title: Enhanced recovery programmes after total hip arthroplasty can result in reduced length of hospital stay without compromising functional outcome.
abstract: OBJECTIVE
  The primary aim of this study was to investigate the effect of an enhanced recovery program (ERP) on the short-term functional outcome after total hip arthroplasty (THA). Secondary outcomes included its effect on rates of dislocation and mortality.
  
  
  METHODS
  Data were gathered on 1161 patients undergoing primary THA which included 611 patients treated with traditional rehabilitation and 550 treated with an ERP.
  
  
  RESULTS
  The ERP was shown to be a significant independent factor which shortened length of stay (LOS) by a mean of 1.5 days (95% confidence interval (CI) 1.3 to 1.8, p < 0.001) after adjusting for confounding variables. The rates of dislocation (traditional 1.03% vs ERP 0.91%, p = 0.84) and mortality (1.5% vs 0.6%, p = 0.14) one year post-operatively were not significantly different. Both groups showed significant improvement in Harris Hip Score (42.8 vs 41.5) at 12 to 18 months post-operatively and there was no significant difference in the magnitude of improvement on univariate (p = 0.09) and multivariate analysis (p = 0.35). There was no significant difference in any of the eight domain scores of the Short-Form - 36 general health surveys post-operatively (p > 0.38).
  
  
  CONCLUSIONS
  We conclude that an ERP after THA shortens LOS by a mean of 1.5 days and does not increase the rate of complications post-operatively. It gives equivalent functional outcomes to a traditional rehabilitation pathway.
  
  
  CONCLUSIONS
  ERP reduces LOS after THA in comparison to traditional rehabilitation, without adversely affecting functional outcomes, dislocation rates or mortality.
authors.affiliation: Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Maempel
authors.affiliation: Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.affiliation: Victoria Hospital , Hayfield Road, Kirkcaldy KY2 5AH, Fife, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Ballantyne
authors.affiliation: Victoria Hospital , Hayfield Road, Kirkcaldy KY2 5AH, Fife, UK.
authors.forename: E
authors.initials: E
authors.lastname: Dunstan
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Enhanced recovery programme; Fast-track; Total hip arthroplasty