: study protocol for a randomized controlled trial

Martina Rocchi, Cesare Stagni, Marco Govoni, Alessandro Mazzotta, Leonardo Vivarelli, Antonella Orlandi Magli, Mariada Perrone, Maria Grazia Benedetti, Dante Dallari, Martina Rocchi, Cesare Stagni, Marco Govoni, Alessandro Mazzotta, Leonardo Vivarelli, Antonella Orlandi Magli, Mariada Perrone, Maria Grazia Benedetti, Dante Dallari

Abstract

Background: To date, hip arthroplasty is one of the most commonly performed surgical procedures, with growing worldwide demand. In recent decades, major progress made in terms of surgical technique, biomechanics, and tribology knowledge has contributed to improve the medical and functional management of the patient. This study aims to assess if the application of a fast track protocol, consisting of a preoperative educational intervention, adequate postoperative pain control, and intensive rehabilitation intervention, reduces the length of stay (LOS) and allows the early functional recovery compared to standard clinical practice for patients undergoing hip arthroplasty.

Methods: The study population consists of 90 patients with primary arthrosis of the hip with an anterior indication of hip arthroplasty. The exclusion criteria are older than 70 years, a contraindication to performing spinal anesthesia, and bone mass index (BMI) greater than 32. Participants, 45 for each group, are randomly allocated to one of two arms: fast track clinical pathway or standard care protocol. During allocation, baseline parameters such as Harris Hip Score (HHS) and Western Ontario and McMaster Universities (WOMAC) index are collected. On the third postoperative day, the functional autonomy for each patient is assessed by the Iowa Level of Assistance (ILOA) scale, and it is expected the discharge for patients in the fast track group (primary outcome). On the other hand, standard care patient discharge is expected after 5-7 days after surgery. During follow-up fixed at 6 weeks and 3, 6, and 12 months, HHS and WOMAC scores are collected for each patient (secondary outcomes).

Discussion: Although total hip replacement has become a widespread standardized procedure, to the authors' knowledge, only few randomized controlled trials were performed to evaluate the effectiveness of fast track pathway vs. standard care procedure in the reduction of the LOS after hip arthroplasty. It is expected that our results collected by the application of minimally invasive surgical interventions with concomitant management of perioperative pain and bleeding and early functional rehabilitation will contribute to enriching the understanding of clinical and organizational aspects linked to fast track arthroplasty.

Trial registration: ClinicalTrials.gov NCT03875976 . Registered on 15 March 2019-"retrospectively registered".

Keywords: Early mobilization; Education; Fast track; Hip arthroplasty; Pain management.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Scheme of the study design. HHS Harris Hip Score, ILOA Iowa Level of Assistance, NRS Numeric Rating Scale, WOMAC Western Ontario and McMaster Universities
Fig. 2
Fig. 2
Schedule of enrollment, intervention, and assessments in the study. FT fast track, SC standard care, d day, w week, m month

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