The Efficacy of Pre-Operative Home Visits for Total Hip Replacement Clients

2003 ◽  
Vol 70 (4) ◽  
pp. 226-232 ◽  
Author(s):  
Annette Rivard ◽  
Sharon Warren ◽  
Don Voaklander ◽  
Allyson Jones
Keyword(s):  
Hospital Stay ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Service Providers ◽  
Length Of Hospital Stay ◽  
Care Practice ◽  
Total Hip ◽  
True Value ◽  
Home Based ◽  
Significant Difference

Background. There is increasing realization among health care administrative decision makers and service providers that we must measure the true value of expensive services by demonstrating the achievement of identified goals. Purpose. The objective of this study was to determine whether clients who received the home-based intervention for a hip arthroplasty would result in a more timely discharge home from hospital. Method. Two hundred and eight clients receiving a total hip replacement at two acute care hospitals comprised the sample. One hospital included the more costly home-based pre-operative teaching by an occupational therapist as part of its protocol while the other provided comparative occupational therapy intervention within its hospital based pre-admission clinic. Discharge disposition and length of hospital stay were measured. Results. Though no significant difference in either of these outcomes was found, a number of issues were raised indicating the complexity of resource allocation to this client population and the importance of the qualitative dimensions of care. Practice Implications. The location for pre-operative teaching for total hip replacements was not found to impact the length of hospital stay nor whether clients are discharged directly home.

scholarly journals Predictors of Length of Hospital Stay after Total Hip Replacement

2011 ◽  
Vol 19 (3) ◽  
pp. 284-287 ◽  
Author(s):  
Kashif Abbas ◽  
Masood Umer ◽  
Irfan Qadir ◽  
Jaweria Zaheer ◽  
Haroon ur Rashid
Keyword(s):  
Hospital Stay ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Demographic Data ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Prolonged Hospital Stay ◽  
Prolonged Stay ◽  
Total Hip ◽  
Prolonged Hospital

Purpose. To identify variables affecting length of hospital stay after total hip replacement (THR) while controlling for potential confounders. Methods. Records of 199 consecutive elective unilateral THRs were reviewed. Clinical and demographic data including age, gender, body mass index, comorbidities, surgical factors (surgical approach, type of prosthesis, use of cement, operating time), anaesthetic factors (type of anaesthesia, ASA physical status), and length of hospital stay were recorded. Results. 64% of patients left hospital within 12 days, 28% within 3 weeks, and 8% after 3 weeks. The median length of hospital stay was longer in women than men (11.5 vs. 9 days, p=0.009), in patients aged >65 years than those younger (13 vs. 9 days, p<0.0001), and in those with American Society of Anesthesiologists (ASA) grades 3 and 4 than grades 1 or 2 (14 vs. 9 days, p<0.0001). A greater proportion of women than men (45% vs. 27%, p=0.007), patients aged >65 years than those younger (61% vs. 37% or 24%, p<0.0001), and those with ASA grades 3 and 4 than grades 1 and 2 (68% vs. 25%, p<0.0001) stayed 12 days or longer. In the multiple regression analysis, the predictors for prolonged hospital stay (≥12 days) were patient age >65 years (p<0.003), female gender (p<0.05), and ASA grades 3 and 4 (p<0.0001). Of the 72 patients with prolonged stay, 7% had no, 26% had one, 42% had 2, and 25% had all 3 predictors. Conclusion. Prolonged hospital stay after THR is largely predetermined by case mix. Our study helps to identify individuals who need longer rehabilitation and more care.

scholarly journals Early Ambulation in Hip Replacement Patients Regarding Length of Hospital Stay

2021 ◽  
Vol 2 (2) ◽  
pp. 30-34
Author(s):  
Jayme Bristol
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Research Study ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Early Ambulation ◽  
Total Hip ◽  
Average Length Of Stay

