Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.
Z Rheumatol. 2022 Apr;81(3):253-262. doi: 10.1007/s00393-021-00978-5. Epub 2021 Mar 11.
Total hip arthroplasty (THA) is reported to be one of the most painful surgical procedures. Perioperative management and rehabilitation patterns are of great importance for the success of the procedure. The aim of this cohort study was the evaluation of function, mobilization and pain scores during the inpatient stay (6 days postoperatively) and 4 weeks after fast-track THA.
A total of 102 consecutive patients were included in this retrospective cohort trial after minimally invasive cementless total hip arthroplasty under spinal anesthesia in a fast-track setup. The extent of mobilization under full-weight-bearing with crutches (walking distance in meters and necessity of nurse aid) and pain values using a numerical rating scale (NRS) were measured. Function was evaluated measuring the range of motion (ROM) and the ability of sitting on a chair, walking and personal hygiene. Furthermore, circumferences of thighs were measured to evaluate the extent of postoperative swelling. The widespread Harris Hip Score (HHS) was used to compare results pre- and 4 weeks postoperatively.
Evaluation of pain scores in the postoperative course showed a constant decrease in the first postoperative week (days 1-6 postoperatively). The pain scores before surgery were significantly higher than surgery (day 6), during mobilization (p < 0.001), at rest (p < 0.001) and at night (p < 0.001). All patients were able to mobilize on the day of surgery. In addition, there was a significant improvement in independent activities within the first 6 days postoperatively: sitting on a chair (p < 0.001), walking (p < 0.001) and personal hygiene (p < 0.001). There was no significant difference between the measured preoperative and postoperative (day 6 after surgery) thigh circumferences above the knee joint. Compared to preoperatively, there was a significant (p < 0.001) improvement of the HHS 4 weeks after surgery. In 100% of the cases, the operation was reported to be successful and all of the treated patients would choose a fast-track setup again.
Application of a fast-track scheme is effective regarding function and mobilization of patients. Low pain values and rapid improvement of walking distance confirms the success of the fast-track concept in the immediate postoperative course. Future prospective studies have to confirm the results comparing a conventional and a fast-track pathway.
全髋关节置换术（THA）被认为是最疼痛的手术之一。围手术期管理和康复模式对手术的成功至关重要。本队列研究的目的是评估快速通道 THA 术后 6 天（住院期间）和 4 周后的功能、活动度和疼痛评分。
本回顾性队列研究纳入了 102 例连续接受微创非骨水泥全髋关节置换术的患者，均在快速通道设置下接受椎管内麻醉。使用数字评分量表（NRS）测量完全负重下使用拐杖的活动范围（米数和是否需要护士帮助）和疼痛值。通过测量关节活动度（ROM）和坐椅子、行走和个人卫生的能力来评估功能。此外，测量大腿周径以评估术后肿胀程度。广泛使用的 Harris 髋关节评分（HHS）用于比较术前和术后 4 周的结果。
术后疼痛评分评估显示，术后第 1 周疼痛持续下降（术后第 1-6 天）。手术前的疼痛评分明显高于手术（第 6 天）、活动时（p<0.001）、休息时（p<0.001）和夜间（p<0.001）。所有患者均能在手术当天活动。此外，术后第 6 天内独立活动能力显著改善：坐椅子（p<0.001）、行走（p<0.001）和个人卫生（p<0.001）。膝关节以上大腿周径的术前和术后（术后第 6 天）测量值之间无显著差异。与术前相比，术后 4 周 HHS 显著改善（p<0.001）。在 100%的病例中，手术被报告为成功，所有接受治疗的患者都将再次选择快速通道设置。
应用快速通道方案在患者功能和活动度方面是有效的。低疼痛值和行走距离的快速改善证实了快速通道概念在术后即刻的成功。未来的前瞻性研究需要比较常规和快速通道途径来证实这些结果。
