The Influence Of Fast-track Surgery On The Bone Condition Around Prothesis After Total Hip Arthroplasty

Objective:A prospective clinical trial was designed for evaluating the the influence of fast-track surgery(FTS)on the bone condition around prothesis after total hip arthroplasty(THA)and discussing the efficiency and safety of applying FTS to THA.Methods:A total of 22 patients(17 unilateral and 5 bilateral hips)who met the inclusion and exclusion criteria undergoing THA were assigned to the fast-track surgery group or standard treatment group from January 2017 to July 2017 according to a double-blind,randomized,controlled principle.The fast-track surgery group used a perioperative treatment strategies which took the up-to-date fast-track surgery idea as guidance,while the standard treatment group accepted a recently normal perioperative treatment.The trial data of patients were recorded,the primary outcomes was the assessment of imaging results 6 months after operation which includes: stress shielding of femoral prosthesis,prosthesis bone ingrowth and heterotopic ossification.In the secondary outcomes,postoperative Harris score(the day of discharge,2 months aftersurgery and 6 months after surgery),postoperative visual analogue scale(VAS)Pain Score(on operation day and first,second and third days after surgery),postoperative activity(2 and 6 months after surgery),postoperative exercise(2 and 6 months after surgery),length of hospital stay(LOS),postoperative LOS and patient satisfaction were used as the index for estimating the efficacy of the treatment.The safety of the treatment was evaluated by Erythrocyte sedimentation rate,hypersensitive C reactive protein,readmission rate within 90 days and postoperative complications.Result:All patients were followed up.Imaging outcomes of the fast-track surgery group(11 cases,13 hips)and the standard treatment group(11 cases,14 hips)at 6 months after operation showed that all patients had stable bone ingrowth,and there was no significant difference in the incidence of heterotopic ossification between the two groups.The degree and incidence of stress shielding of the femoral prosthesis in the fast-track surgery group were higher than that in the standard treatment group,and the difference was statistically significant.Comparison of the therapeutic effect of two groups,fast-track surgery group was higher on the postoperative Harris score(theday of discharge)and activity within 6 months after operation than the standard treatment group,the difference was statistically significant.In the field of postoperative VAS pain scores,Harris scores(2 months and 6 months after surgery),exercise after discharge,LOS and postoperative LOS,two groups had no obvious difference with no statistically significant.As a result of comparison of the safety index,there was no rehospitalized patients within 90 days and postoperative complications like dislocation,fracture,infection,thrombosis in both groups.The postoperative level of ESR,CRP,incision exudation and blood transfusion between the two groups showed no differences in statistical significance.But The incidence of postoperative incision swelling in the fast-track surgery group was higher than that in the standard treatment group,the difference was statistically significant.The LOS is not less than 5 days in both groups,and a questionnaire was used to find the reason of delayed discharge from which 12 people(55%)worry about the poor local medical conditions that could not support valid protection and treatment for postoperative complications,6(27%)due to poor pain control and4(18%)for unsatisfactory functional recovery.Conclusion:1.An optimized FTS with preoperative education,preemptive analgesia,drain cessation and early mobilization would increase postoperative femoral stress shielding level and incidence in primary THA.It may relate to increased postoperative activity which need further studies to prove.2.Preemptive analgesia by using NSAIDs has limited effect on reducing postoperative pain in a patient receiving THA with FTS.3.The optimized FTS can accelerate the early functional recovery of patients undergoing primary total hip arthroplasty,but the duration of this promoting effect may not exceed 2 months after the operation,which means the efficiency of FTS on THA need to be further evaluated.4.The application of optimized FTS in primary THA can increase the activity of patients within 6 months,but does not affect long term(>2 months)postoperative functional recovery.The amount of exercise may play a major role in functional recovery due to no significant difference in two groups.5.Drain cessation and early mobilization of FTS on THA may play a role in increasing the incidence of postoperative swelling of the incision,but it did not affect the wound healing.Moreover,application of FTS on THA did not increase postoperative complications,which proved safety of it.6.The lack of fundamental medical support may be the main reason for delaying discharge in China,which is not conducive to the application of FTS.