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Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

  • Symposium: Advanced Techniques for Rehabilitation after Total Hip and Knee Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consectutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices. Thirty-eight patients required some additional intervention outside the pathway to resolve nausea, hypotension, or sedation prior to discharge. There were no readmissions for pain, nausea, or hypotension yet there was one readmission for fracture and nine emergency room evaluations in the three month perioperative period. This anesthetic and rehabilitation protocol allowed outpatient total hip arthroplasty to be routinely performed in these consectutive patients undergoing primary total hip arthroplasty. With current reimbursement approaches the modest savings to the hospital in length of stay may be outweighed by the additional costs of personnel, thereby making this outpatient system more expensive to implement.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush Medical College, Rush-Presbyterian-St. Luke’s Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL, 60612, USA

    Richard A. Berger MD, Sheila A. Sanders RN, Elizabeth S. Thill RN, Scott M. Sporer MD & Craig Della Valle MD

Authors
  1. Richard A. Berger MD
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  2. Sheila A. Sanders RN
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  3. Elizabeth S. Thill RN
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  4. Scott M. Sporer MD
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  5. Craig Della Valle MD
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Corresponding author

Correspondence to Richard A. Berger MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Berger, R.A., Sanders, S.A., Thill, E.S. et al. Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients. Clin Orthop Relat Res 467, 1424–1430 (2009). https://doi.org/10.1007/s11999-009-0741-x

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  • DOI: https://doi.org/10.1007/s11999-009-0741-x

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