Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4,500 consecutive procedures.
OBJECTIVE
Our unit started to use routine multimodal techniques to enhance recovery for hip and knee arthroplasty in 2008. We have previously reported earlier discharge, a trend toward a reduction in complications, and a statistically significant reduction in mortality up to 90 days after surgery. In this study, we evaluated the same cohort to determine whether survival benefits were maintained at 2 years.


METHODS
We prospectively evaluated 4,500 unselected consecutive total hip and knee replacements. The first 3,000 underwent a traditional protocol (TRAD) and the later 1,500 underwent an enhanced recovery protocol (ER). Mortality data were collected from the Office of National Statistics (UK).


RESULTS
There was a difference in death rate at 2 years (TRAD vs. ER: 3.8% vs. 2.7%; p = 0.05). Survival probability up to 3.7 years post surgery was significantly better in patients who underwent an ER protocol.


CONCLUSIONS
This large prospective case series of unselected consecutive patients showed a reduction in mortality rate at 2 years following elective lower-limb hip and knee arthroplasty following the introduction of a multimodal enhanced recovery protocol. This survival benefit supports the routine use of an enhanced recovery program for hip and knee arthroplasty.
Northern Deanery Orthopedic Training Programme, UK. TSavaridas@doctors.net.uk
Terence
T
Savaridas
Ignacio
I
Serrano-Pedraza
Sameer K
SK
Khan
Kate
K
Martin
Ajay
A
Malviya
Mike R
MR
Reed
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality / Q000534:rehabilitation*; D002423:Cause of Death; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology