Implementation of an accelerated mobilization protocol following primary total hip arthroplasty: impact on length of stay and disposition

  • Samuel S. Wellman
  • Andrew C. Murphy
  • Diane Gulcynski
  • Stephen B. Murphy


With improvements in surgical techniques, implant design, and patient caremaps, surgeons have sought to accelerate early rehabilitation after total hip arthroplasty. Many authors have reported results of fundamentally similar protocols to achieve this end. These protocols focus on multi-modal pain management, early therapy, tissue-preserving surgical technique, and careful blood management. We present the implementation and results of such a protocol involving a different surgical approach, and highlight the published literature on this topic.


Total hip arthroplasty Rehabilitation Accelerated mobilization protocol 



To George Babikian, MD of Orthopedic Associates of Portland, Portland ME, and to Nora Bowne, RN of Maine Medical Center, Portland, ME.


S. Wellman: none; A. Murphy: none; D. Gulczynski: none; S. Murphy: Consultant to Ceramtec, GmbH; patents and royalties from Wright Medical Technology, Inc.; holds stock/stock options in Surgical Planning Associates, Inc.


  1. 1.
    Johanson NA, Lachiewicz PF, Lieberman JR, Lotke PA, Parvizi J, Pelegrini V, et al. Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg. 2009;17:183–96.PubMedGoogle Scholar
  2. 2.
    Mancuso CA, Salvati EA, Johanson NA, Peterson ME, Charlson MA. Patients’ expectations and satisfaction with total hip arthroplasty. J Arthroplast. 1997;12:387–96.CrossRefGoogle Scholar
  3. 3.
    Murphy SB, Ecker TM, Tannast M. Total hip arthroplasty performed using conventional and navigated tissue-preserving techniques. Clin Orthop Relat Res. 2006;453:160–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Jacobs CA, Christensen CP. Progressive subsidence of a tapered, proximally coated femoral stem in total hip arthroplasty. Int Orthop. 2009;33:917–22.PubMedCrossRefGoogle Scholar
  5. 5.
    Steppacher SD, Kowal JH, Murphy SB. Improving cup positioning using a mechanical navigation instrument. Clin Orthop Relat Res. 2011;469:423–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Berger RA, Sanders SA, Thill ES, Sporer SM, Della Valle C. Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. Clin Orthop Relat Res. 2009;467:1424–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Dorr LD, Thomas DJ, Zhu J, Dastane M, Chao L, Long WT. Outpatient Total Hip Arthroplasty. J Arthroplast. 2010;25:501–6.CrossRefGoogle Scholar
  8. 8.
    Lombardi AV, Berend KR, Adams JB. A rapid recovery program: early home and pain free. Orthopedics. 2010;33:656.PubMedGoogle Scholar
  9. 9.
    Mears DC, Mears SC, Chelly JE, Dai F, Vulakovich KL. THA with a minimally invasive technique, multi-modal anesthesia, and home rehabilitation. Clin Orthop Relat Res. 2009;467:1412–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Thomas KM, Sethares KA. An investigation of the effects of preoperative interdisciplinary patient education on understanding postoperative expectations following a total joint arthroplasty. Orthop Nurs. 2008;27:374–81.PubMedCrossRefGoogle Scholar
  11. 11.
    Pour AE, Parvizi J, Sharkey PF, Hozack WJ, Rothman RH. Minimally invasive hip arthroplasty: What role does patient preconditioning play? J Bone Joint Surg. 2007;89(9):1920–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Hoogeboom TJ, Dronkers JJ, van den Ende CH, Oosting E, van Meetern NL. Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: A randomized pilot trial. Clin Rehabil. 2010;24:901–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Buvanendran A, Kroin JS, Tuman KJ, Lubenow TR, Elmofty D, Moric M, et al. Effects of perioperative administration of selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement: A randomized controlled trial. J Am Med Assoc. 2003;290:2411–8.CrossRefGoogle Scholar
  14. 14.
    Sukeik M, Alshryda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg. 2011;93B(1):39–46.Google Scholar
  15. 15.
    Hatzidikis AM, Mendlick MR, McKillip T, Reddy RL, Garvin KL. Preoperative autologous donation for total joint arthroplasty: An analysis of risk factors for allogenic transfusion. J Bone Joint Surg. 2000;82:89–100.Google Scholar
  16. 16.
    Maund E, McDaid C, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: A systematic review. Br J Anaesth. 2011;106:292–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Horlocker TT, Kopp SL, Pagnano MW, Hebl JR. Analgesia for total hip and knee arthroplasty: A multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg. 2006;14:126–35.PubMedGoogle Scholar
  18. 18.
    Kehlet H, Andersen LO. Local infiltration analgesia in joint replacement: The evidence and recommendations for clinical practise. Acta Anaesthesiologica Scandanavica 2011, Epub ahead of print.Google Scholar
  19. 19.
    Meneghini RM, Smits SA. Early discharge and recovery with three minimally invasive total hip arthroplasty approaches: A preliminary study. Clin Orthop Relat Res. 2009;467:1431–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Samuel S. Wellman
    • 1
  • Andrew C. Murphy
    • 2
  • Diane Gulcynski
    • 2
  • Stephen B. Murphy
    • 2
  1. 1.Department of Orthopaedic SurgeryDuke University Medical CenterDurhamUSA
  2. 2.The Center for Computer Assisted and Reconstructive Surgery, New England Baptist HospitalTufts University School of MedicineBostonUSA

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