title: Efficacy of multimodal optimization of mobilization and nutrition in patients undergoing hip replacement: a randomized clinical trial.
abstract: BACKGROUND
  The aim of this trial was to assess the effects of optimization of mobilization and nutrition on patients undergoing primary total hip replacement (THR).
  
  
  METHODS
  Seventy-nine patients undergoing elective primary THR were recruited prospectively. After randomization, one group received optimized pre-operative information and enforced mobilization and nutrition, another group received conventional peri-operative care. Epidural anaesthesia and post-operative epidural analgesia with local anaesthetics and opioids were used in all cases. Outcome related to length of stay, complications, pain, mobilization, energy intake, and physical activities of daily living (PADL).
  
  
  RESULTS
  Although mobilization and nutrition were highly significantly increased in the intervention group, the reduction in length of stay was moderate (7.0 vs. 8.0 days P = 0.019). We found no differences between groups in relation to complications or pain. In the intervention group, the median day of independence in PADL was the third post-operative day (2 : 6 day) and the fourth post-operative day (2 : 7 day) in the control group. The difference was not significant.
  
  
  CONCLUSIONS
  Compared with conventional care, optimal and aggressive nutrition and mobilization resulted in a very moderate reduction in length of stay. There were no differences regarding pain, complications or time until independence in PADL.
authors.affiliation: Department of Orthopaedics, Aarhus Sygehus, Aarhus University Hospital, Aarhus, Denmark. mekp@mail.dk
authors.forename: M K
authors.initials: MK
authors.lastname: Petersen
authors.forename: C
authors.initials: C
authors.lastname: Madsen
authors.forename: N T
authors.initials: NT
authors.lastname: Andersen
authors.forename: K
authors.initials: K
authors.lastname: Søballe
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation; D004434:Early Ambulation; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome