Enhanced recovery programmes after total hip arthroplasty can result in reduced length of hospital stay without compromising functional outcome

Bone Joint J. 2016 Apr;98-B(4):475-82. doi: 10.1302/0301-620X.98B4.36243.


Aims: The primary aim of this study was to investigate the effect of an enhanced recovery program (ERP) on the short-term functional outcome after total hip arthroplasty (THA). Secondary outcomes included its effect on rates of dislocation and mortality.

Patients and methods: Data were gathered on 1161 patients undergoing primary THA which included 611 patients treated with traditional rehabilitation and 550 treated with an ERP.

Results: The ERP was shown to be a significant independent factor which shortened length of stay (LOS) by a mean of 1.5 days (95% confidence interval (CI) 1.3 to 1.8, p < 0.001) after adjusting for confounding variables. The rates of dislocation (traditional 1.03% vs ERP 0.91%, p = 0.84) and mortality (1.5% vs 0.6%, p = 0.14) one year post-operatively were not significantly different. Both groups showed significant improvement in Harris Hip Score (42.8 vs 41.5) at 12 to 18 months post-operatively and there was no significant difference in the magnitude of improvement on univariate (p = 0.09) and multivariate analysis (p = 0.35). There was no significant difference in any of the eight domain scores of the Short-Form - 36 general health surveys post-operatively (p > 0.38).

Conclusion: We conclude that an ERP after THA shortens LOS by a mean of 1.5 days and does not increase the rate of complications post-operatively. It gives equivalent functional outcomes to a traditional rehabilitation pathway.

Take home message: ERP reduces LOS after THA in comparison to traditional rehabilitation, without adversely affecting functional outcomes, dislocation rates or mortality.

Keywords: Enhanced recovery programme; Fast-track; Total hip arthroplasty.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / rehabilitation*
  • Female
  • Follow-Up Studies
  • Hip Joint / physiopathology*
  • Hip Joint / surgery
  • Humans
  • Length of Stay / trends*
  • Male
  • Middle Aged
  • Postoperative Care / methods*
  • Range of Motion, Articular / physiology*
  • Recovery of Function*
  • Retrospective Studies
  • Treatment Outcome