Acta Orthopaedica, 85:5, 488-492, DOI: 10.3109/17453674.2014.934186

Role of preoperative pain, muscle function, and activity level in discharge readiness after fast-track hip and knee arthroplasty

Bente Holm, Thomas Bandholm, Troels Haxholdt Lunn, Henrik Husted, Peter Kloster Aalund, Torben Bæk Hansen & Henrik Kehlet
Hip Knee

Background and purpose — The concept of fast-track surgery has led to a decline in length of stay after total hip arthroplasty (THA) and total knee arthroplasty (TKA) to about 2–4 days. However, it has been questioned whether this is only achievable in selected patients—or in all patients. We therefore investigated the role of preoperative pain and functional characteristics in discharge readiness and actual LOS in fast-track THA and TKA.

Methods — Before surgery, hip pain (THA) or knee pain (TKA), lower-extremity muscle power, functional performance, and physical activity were assessed in a sample of 150 patients and used as independent variables to predict the outcome (dependent variable)—readiness for hospital discharge —for each type of surgery. Discharge readiness was assessed twice daily by blinded assessors.

Results — Median discharge readiness and actual length of stay until discharge were both 2 days. Univariate linear regression followed by multiple linear regression revealed that age was the only independent predictor of discharge readiness in THA and TKA, but the standardized coefficients were small (≤ 0.03).

Interpretation — These results support the idea that fast-track THA and TKA with a length of stay of about 2–4 days can be achieved for most patients independently of preoperative functional characteristics.

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