Does rapid mobilisation as part of an enhanced recovery pathway improve length of stay, return to function and patient experience post primary total hip replacement? A randomised controlled trial feasibility study

Abstract

Purpose

Day-zero ambulation may enable patients to recover and leave hospital quicker following total hip replacement (THR). The present randomised control feasibility study investigated the efficacy of day-zero ambulation as a physiotherapeutic intervention.

Methods

Thirty-six non-blinded adults aged 44–85 (Mean 67.1; SD 9.6 years) undergoing primary, uncomplicated THR were block randomized to either a control group (n = 18) with standard post-operative physiotherapy or an intervention group (n = 18) incorporating walking on the same day as the operation. Outcomes were length of hospital stay (LOS), time to reach functional milestones and achieve all physiotherapy discharge criteria, post-operative pain scores, complications and patient experience.

Results

Participants treated with day-zero ambulation had reduced median hospital LOS of 1 day (p = .096), and median reduced times to reaching functional milestones of 39.7 h quicker to transfer to a chair (p < .001), 24.5 h quicker to walk 10 m (p = .009) and 26.4 h quicker to independently ascend and descend stairs (p = .01). Participants in the intervention group were deemed physiotherapy ready to leave hospital significantly earlier than control group (1.04 days, p = .015).

Conclusions

Day-zero ambulation appears safe and may have clinically relevant effects in speeding patient functional recovery and facilitating earlier discharge from hospital.

Implications for Rehabilitation

• Day-zero ambulation following total hip replacement (THR) appears safe.

• Preliminary data suggest that day-zero mobilisation following THR could be efficacious and support the need for a fully powered randomised controlled trial.

• There may be a clinically relevant effect in speeding patient functional recovery and facilitating an earlier discharge from hospital.

Keywords:

• Total hip replacement
• total hip arthroplasty
• accelerated
• day-zero
• ambulation
• mobilization

Acknowledgements

The authors would like to thank study participants, clinical orthopaedic staff at the Royal Bournemouth Hospital and acknowledge support from the Faculty of Environmental and Life Sciences, University of Southampton.

Disclosure statement

The author(s) reported there is no funding associated with the work featured in this article.