Fast-Track-Arthroplasty

Abstract

Essential components of fast-track or enhanced recovery programs in arthroplasty are the optimization of interdisciplinary organizational processes, as well as pre-, intra- and postoperative procedures in everyday clinical practice. The early postoperative mobilization of patients after joint replacement surgery is of central importance, with the aim of avoiding pain and complications. This article provides adetailed overview of fast-track procedures that have already been established in many units. Furthermore, it demonstrates the clinical advantages of FastTrack for total hip arthroplasty (THA) in an evidence-based manner within the framework of arandomized study design. 194 primary THA patients were examined after randomization into two single-blinded groups; Fast-Track (n = 98) or conventional treatment path (n = 96). Mobilization was defined as the primary outcome parameter, measured in seconds using the Timed Up and Go Test (TUG). Secondary parameters were the achievable walking distance in meters and pain using the numerical rating scale (NRS). All parameters were recorded preoperatively and daily until the sixth postoperative day. No complications or revisions were recorded within the first postoperative week. The fast-track group showed significantly better TUG values and walking distance results compared to the conventional group until the sixth postoperative day (p < 0.05, respectively). There was no significant difference regarding the pain assessment (NRS) (p > 0.05). The use of Fast-Track in hip arthroplasty can evidently improve short-term postoperative clinical outcomes. This first prospective, single-blinded, randomized controlled study showed very good clinical results with comparable pain after FastTrack THA compared to aconventional treatment path. Fast-Track concepts are highly effective in terms of early mobilization and clinical outcome-without incurring ahigher risk of complications in the short term.