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Archives of Orthopaedic and Trauma Surgery

, Volume 130, Issue 9, pp 1185–1191 | Cite as

Readmissions after fast-track hip and knee arthroplasty

  • Henrik Husted
  • Kristian Stahl Otte
  • Billy B. Kristensen
  • Thue Ørsnes
  • Henrik Kehlet
Orthopaedic Outcome Assessment

Abstract

Introduction

With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA).

Materials and methods

1,731 consecutive, unselected patients were operated with primary THA or TKA in a well-described standardized fast-track setup from 2004 to 2008. All readmissions and deaths within 90 days were analyzed using the national health register.

Results

Mean LOS decreased from 6.3 to 3.1 days. Within 90 days, 15.6% of patients following TKA were readmitted as opposed to 10.9% after THA (p = 0.005). Three deaths (0.17%) were associated with clotting episodes. Suspicion of DVT (not found) and suspicion of infection made up half of the readmissions. Readmissions in general and for thromboembolic events, dislocations and manipulations in specific did not increase with decreasing LOS. There was no difference between readmission rates per year for either TKA or THA but there was a significantly reduced risk of dislocation found with decreasing LOS comparing each year from 2005 to 2007 with the index year of 2004 (with the longest LOS and the highest incidence of dislocation).

Conclusion

Fast-track TKA and THA do not increase the readmission rate. Readmissions are more frequent after TKA than THA, but dislocation after THA and manipulation after TKA do not increase as LOS is decreasing.

Keywords

Fast-track Total hip arthroplasty Total knee arthroplasty Readmissions Dislocation Manipulation 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Henrik Husted
    • 1
    • 4
  • Kristian Stahl Otte
    • 1
    • 4
  • Billy B. Kristensen
    • 2
    • 4
  • Thue Ørsnes
    • 1
    • 4
  • Henrik Kehlet
    • 3
    • 4
  1. 1.Department of Orthopedic SurgeryHvidovre University HospitalCopenhagenDenmark
  2. 2.Department of AnesthesiologyHvidovre University HospitalCopenhagenDenmark
  3. 3.Section of Surgical Pathophysiology, RigshospitaletCopenhagen UniversityCopenhagenDenmark
  4. 4.The Lundbeck Centre for Fast-track Hip and Knee ArthroplastyCopenhagenDenmark

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