Patient selection process for 1-day total hip arthroplasty

Abstract

Osteoarthritis (OA) is a degenerative joint disease and OA of hips and knees tends to cause the greatest burden to the population. In the case of hip joint failure, a Total Hip Arthroplasty (THA), a surgical replacement of the hip joint with an artificial prosthesis, is required to relieve patients from pain and regain mobility. In order to deal with the growing number of THA surgeries, optimize the cost effectiveness, reduce the length of hospital stay and minimize the risk, rapid recovery protocols have been introduced worldwide for elective primary THA. The next challenge for the orthopedic care was outpatient THA, aiming to send the patient to home the same day of surgery. To improve patient safety and managing expectation of the patients and medical professionals the current outpatient THA care pathway was analyzed and redesign suggestions were made. Pre-assessment where clinical patient data is integrated with patient characteristics (mental and physical condition, life circumstances, etc.) seems very important to support the orthopedic surgeon with sufficient data to make an informed decision whether a patient is suitable for outpatient THA. According to the results, current patient selection process is mainly guided by clinical patient data and should be extended with patient characteristics. The relevant data provided by one of the medical professionals should be transparently available for the other medical professionals to support shared decision-making. The patients should be involved more actively in their healthcare process and advice they receive should be tailored and personalized according to their life circumstances.