Original Article

HSS Journal

, Volume 7, Issue 3, pp 223-228

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Fast Track THR: One Hospital’s Experience with a 2-Day Length of Stay Protocol for Total Hip Replacement

  • Lawrence V. GulottaAffiliated withSports Medicine and Shoulder Service, Hospital for Special Surgery
  • , Douglas E. PadgettAffiliated withArthroplasty Service, Hospital for Special Surgery
  • , Thomas P. SculcoAffiliated withArthroplasty Service, Hospital for Special Surgery
  • , Michael UrbanAffiliated withDepartment of Anesthesiology, Hospital for Special Surgery
  • , Stephen LymanAffiliated withDepartment of Epidemiology and Biostatistics, Hospital for Special Surgery
  • , Bryan J. NestorAffiliated withArthroplasty Service, Hospital for Special Surgery Email author 



Current trends in total joint replacement have focused on shorter hospital stays.


This study aimed to determine if a pathway for total hip replacement (THR) with the goal of a 2-day discharge (fast track) is safe and effective compared to our traditional pathway (control).


One hundred forty-nine patients undergoing unilateral, uncomplicated, THR were enrolled in an accelerated postoperative pathway and 134 were enrolled in the traditional pathway. Patients were followed prospectively and outcomes included hospital length of stay, intra- and postoperative complications, readmissions, reoperations. A statistical model was created to determine factors predictive of a 2-day discharge.


At 1 year, there were no differences in complications, readmissions, or reoperations. The average length of stay decreased from 4.1 to 2.6 days (p < 0.0001). In the fast track group, 58% of patients were discharged home within 2 days. Barriers to a 2-day discharge were postoperative pain, nausea, and dizziness. The only preoperative factor that was predictive of a 2-day discharge was hypertension.


In a select group of patients, a protocol that allows for a 2-day discharge following THR is safe and effective.


total hip replacement postoperative protocol accelerated discharge clinical pathway