Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan-Feb;73(1):54-71.
doi: 10.1016/j.bjane.2021.05.008. Epub 2021 Jun 10.

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER.2 study

Javier Ripoll S-Melchor  1 , C Sar Aldecoa  2 , Raquel Fern Índez-Garc A  3 , Marina Varela-Dur Ín  4 , Norma Aracil-Escoda  5 , Daniel Garc A-Rodr Guez  6 , Lucia Cabezudo-de-la-Muela  7 , Luc A Hormaechea-Bolado  8 , Beatriz Nacarino-Alcorta  3 , Rolf Hoffmann  9 , Juan V Lorente  10 , Jos M Ram Rez-Rodr Guez  11 , Ane Abad-Motos  12 ; POWER2 Study Investigators Group for the Spanish Perioperative Audit and Research Network (RedGERM-SPARN)
Affiliations

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER.2 study

Javier Ripoll S-Melchor et al. Braz J Anesthesiol. 2023 Jan-Feb.

Abstract

Background: Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization.

Methods: This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery.

Results: A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24.áhours [16.Çô30]. 4,222 (69.3%) patients moved in .ëñ 24.áhours after surgery. Local anesthesia [OR.á=.á0.80 (95% confidence interval [CI]: 0.72.Çô0.90); p.á=.á0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55.Çô0.60); p.á<.á0.001], mean adherence to ERAS items [OR.á=.á0.93 (95% CI: 0.92.Çô0.93); p.á<.á0.001], and preoperative hemoglobin [OR.á=.á0.97 (95% CI: 0.96.Çô0.98); p.á<.á0.001] were associated with shorter time to mobilization.

Conclusions: Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Keywords: Early mobilization; Enhanced Recovery After Surgery (ERAS); Local anesthesia; Total hip arthroplasty; Total knee arthroplasty.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CONSORT flow diagram for included patients.
Figure 2
Figure 2
Distribution of hours of mobilization. ERAS, Enhanced recovery after surgery; IQR, Interquartile range; THA, total hip arthroplasty; TKA, total knee arthroplasty. Dots represent number of hours of mobilization according to ERAS and surgery. Box lines represent median and IQR. By using quasi-poison regression, p-values were obtained between the ERAS and non-ERAS groups for THA and TKA.
Figure 3
Figure 3
Scatter plot. Relation between hours of mobilization and length of stay (LOS) stratified by postoperative complications.
See this image and copyright information in PMC

References

    1. Sloan M., Premkumar A., Sheth N.P. Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018;100:1455–1460. - PubMed
    1. Kehlet H. Enhanced Recovery After Surgery (ERAS): good for now, but what about the future? Can J Anaesth. 2015;62:99–104. - PubMed
    1. Vendittoli P.-A., Pellei K., Desmeules F., et al. Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs. Orthop Traumatol Surg Res. 2019;105:1237–1243. - PubMed
    1. Wainwright T.W., Gill M., Mcdonald D.A., et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS.«) Society recommendations. Acta Orthop. 2020;91:3–19. - PMC - PubMed
    1. Tayrose G., Newman D., Slover J., et al. Rapid mobilization decreases length-of-stay in joint replacement patients. Bull Hosp Jt Dis. 2013;71:222–226. - PubMed

Publication types