Enhanced recovery after surgery pathway: The use of fascia iliaca blocks causes delayed ambulation after total hip arthroplasty

Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction; results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p < 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p < 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p < 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.

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Enhanced recovery after posterior minimally invasive total hip arthroplasty with continuous intraarticular anaesthesia

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-018-2169-z ◽

2018 ◽

Vol 28 (5) ◽

pp. 761-769 ◽

Cited By ~ 2

Author(s):

Claude Schwartz

Keyword(s):

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Enhanced Recovery ◽

Total Hip

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Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0946-2523 ◽

2019 ◽

Vol 158 (02) ◽

pp. 214-220

Author(s):

Karl Philipp Kutzner ◽

Alexander Meyer ◽

Marie Bausch ◽

Michael Schneider ◽

Philipp Rehbein ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Enhanced Recovery ◽

Weight Bearing ◽

Hemoglobin Concentration ◽

Inpatient Rehabilitation ◽

Clinical Results ◽

Total Hip ◽

Recovery Program ◽

Inpatient Length Of Stay

Abstract Background An inpatient hospital stay of up to 10 days after total hip arthroplasty (THA) is still common in Germany, mostly followed by inpatient rehabilitation. Internationally already widespread concepts for enhanced recovery are increasingly gaining popularity in Germany. Objectives The presentation of content and results of a newly implemented enhanced recovery concept in THA. Materials and Methods In this single-center, prospective observational study of a consecutive patient collective of a single surgeon, between January 2016 and July 2016, 103 short-stem THA patients were enrolled and treated using a newly introduced enhanced recovery concept. After 6 weeks and 6 months clinical examination was performed regarding function, pain, satisfaction and possible complications. Results The goal of discharge on day 4 after operation was reached in 61.2% of the patients with a mean postoperative inpatient stay of 4.9 days. After 6 weeks and 6 months respectively, excellent clinical results were achieved with high patient satisfaction. The complication rate was found to be low. Mean hemoglobin concentration decreased by 2.1 g/dl. A fissure of the femur below the implant healed conservatively applying no weight bearing for a total of 6 weeks. A pulmonary embolism that occurred during rehabilitation was also successfully treated. After 6 months one case showed a bursitis trochanterica. Conclusions Inpatient length of stay can be reduced by enhanced recovery concepts without increasing the risks to patients. Thus, in Germany these concepts will be applied increasingly.

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Tissue Adhesive for Wound Closure in enhanced-recovery Total Hip Arthroplasty: A Prospective, Randomized and Controlled Study

10.21203/rs.2.20875/v2 ◽

2020 ◽

Author(s):

Xiangpeng Kong ◽

Minzhi Yang ◽

Zheng Cao ◽

Jiying Chen ◽

Wei Chai ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Wound Closure ◽

Enhanced Recovery ◽

The Other ◽

Tissue Adhesive ◽

Controlled Study ◽

Total Hip ◽

Related Cost ◽

Patient Reported

Abstract Background: We aimed to present our experience of adopting tissue adhesive as adjunct to standard wound closure in total hip arthroplasty (THA) and evaluate its performance.Methods: From September 2019 to November 2019, we prospectively enrolled consecutive patients who underwent simultaneous bilateral THA in this randomized and controlled study. Standard wound closure was applied on one side of hip and additional tissue adhesive on the other side at random. We collected and analyzed patients’ information, including age, gender, body mass index (BMI), diagnosis, postoperative length of stay (LOS), dressing changes, wound evaluation scores, wound-related cost and complications. Results: Thirty patients with simultaneous bilateral THA were enrolled in this study. During the hospital stay, the dressing change in hips with tissue adhesive was significantly less than that in the other hips (p=0.000). However, the wound-related cost in hips with tissue adhesive was significantly higher (p=0.000). At one-month follow up, patient-reported wound measurement of hips with tissue adhesive was significantly better than the other hips (p=0.004). Seventeen patients preferred tissue adhesive and only five patients preferred standard wound closure. Conclusions: Tissue adhesive could significantly reduce wound drainage and increase patient satisfaction, which can be an ideal adjunct to standard wound closure in enhanced-recovery THA.

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