Day two post operative 'fast-track' discharge following primary total hip replacement

Since December 2002 one Surgeon in the Outcomes unit at Musgrave Park Hospital (MPH), Belfast, has been carrying out minimally invasive hip arthroplasty. The use of a smaller surgical incision and a 'fast track' rehabilitation protocol for selected patients is enabling earlier mobilisation and discharge. Between January 2003 and February 2004, 428 total hip replacements (THRs) were carried out, and 58% of the patients were eligible for day 2 discharge. 82 patients were discharged on day 2 (19.1%), all to their own home. 57 (69.5%) were males and 25 (30.5%) were females. The mean patient age was 59 years (range 37-84). Men were more likely to be discharged than women. This patient group tended to have a lower body mass index (mean 27.6, range 20.5-37.0) than the overall population of patients (29.6, range 17-45). 73 patients had a normal post discharge recovery and only 9 had problems. This study has shown that patients who successfully went home on day 2 are typically thinner (as evidenced by mean BMI of 27.6), younger (mean age 59), healthier (all ASA 1 or 2), and more likely to be male. We have concluded that it is safe to discharge young fit patients on day two following primary THR. Patient education, motivation and good home support are the key to day 2 discharge.