Perioperative gait analysis after total hip arthroplasty: Does outpatient surgery compromise patient outcomes?

Background: There has been a continuing trend toward decreasing the length of hospital stay for patients undergoing total hip arthroplasty (THA). We aimed to investigate the impact of timing of discharge on gait and patient-reported outcomes early after THA. Methods: In this prospective observational cohort study conducted from May 2014 to November 2015, we measured gait velocity, stride length, single-limb support and single-limb support symmetry in adults aged 18-75 years before direct anterior THA, at discharge from the hospital, and 2, 6 and 12 weeks postoperatively. All procedures were performed by a single surgeon. Patients were discharged on the same day as surgery (outpatient group) or stayed at least 1 night in hospital (inpatient group). Participants also completed the Timed Up and Go test (all postoperative time points) and a series of questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index [6 and 12 wk], 12-Item Short Form Health Survey [2, 6 and 12 wk], Harris Hip Score [12 wk] and a pain visual analogue scale [all postoperative time points]). Results: Thirty-six participants were enrolled in the study, of whom 16 were outpatients and 20 were inpatients. The mean pain rating at the time of discharge was lower in the outpatient group than in the inpatient group (adjusted mean difference -1.5, 95% confidence interval-3.0 to 0.0). We found no other significant differences between the groups for any gait, patient-reported or surgical outcome. Conclusion: There were no statistically significant differences in gait or patient-reported outcomes after direct anterior THA between patients who stayed overnight and those who were discharged as outpatients. Patients discharged as outpatients were younger than those who stayed overnight. Our results suggest that discharging patients as an outpatient after direct anterior THA may have a similar impact on patient function and outcomes as a standard overnight stay in hospital. Contexte: La tendance a reduire la duree de l'hospitalisation des patients soumis a une intervention pour prothese totale de la hanche (PTH) se maintient. Nous avons voulu evaluer l'impact du moment du conge sur la demarche et sur les parametres rapportes par les patients peu de temps apres la PTH. Methodes: Au cours de cette etude de cohorte observationnelle prospective realisee entre mai 2014 et novembre 2015, nous avons mesure la vitesse de la deambulation, la longueur de la foulee, l'equilibre sur une jambe et sa symetrie chez des adultes de 18 a 75 ans avant une PTH anterieure directe, au moment du conge hospitalier et 2, 6 et 12 semaines apres l'intervention. Toutes les interventions ont ete effectuees par 1 seul chirurgien. Les patients recevaient leur conge le jour meme de l'operation (groupe de patients ambulatoires) ou sejournaient au moins 1 nuit a l'hopital (groupe de patients hospitalises). Les participants effectuaient aussi un test de lever-marcher chronometre (Timed Up and Go test) a toutes les evaluations postoperatoires, et on leur administrait une serie de questionnaires: score WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) a 6 et 12 semaines, SF-12 (12-Item Short Form Health Survey) a 2, 6 et 12 semaines, score de hanche de Harris a 12 semaines et echelle visuelle analogique d'intensite de la douleur a toutes les evaluations postoperatoires. Resultats: Trente-six participants ont ete inscrits a l'etude, dont 16 dans le groupe ambula-toire et 20 dans le groupe hospitalise. L'evaluation moyenne de la douleur au moment du conge etaient moindre dans le groupe de patients hospitalises (difference moyenne ajustee -1,5, intervalle de confiance de 95 %-3,0 a 0,0). Nous n'avons observe aucune autre difference significative entre les groupes pour la demarche et les parametres autorapportes ou operatoires. Conclusion: Nous n'avons observe aucune difference statistiquement significative entre les groupes aux plans de la demarche ou des parametres autorapportes apres la PTH anterieure directe selon que les patients avaient sejourne 1 nuit a l'hopital ou qu'ils avaient recu leur conge le jour meme. Les patients non hospitalises etaient plus jeunes que les patients hospitalises. Selon nos resultats, l'impact sur le fonctionnement et sur les parametres des patients pourrait etre le meme, que ces derniers recoivent leur conge hospitalier le jour meme ou le lendemain.
Total hip arthroplasty (THA) is a successful procedure for the treatment of osteoarthritis. Length of stay after this procedure continues to decrease, and some institutions have started to perform THA [...]