Clinical pathways in hip and knee arthroplasty: a prospective randomised controlled study

Med J Aust. 1999 Jan 18;170(2):59-62. doi: 10.5694/j.1326-5377.1999.tb126882.x.


Objective: To ascertain the effectiveness of clinical pathways for improving patient outcomes and decreasing lengths of stay after hip and knee arthroplasty.

Design and setting: Twelve-month randomised prospective trial comparing patients treated through a clinical pathway with those treated by an established standard of care at a single tertiary referral university hospital.

Participants: 163 patients (56 men and 107 women; mean age, 66 years) undergoing primary hip or knee arthroplasty, and randomly allocated to the clinical pathway (92 patients) and the control group (71 patients).

Main outcome measures: Time to sitting out of bed and walking; rates of complications and readmissions; match to planned discharge destination; and length of hospital stay.

Results: Clinical pathway patients had a shorter mean length of stay (P = 0.011), earlier ambulation (P = 0.001), a lower readmission rate (P = 0.06) and closer matching of discharge destination. There were beneficial effects of attending patient seminars and preadmission clinics for both pathway and control patients.

Conclusion: Clinical pathway is an effective method of improving patient outcomes and decreasing length of stay following hip and knee arthroplasty.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Hip / nursing*
  • Arthroplasty, Replacement, Knee / adverse effects
  • Arthroplasty, Replacement, Knee / nursing*
  • Critical Pathways / standards*
  • Early Ambulation / statistics & numerical data
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Patient Education as Topic / standards
  • Patient Readmission / statistics & numerical data
  • Prospective Studies
  • Quality Indicators, Health Care