title: The effect of navigator on length of stay and rehabilitation for total hip arthroplasty patients.
abstract: BACKGROUND
  Navigated THA is a new procedure in Thailand that has been performed since 2012. The previous studies have reported that navigated THA was a safe and reliable procedure that resulted in a more consistent cup placement compared to the conventional free hand technique. Furthermore, it decreased complications of THA, especially dislocation. Perioperative protocols are based on the surgeon's concern about stability of the prosthesis and the patient's health condition. Assuming that the navigator can improve the alignment and stability of THA, the time to start rehabilitation and the post-operative length of stay should be reduced in the hospital that does not implement any perioperative protocols. The purpose of the present study was to compare the time to start rehabilitation and the length of stay between navigated and non-navigated THA.
  
  
  METHODS
  This retrospective study of patients underwent THA using short stem by a single surgeon between March 2011 and November 2012. Seventy-six patients were classified into navigated and non-navigated groups. The patient's characteristic data that were recorded included age, sex, BMI, comorbid illness, diagnosis, ASA classification, preoperative hematocrit, operative time, type of anesthesia, intraoperative blood transfusion, postoperative length of stay, postoperative complication, and time to start rehabilitation. The data were compared between two groups by t-test and Chi-square test.
  
  
  RESULTS
  There were 41 patients in the navigated THA and 35 patients in the non-navigated THA. There were 35 male patients (85.37%) in the navigated group and 27 (77.14%) in the non-navigated group. The mean age was 44.17 +/- 11.39 years in the navigated group and 44.51 +/- 8.17 years in the non-navigated group. The mean BMI was 21.77 +/- 3.09 kg/m2 in the navigated group and 22.44 +/- 4.3 kg/m2 in the non-navigated group. Most of the patients were diagnosed with osteonecrosis (more than 85% in both groups). There were no significant differences between the demographic data of the two groups except the cup abduction and anteversion angle. The mean cup abduction angle in the navigated group was 41.37 +/- 2.01 degrees and 43.97 +/- 4.44 degrees in the non-navigated group (p-value < 0.01). The mean cup anteversion angle in the navigated group was 13.57 +/- 3.28 degrees and 22.58 +/- 10.68 degrees in the non-navigated group (p-value < 0.01). The mean number of days from operation to rehabilitation in the navigated group was 3.27 +/- 1.83 days and 4.34 +/- 1.33 days in the non-navigated group (p-value < 0.01), which was significantly shorter. The postoperative length of stay was 5.37 +/- 2.42 days in the navigated group and 5.89 +/- 1.98 days in the non-navigated group. There were two patients with minor complications after operation. There was no dislocation or infection in both groups.
  
  
  CONCLUSIONS
  The navigated THA procedure resulted in a significantly shorter time to start rehabilitation. The postoperative length of stay was lower in the navigated group; however it was not significant. The navigated THA technique increased the surgeon's confidence to provide early mobilization and rehabilitation program.
authors: Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. rachawan.su@cpird.in.th
authors: Rachawan
authors: R
authors: Suksathien
authors: Department of Orthopaedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
authors: Yingyong
authors: Y
authors: Suksathien
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013785:Thailand; D016896:Treatment Outcome