23-hour Total Hip Replacement Requiring Only 3.5 Opioid Pills Through 6 Weeks: A Non-selected Prospective Consecutive One Year Cohort
Andrew Wickline, Kimberly Strong, Jeffrey MurphyBackground
Many treatment protocols surrounding post-surgical pain management following total hip arthroplasty (THA) rely heavily on opioid medications and conventional formal physical therapy. We hypothesized that an expanded 90-day multimodal protocol could lead to a postoperative opioid-free or significantly reduced-opioid THA recovery with little or no need for formal physical therapy.
Methods
Prospective consecutive patients undergoing THA were enrolled in a 3 month long (6 weeks preoperatively and 6 weeks postoperatively) multimodal protocol including a robust education and optimization program with home-based physical therapy. All patients received a direct anterior approach THA on a Hana table by a single, fellowship-trained surgeon in a community practice. Opioid consumption was recorded at preoperative, postoperative, 3 week and 6 week timepoints.
Results
A total of 207 consecutive patients underwent THA and completed their 6-week follow-up evaluations. Seventy-nine patients (38%) required no opioid pills, 75 (36%) used 1-5 pills, 47 (23%) used 6-10 pills and 6 (3%) used more than ten pills. Overall 97% of patients undergoing DAA THA required 10 pills or less. Of those patients who reported taking at least one opioid pill, 92/128 (72%) took tramadol rather than stronger opioids. Average number of opioids was 3.5 pills per patient. Additionally, at 6 weeks, 95% of patients required no formal physical therapy. The percentage of patients discharged home the same day was 64% with 94% home by POD #1. Average length of stay was .42 days.
Conclusion
This study confirms that an expanded length multimodal protocol can significantly reduce or eliminate opioid consumption following outpatient DAA THA. It additionally confirms that the majority of patients may do well with a simple home exercise program.