Improved early recovery and shorter hospital stay with fast track protocol versus standard care in total hip arthroplasty: 5-year results from a prospective randomised controlled study.

PURPOSE: Total hip arthroplasty (THA) is a widely performed surgery with growing demand globally. This study aims to evaluate the effectiveness of a fast track (FT) protocol compared to standard care (SC) in patients undergoing THA.

METHODS

Ninety patients aged 18-70 years with primary unilateral hip osteoarthritis, American Society of Anesthesiologists (ASA) score <3, body mass index (BMI) ≤ 32 and no cognitive or psychiatric disorders were prospectively enrolled from March 2018 to January 2020. All patients provided informed consent and were randomised to the FT or SC groups. The FT protocol consisted of preoperative education, oral analgesic pain management and early intensive rehabilitation. Functional autonomy was assessed on postoperative Day 3 using the Iowa Level of Assistance (ILOA) scale. Follow-up assessments at 6 weeks, 3, 6, 12 and 60 months included the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

RESULTS

Forty-six patients were assigned to the FT group. Both groups were comparable in baseline demographics. The FT group showed significantly faster early functional recovery, with lower ILOA scores on postoperative Day 3 (9.60 ± 5.2 vs. 11.7 ± 3.4; p = 0.024), and a shorter hospital stay (3.54 ± 1.25 vs. 6.39 ± 1.59 days; p < 0.0001). WOMAC scores were significantly better in the FT group at 6 weeks (10.38 ± 9.18 vs. 14.21 ± 8.76; p = 0.035) and remained superior at 60 months (0 ± 0 vs. 0.27 ± 0.81; p = 0.027). Although baseline HHS was higher in the FT group, greater improvements from baseline were seen in the SC group at later follow-ups, likely due to a ceiling effect.

CONCLUSIONS

The FT protocol enhances early postoperative recovery and significantly reduces hospital stay after THA without compromising safety. Long-term functional outcomes favour the FT approach, supporting its implementation to improve recovery in appropriately selected patients undergoing hip arthroplasty.

LEVEL OF EVIDENCE: Level II.