Bowel management post major joint arthroplasty: results from a randomised controlled trial

AimTo evaluate the effect of a new post-operative bowel protocol in total hip and total knee replacement patients.BackgroundUp to 65% of total hip and total knee replacement patients experience some degree of constipation post-operatively. A lack of robust evidence to guide bowel management and reduce constipation in this cohort was the impetus for this study.DesignA multisite cluster randomised trial in private secondary and tertiary hospitals.MethodsIn total 331 patients were recruited across seven Australian hospitals over 13 months. Control participants (n = 171) received routine bowel management whilst intervention participants (n = 160) received bowel management as per the trial protocol.ResultsIntervention patients took 6 days less than controls to return to normal bowel function, and were more than seven times more likely to return to normal bowel function by day 5 post operatively. Age, gender and length of pre-operative fasting had no effect on these outcomes.ConclusionThese results support the use of the Murdoch Bowel Protocol® for hip and knee replacement patients and may be relevant for other patient groups who experience opioid induced bowel dysfunction.