Abstract
Introduction
The current study reports on the impact of immediate mobilization of patients treated by tissue-preserving, computer-assisted total hip arthroplasty on length of stay, disposition, and complications.
Methods
From March, 2010 to April, 2011, a total of 231 consecutive primary THA were performed. Of these, 218 hips met the inclusion criteria of treatment using the superior capsulotomy surgical technique1 (Fig. 1), navigation of acetabular component implantation using a patient-specific mechanical navigation device (HipSextant™ navigation System, Surgical Planning Associates, Inc., Boston, MA)2, and patient age less than 80 years. Mean age of the patients was 57.3 years (range 23.5–79.9 years). The superior capsulotomy approach1 was used in all cases. This technique allows for both the femoral and the acetabular components to be placed with the patient in a lateral position through an incision in the superior capsule, posterior to the abductors and anterior to the short external rotators. The hip is not dislocated during surgery. Rather, the femur is prepared in situ through the top of the femoral neck, the neck is then transected, and the femoral head is excised en bloc. The acetabulum is prepared under direct vision using angled reamers, and the socket is placed with an offset inserter. The final construct is then reduced in situ. The protocol also involved the use of pre-emptive oral analgesia, pre-emptive autologous blood transfusion, and immediate mobilization3. Length of stay and disposition in this study group were compared to a cohort of 698 total hip arthroplasty performed at the same institution by all other techniques.
Results
In the 218 hips in this study, the mean length of stay was 1.65 days with 97% of patients discharged directly home. Comparatively, the control group of 698 primary hips had an average length of stay of 3.2 days with 68% of patients discharged directly home. Of the 3 patients transferred to rehabilitation, one had cerebral palsy and another had end stage renal disease, a mechanical heart valve, and a longstanding complete sciatic palsy on the contralateral side. One patient, discharged on post op day 3, was readmitted 3 weeks postop for a GI bleed in association with prolonged anti-inflammatory use prior to surgery. Otherwise, there were no readmissions, reoperations, dislocations, nerve injuries, or post-discharge blood transfusions.
Conclusions
The current study demonstrates that performing THA with combined tissue preservation and mechanical navigation techniques together with immediate mobilization can be safe and effective and have the potential of greatly reducing healthcare costs and dependence upon prolonged institutionalization following surgery.
