Abstract:
BACKGROUND : Traditionally, hip replacement surgery was associated with prolonged recovery and rehabilitation in a hospital
setting. Prolonged stay is causing growing concern internationally, where there is an increased drive to cost-effective practice
and a realisation that prolonged hospitalisation is not required and may be detrimental. Enhanced Recovery After Surgery
(ERAS) protocols address this problem by advocating evidence-based multidisciplinary peri-operative management pathways
associated with rapid recovery, without compromising safety. Despite proven efficacy, these protocols are not being
implemented in most South African orthopaedic practices.
METHODS : Data from two cohorts (80 patients) undergoing elective primary total hip arthroplasty were included. One group
was rehabilitated according to a prolonged stay protocol and the other according to ERAS. Cohorts were matched according
to demographics and comorbidities. The functional outcome was compared using the Oxford Hip Score. The 30-day
readmission rate was compared to assess the safety of early discharge, and the length of stay of patients was compared.
RESULTS : The readmission rate and Oxford Hip Scores showed no clinically significant difference between the cohorts. The
length of stay was markedly decreased in the ERAS group.
CONCLUSION : ERAS protocols can decrease the length of stay in elective total hip replacement without compromising patient
safety or functional outcome.
LEVEL OF EVIDENCE : Level 4
