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General Orthopaedics

RAPID MOBILISATION FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY

The South African Orthopaedic Association (SAAO) 59th Annual Congress



Abstract

Background

Rapid mobilisation programs, or “fast track” protocols, are aimed at shorter hospital stays. We found a limited local experience with these programs in total hip arthroplasty in South Africa, and decided to introduce a pilot study at our institution.

Purpose

This pilot study is aimed at the feasibility and safety of a RM program in the private sector setting, as well as a review of the pertinent literature.

Methods

40 patients who met inclusion criteria underwent THR and TKR according to a specific protocol. Key aspects of the protocol included: minimum use of opiates, high volume pericapsular local block at time of surgery, no urinary catheter, mobilisation within 6 hrs of surgery and no high care admission. Target Discharge was 3 days. Patients were followed up retrospectively and outcomes included; length of stay, intra- and post-operative complications, subjective patient experience, re-admissions and re-operations.

Results

36 patients, (90 %), were discharged by day 3, 4 patients were discharged at day 4. Mean stay 2,8 days, shortest 2 days, and longest 4 days.

3 elderly female patients required catheterization for urinary incontinence, on the first night post surgery.

No complications were experienced. The problems that prevented discharge within 3 days were post operative pain and orthostatic hypotension. There were no re-admissions or re-operations. One TKR required manipulation at 6 weeks. 5 patients required changes of dressings at home within one week post surgery.

All the patients in this study were extremely satisfied.

Conclusion

A rapid mobilisation program is relatively easy to implement although extra paramedical staff input is required. The results of this pilot study show that the protocol was effective and safe, as well as showing a significant hospital cost reduction. The obvious saving of costs are encouraging us to implement the protocol on a wider scale.

Appendix

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