Background: Total hip replacement surgeries are one of the most common orthopedic surgeries performed today1. This number continues to rise. One way to accommodate the growing need for inpatient orthopedic beds is through high hospital turnover. High turnover can possibly be accomplished through early ambulation. The goal of the study is to see if standing or walking before eight hours post-operative decreased overall length of hospital stay. Methods: This research study is a retrospective chart review that looked at 92 randomly selected general anesthesia total hip replacement patients from Nebraska Medicine in Omaha, NE from August 2017 to August 2018. This research study makes a clear definition of early ambulation after total hip replacement surgery: standing or walking within eight hours of surgery. Results: From the analyzed research the average length of stay for all 92 total hip replacement patients was 4.23 days. For those total hip replacement patients who were ambulated within eight hours of surgery completion the average length of stay was 2.83 days. For the total hip replacement patients who were ambulated after eight hours of surgery completion the average length of stay was 5.14 days. Conclusion: There is a statistically significant difference in length of hospital stay for total hip replacement patients at Nebraska Medicine who were ambulated within eight hours of surgery completion compared to those who were not.

scholarly journals The Benefit of Modified Rehabilitation and Minimally Invasive Techniques in Total Hip Replacement

2008 ◽  
Vol 90 (5) ◽  
pp. 406-411 ◽  
Author(s):  
Anastasios K Lilikakis ◽  
Beryl Gillespie ◽  
Richard N Villar
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Minimally Invasive Techniques ◽  
Rehabilitation Protocol ◽  
Total Hip ◽  
Invasive Techniques

INTRODUCTION We wished to assess if an intensive rehabilitation regimen alone, or one combined with modified anaesthetic and surgical techniques, can change the speed of rehabilitation or the length of hospital stay after total hip replacement. PATIENTS AND METHODS We compared 44 patients who had followed a traditional care pathway, with 38 patients who had rehabilitated under a new rehabilitation protocol, with 40 patients who had also received modified, minimally invasive techniques. The speed of rehabilitation was measured in terms of three specific milestones accomplished on the day after surgery. RESULTS We found a statistically significant improvement in the day after surgery each activity was possible. The length of hospital stay was reduced from 6.5 days to 5.4 days to 4.1 days, a difference which was also statistically significant. CONCLUSIONS The data support the view that a new rehabilitation protocol alone can reduce the length of hospital stay and hasten rehabilitation. The combination of modified anaesthetic and minimally invasive surgical techniques with the new rehabilitation regimen can further improve short-term outcome after total hip replacement.

scholarly journals Changes in Invasiveness and Latent Infection Rate Associated with Switching the Approach in Total Hip Replacement

2021 ◽  
Vol 14 ◽  
pp. 117954412110313
Author(s):  
Hiroaki Kijima ◽  
Kenji Tateda ◽  
Shin Yamada ◽  
Satoshi Nagoya ◽  
Masashi Fujii ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Infection Rate ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Lymphocyte Count ◽  
Operative Time ◽  
Latent Infection ◽  
Total Hip ◽  
Bleeding Volume ◽  
Muscle Sparing

Purpose: Muscle-sparing approaches for total hip replacement (THR) involve learning curves. This study aimed to clarify changes in invasiveness and infection rate with changes in approach. Methods: One surgeon changed the approach of THR from Dall’s approach (Dall) to anterolateral modified Watson-Jones approach (OCM). Another changed from Dall to a direct anterior approach (DAA). Another 3 surgeons changed from posterolateral approach (PL) to OCM. Subjects were 150 cases, comprising the last 25 cases with conventional approaches and the first 25 cases with new approaches (Dall to OCM: 25 + 25; Dall to DAA: 25 + 25; PL to OCM: 25 + 25 cases). Differences in operative time, bleeding volume, hospital stay, haemoglobin (Hb), white blood cell count, lymphocyte count, creatine kinase (CK) and C-reactive protein (CRP) were investigated. Results: In the change from Dall to OCM, only hospital stay decreased. In the change from Dall to DAA, hospital stay and CRP decreased, but bleeding volume increased. In the change from PL to OCM, operative time, CRP and CK decreased, but Hb also decreased. Cases with lymphocyte count <1000/μL or lymphocytes comprising <10% of total white blood cells at around day 4 after surgery were defined as latent infection cases. In these cases, operative time was longer, Hb was lower and CK was higher. Conclusion: Introducing muscle-sparing approaches improved many markers of invasiveness, but some items deteriorated. In the early stages of introducing a new approach, choosing cases without obesity and without high muscle volume may reduce the risk of infection.

