title: Bowel management post major joint arthroplasty: results from a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of a new post-operative bowel protocol in total hip and total knee replacement patients.
  
  
  BACKGROUND
  Up to 65% of total hip and total knee replacement patients experience some degree of constipation post-operatively. A lack of robust evidence to guide bowel management and reduce constipation in this cohort was the impetus for this study.
  
  
  METHODS
  A multisite cluster randomised trial in private secondary and tertiary hospitals.
  
  
  METHODS
  In total 331 patients were recruited across seven Australian hospitals over 13 months. Control participants (n = 171) received routine bowel management whilst intervention participants (n = 160) received bowel management as per the trial protocol.
  
  
  RESULTS
  Intervention patients took 6 days less than controls to return to normal bowel function, and were more than seven times more likely to return to normal bowel function by day 5 post operatively. Age, gender and length of pre-operative fasting had no effect on these outcomes.
  
  
  CONCLUSIONS
  These results support the use of the Murdoch Bowel Protocol(®) for hip and knee replacement patients and may be relevant for other patient groups who experience opioid induced bowel dysfunction.
authors.affiliation: Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, 100 Murdoch Drive, Murdoch 6150, Australia; The University of Notre Dame Australia, Fremantle, Australia. Electronic address: Gail.Ross-Adjie@sjog.org.au.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Ross-Adjie
authors.affiliation: Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, 100 Murdoch Drive, Murdoch 6150, Australia; The University of Notre Dame Australia, Fremantle, Australia; Edith Cowan University, Perth, Australia.
authors.forename: Leanne
authors.initials: L
authors.lastname: Monterosso
authors.affiliation: The University of Notre Dame Australia, Fremantle, Australia; Institute for Health and Rehabilitation Research, Fremantle, Australia.
authors.forename: Max
authors.initials: M
authors.lastname: Bulsara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001315:Australia; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D008297:Male; D008875:Middle Aged; D063728:Secondary Care Centers; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Analgesia; Arthroplasty; Constipation; Hip replacement; Knee replacement; Narcotic; Opioid; Polyethylene glycol