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

PurposeDay-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.MethodsThirty-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.ResultsParticipants 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).ConclusionsDay-zero ambulation appears safe and may have clinically relevant effects in speeding patient functional recovery and facilitating earlier discharge from hospital.Implications for RehabilitationDay-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.