By: 25 October 2011

John Bottros, et al.
In Current Orthopaedic Practice. July/August 2010. Vol. 21. No. 4. Pp. 381-384.

Surgeons from the Cleveland Clinic in Ohio divided a group of 103 total hip patients into two groups. One group (73 patients) had the traditional post-operative treatment after hip replacement. The second group (30 patients) tried a new rapid recovery program.

The rapid recovery program combines several factors to enhance recovery. First, the surgeon uses incisions that don’t cut through the abductor muscles. The abductor muscles are along the inside of the thigh and help bring the legs together. Second, nurses supervise the use of pain medications. Pain management begins in the operating room where patients receive a special injection of numbing agents around the joint just operated on.

And third, the patients are seen right away by physical therapists on the multidisciplinary team. The traditional program allows patients to rest the first day after surgery. They get up and move much more slowly with the traditional approach compared with the rapid recovery program. Getting up the day of surgery and walking small amounts frequently throughout the day is part of the rapid recovery program. Walking is followed up with an exercise program that is supervised by the therapist twice a day.

The results speak for themselves. Patients in the rapid recovery program went directly home two days (sometimes three days) after surgery. Patients in the traditional treatment group were more likely to be discharged to a rehabilitation center around day 4 after surgery. If the traditionally treated patient went home directly from the hospital, then a treatment program continued at home.

Walking distance was twice as far in half the time for the rapid recovery group. That result alone brought smiles to the patients’ faces as they reported a much higher level of satisfaction compared with the traditional group. But there was another positive finding from this study. The rapid recovery group reported significantly less pain and less use of pain medication.

The goal of the rapid recovery program was to cut costs while still maintaining patient safety and excellent results. Decreasing the number of days patients are in the hospital while increasing their level of independent function by the time they are discharged is possible.

The authors of this study conclude the results show what they call compelling evidence that the rapid recovery program accomplishes the intended goals as stated above. They suggest that the importance of physical therapy right away translates into cost savings as well as increased patient satisfaction.

This type of post-operative treatment plan deserves further attention. Before it can be used by all patients, it will be necessary to compare complications and long-term results between these two groups. And it will be important to compare the three key factors (surgical approach, anesthesia and pain control, PT program) to find out if one of those variables is more important, more powerful, or more successful in contributing to the outcomes.