Evolution of the rapid recovery program to outpatient surgery in total hip arthroplasty. / Evolución del programa de recuperación rápida a cirugía ambulatoria en artroplastia total de cadera.

INTRODUCTION: The implementation of Enhanced Recovery programs has transformed total hip arthroplasty (THA) surgery. Outpatient prosthetic surgery is a safe and beneficial technique. Few centers in our country perform Outpatient Total Hip Arthroplasty (OTHA). We present the preliminary results of our experience Material and Method: This is a prospective observational study conducted in 2023 with a sample of 30 patients proposed for THA following an outpatient surgery protocol by the Orthopedic Surgery and Traumatology Service. RESULTS: In 2023, we performed 132 THAs in our center. Thirty patients, 27 men and 3 women with an average age of 55.7 years were included for an outpatient surgery circuit. Three patients did not meet the inclusion criteria identified by the Anesthesiology Department. Of the 27 patients included in the program, 25 were discharged on the same day. Two patients were admitted: one due to an intraoperative fracture and the other due to poor pain control and dizziness. No secondary complications related to the program were observed after discharge. All patients except one would recommend the outpatient protocol. CONCLUSIONS: OTHA programs should evolve from rapid recovery programs. Their implementation depends on an experienced multidisciplinary team. In this study, inclusion criteria were defined, achieving high satisfaction without increased complications. Outpatient surgery is a good option, and the implementation of this circuit is a safe, effective, and a satisfactory practice for selected patients.

Local infiltration analgesia does not have benefits in fast-track hip arthroplasty programmes: a double-blind, randomised, placebo-controlled, clinical trial.

BACKGROUND: Multimodal analgesia regimes including local infiltration analgesia (LIA) have been successfully applied in fast-track hip arthroplasty programmes. LIA's contribution to the analgesic effect in hip arthroplasty has been questioned. Our study sought to determine the analgesic efficacy of LIA in THA surgery in a fast-track programme. METHODS: Patients diagnosed with hip osteoarthritis scheduled for arthroplasty were randomised to receive LIA (120 ml ropivacaine 0.2% plus epinephrine 0.5 µ/ml) or saline as a part of a multimodal analgesia regime. The surgical team, the nursing staff, and patients were all blinded regarding patient allocation throughout the study. The primary outcome was pain assessed as a continuous variable using the visual analogue scale (VAS) at 4, 8, 24 and 48 hours postoperatively. Secondary outcomes included the amount of analgesic rescue consumption, complications and length of hospital stay. RESULTS: A total of 63 patients were interviewed and agreed to participate in the study. No statistically significant differences were found between groups for pain measurements at 4, 8, 12, 24 and 48 hours after surgery. There were also no differences in rescue medication consumption, complications, or length of stay. CONCLUSIONS: Our results suggest LIA (ropivacaine plus epinephrine, single shot) has no effect in pain management and has not shown benefits for early ambulation in primary THA surgery. Further research is needed to establish the optimal multimodal analgesia regime for THA fast-track programmes. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov (NCT03513276).

Burden of First Osteoporotic Hip Fracture in Spain: A Prospective, 12-Month, Observational Study.

The purpose of this study was to estimate the burden of osteoporotic fractures beyond the hospitalization period covering up to the first year after the fracture. This was a prospective, 12-month, observational study including patients aged ≥65 years hospitalized due to a first low-trauma hip fracture, in six Spanish regions. Health resource utilization (HRU), quality of life (QoL) and autonomy were collected and total costs calculated. Four hundred and eighty seven patients (mean ± SD age 83 ± 7 years, 77 % women) were included. Twenty-two percent of patients reported a prior non-hip low-trauma fracture, 16 % were receiving osteoporotic treatment at baseline, and 3 % had densitometry performed (1.8 % T-score ≤-2.5). Sixteen percent of patients died (women 14 %; men 25 %; p = 0.0011) during the first year. Mean hospital stay was 11.8 ± 7.9 days and 95.1 % of patients underwent surgery. Other relevant HRUs were: outpatient visits in 78 % of patients (mean 9.2 ± 9.7); walking aids, 58.7 %; rehabilitation facilities, 35.5 % (28.7 ± 41.2 sessions); and formal and informal home care, 22.2 % (49.6 ± 72.2 days) and 53.4 % (77.1 ± 101.0 h), respectively. Mean direct cost was €9690 (95 % confidence interval: 9184-10,197) in women and €9019 (8079-9958) in men. Main cost drivers were: first hospitalization episode (women €7067 [73 %]; men €7196 [80 %]); outpatient visits (€1323 [14 %]; €997 [11 %]); and home care (€905 [9 %]; €767 [9 %]). QoL and autonomy showed a marked decrease during hospitalization, not entirely recovered at 12 months (p < 0.05 vs. baseline for EQ-5D, Harris hip score and modified Barthel index). In a Spanish setting, osteoporotic hip fractures incur a high societal and economic cost, mainly due to the first hospitalization HRU, but also due to subsequent outpatient visits and home care.