Patient-Reported Outcome following Metal-On-Metal Resurfacing of the Hip and Total Hip Replacement

2009 ◽  
Vol 19 (3) ◽  
pp. 245-250 ◽  
Author(s):  
David P. Hall ◽  
Del Srikantharajah ◽  
Raimond E. Anakwe ◽  
Paul Gaston ◽  
Colin R. Howie
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Short Form ◽  
Length Of Hospital Stay ◽  
Multivariate Regression Analysis ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Additional Patient ◽  
Total Hip ◽  
Patient Reported

Patient-reported outcome and satisfaction scores have become increasingly important in evaluating successful surgery. This case-matched control study compared patient-reported outcome and satisfaction data following hip resurfacing and total hip arthroplasty. Thirty-three consecutive patients selected for hip resurfacing were compared with 99 patients undergoing cemented total hip replacement (THR), matched for age, sex and pathology. Participants completed a Short-Form 12 Health Survey (SF-12) and Oxford Hip Score questionnaire preoperatively and 6 months post operatively with an additional patient satisfaction questionnaire. There was no difference in length of hospital stay. While both groups reported improved outcome scores, multivariate regression analysis did not demonstrate any significant benefit for one group over the other. Both groups reported high levels of satisfaction, which tended to be better in patients undergoing hip resurfacing.

scholarly journals Evaluation of version of acetabular component following total hip replacement on conventional radiograph and computed tomography

2020 ◽  
Vol 27 (2) ◽  
pp. 179-185
Author(s):  
Manish Raj ◽  
Ashish Jaiman ◽  
Rajesh Kumar Chopra
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Total Hip Replacement ◽  
Gold Standard ◽  
Hip Replacement ◽  
Regression Line ◽  
Patient Positioning ◽  
Acetabular Version ◽  
Total Hip ◽  
Significant Difference

Background/Purpose: Total hip replacement (THR) is considered as one of the most successful orthopedic procedures. However, improperly placed components can lead to instability and accelerated wear. Acetabular cup inclination can be very well accessed by anteroposterior pelvis X-rays; for acetabular version assessment, computed tomography (CT) scan is the gold standard. CT scan is not readily available at many centers and the surgeon has to rely on X-ray methods for evaluation of acetabular version to audit results and to predict behavior of the surgical intervention. This prospective study was undertaken to compare Woo and Morrey’s and ischiolateral methods of assessment of acetabular version on cross-table lateral radiographs with CT assessment and to assess the validity of radiographic methods with respect to CT scan method. Material and methods: A prospective follow-up study was conducted for 18 months’ duration (October 2016 to March 2018) on 30 adult patients who underwent THR surgery. Cross-table lateral radiograph was obtained at 3 and 6 weeks in the postoperative period. Two observers made each observation at two different points of time. CT scan was performed at 3 weeks. Version as measured by radiographs and CT scan was recorded. Results: The major overlap in the distribution of the values of the Woo and Morrey method suggests that there is no significant difference between the observations. Distribution of the values of the ischiolateral view and the CT scan value distributions have a very small overlap and hence suggest a strong significant difference between the two. Conclusion: In this study, Woo and Morrey’s method and ischiolateral method of assessment of acetabular version were compared with CT assessment. We found that in Woo and Morrey’s method, values were comparable to CT scan values, when put on regression line. However, in situation of change in patient positioning, namely hip stiffness in contralateral hip, measurement of component changed in series of radiography due to differences in pelvis tilt. So, in these circumstances, we can use ischiolateral method which can give consistent measurement. But it will not be in concordance with CT scan values and Woo and Morrey values, as represented in regression line. The high intra-class correlation coefficients for both intra- and inter-observer reliability indicated that the angle measured with these methods is consistent and reproducible for multiple observers. CT, however, be considered as gold standard for measurement owing to control over pelvic rotation and/or tilt/patient positioning.

