Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty

Background

Fast track rehabilitation after primary total hip (THR) and total knee replacement (TKR) is gaining popularity. We performed a prospective clinical trial to identify predictive factors for successful fast track rehabilitation.

Methods

Between June 2005 and January 2006, 52 THR and 48 TKR were performed on consecutive patients off the local waiting list with no pre-selection or exclusion criteria. Patients underwent a fast track rehabilitation programme within a group-dynamic set-up aiming for discharge day 3 to 5 postoperatively. Demographic, clinical and social factors were analysed.

Results

Eighty-four percent (n = 44) of THR patients and 73% (n = 35) following TKR achieved the target discharge. Average discharge after THR was 5.4 and 5.5 days after TKR. Delayed discharge was mostly related to medical, social and organisational reasons. Age, 3 m-get-up-and-go-test (3 m-TGUGT), home situation and preoperative walking distance were the main predictors for the early discharge after THR; age, diagnosis, ASA class and preoperative pain medication were influential for TKR. Perioperative complication rates were within or below the national average.

Conclusion

Successful fast track rehabilitation is possible without pre-selection and does not seem to compromise clinical safety. However, a good social and physiotherapy community set-up should be available. The identified predictive factors could be helpful to identify candidates for fast track rehabilitation.