[Preliminary evaluation of a treatment protocol for total hip arthroplasty].
The hip arthrosis is a degenerative joint disease occurring mainly in the elderly patients, a recently growing population. Rational measures are needed to better carry out the surgical procedures and to reduce cost for the health system, since almost two thirds of the costs are due to the admission period. Therefore, a global, multidisciplinary assistance program for total hip arthroplasty (THAAP), including ambulatory appointments and programmed home care by a nursing team, was established to guide patients and their relatives for the procedure. This is a pilot study for a randomized prospective clinical trial to assess the feasibility of the THAAP and to determine the protocol adherence by the medical and nurse team. Secondarily, it attempts to determine the impact of the program on admission period, patient functional autonomy and postoperative events, as well as to assess the feasibility of the programmed nursing home-care. A total of 22 patients (8 males, 12 females) with mean (SD) age of 59.45 (16.87) ranging from 21 to 86 years were included in the study. They were divided into two groups according whether they were (group 1, n = 10) or were not (group 2, n = 10) included in the THAAP. The main comorbidity for both groups were SAH (2 vs. 1), diabetes (1 vs. 0) and alcohol consumption (1 vs. 0), respectively. Mean (SD) postoperative (p.o.) period was significantly reduced (p = 0.0055) in group 1; 5.2 (0.4) as compared to group 2; 7.5 (2.3). Adherence to the THAAP was 90% and 100% for doctors and nurses, respectively. Seven out of nine patients in group 1 were bed-seated on the second POD, two were seated on the third POD and none were bed-ridden. All of them were able to walk with crutches a day later. All patients in group 2 left bed on the fourth POD. In conclusion, the present protocol demonstrated to be feasible, team adherence was adequate and resulted in a reduced admission period. The progress of the program shall determine its efficacy and the feasibility of programmed nursing home care.
Galia
Carlos Roberto
CR
Universidade Federal do Rio Grande do Sul-Faculdade de medicina Programa de Pos-Graduaçao em Medicina.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000451:nursing; D016022:Case-Control Studies; D002985:Clinical Protocols / Q000592:standards*; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D018709:Statistics, Nonparametric