scholarly journals Comparison of short-term outcomes between minimal invasive superpath approach and conventional posterior approach in total hip arthroplasty: a randomized controlled trial

2021 ◽  
Vol 7 (3) ◽  
pp. 431
Author(s):  
Carlos B. Branco ◽  
Rita M. Sousa ◽  
Diogo Sousa ◽  
Joao Reis ◽  
Andre Guimaraes ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Harris Hip Score ◽  
Short Term ◽  
Total Hip ◽  
The Third ◽  
Posterior Group ◽  
Approach Group

<p><strong>Background:</strong> The objective of current study was to compare the short-term outcomes between a cohort of patients that undergone total hip replacement by a superpath technique at the beginning of the surgeon's learning curve, and a cohort of patients that undergone a total hip replacement by a conventional posterior approach.</p><p><strong>Methods:</strong> A cohort of 22 patients was prospectively and randomly selected for being part of a superpath approach group or a conventional posterior approach group. Clinical evaluation was performed in two primary end-points - the third post-operative day and the first month after surgery - using physical exams as the “20 meter walking test” and the “30 seconds sit to stand test”, the Harris hip score, the visual analogue scale for pain. Radiological evaluation was also performed.</p><p><strong>Results:</strong> 11 patients underwent the superpath approach and 11 patients underwent the conventional posterior approach. The surgery time was 78.2 min in the superpath group and 59.4 min in the posterior group. The average hospital stay was 3.4 days in the superpath group and 5.3 days in the posterior group. When assessing pain improvement through VAS, it was found that both on the third postoperative day and on the first postoperative month, patients in the superpath group showed greater improvement. There were no differences in functional results with statistical significance. No complications were seen in both groups.</p><p><strong>Conclusions:</strong> Despite the longer surgical time seen with the superpath approach, it managed to significantly decrease the length of hospital stay and obtained better results in improving pain in the short term.</p>

Radiographic Assessment of Biomechanical Parameters following hip Resurfacing and Cemented Total Hip Arthroplasty

2009 ◽  
Vol 19 (3) ◽  
pp. 251-256 ◽  
Author(s):  
Curtis Robb ◽  
Richard Harris ◽  
Kevin O'dwyer ◽  
Nadim Aslam
Keyword(s):  
Total Hip Replacement ◽  
Hip Arthroplasty ◽  
Hip Replacement ◽  
Hip Resurfacing ◽  
Leg Length ◽  
Femoral Offset ◽  
Normal Side ◽  
Total Hip ◽  
Significant Difference ◽  
Joint Reaction Forces

Resurfacing hip arthroplasty and total hip replacement both aim to restore anatomical parameters. Leg length and offset discrepancy can result in altered joint reaction forces, and are associated with increased wear, dislocation, and decreased patient satisfaction. This study assesses the accuracy of leg length and offset restoration after either a Birmingham Hip Resurfacing (BHR) or a cemented total hip replacement (THR). Standardised antero-posterior radiography was performed on two groups of 30 patients with unilateral primary osteoarthritis undergoing either a cemented total hip or resurfacing. The normal contra-lateral hip was used as the control. Leg length and offset were measured pre-operatively with no significant difference between the two groups. Cup offset, femoral offset, total offset and leg length of the prosthesis and normal side were measured by two observers and mean measurements were analysed by a paired t test. Leg lengths in each group did not differ significantly from the normal side, THR 0.53 mm (95% CI -2.4 to 3.4 mm) but BHR implantation did result in mean leg shortening of -1.9 mm (95% CI -4.5 mm to 0.6 mm). Cup offset differed significantly from normal anatomy in both groups, as did femoral and total offset for the total hip replacement group. However, femoral offset was restored in the Birmingham resurfacing group. When the THR group was compared against the BHR group we found no difference between restoration of leg lengths (p = 0.21) and cup offset (p = 0.30) but femoral (p = 0.0063) and total offset (p = 0.03) were restored more accurately with a BHR.

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