Fast track in hip arthroplasty

Abstract

'Fast-track' surgery was introduced more than 20 years ago and may be defined as a co-ordinated peri-operative approach aimed at reducing surgical stress and facilitating post-operative recovery. The fast-track programmes have now been introduced into total hip arthroplasty (THA) surgery with reduction in postoperative length of stay, shorter convalescence and rapid functional recovery without increased morbidity and mortality. This has been achieved by focusing on a multidisciplinary collaboration and establishing 'fast-track' units, with a welldefined organisational set-up tailored to deliver an accelerated peri-operative course of fast-track surgical THA procedures. Fast-track THA surgery now works extremely well in the standard THA patient. However, all patients are different and fine-tuning of the multiple areas in fast-track pathways to get patients with special needs or high co-morbidity burden through a safe and effective fast-track THA pathway is important. In this narrative review, the principles of fast-track THA surgery are presented together with the present status of implementation and perspectives for further improvements.