Standard Table Direct Anterior Approach Within An Early Discharge Protocol For Cementless Total Hip Arthroplasty: Experience From A Japanese Hospital

AimsClinical and economic outcomes associated with an early discharge protocol for cementless total hip arthroplasty (THA) via a direct anterior approach (DAA) on a standard table without a dedicated traction table) were assessed. These outcomes were compared against a benchmark of THA care approximated from a national database.Materials and methodsThis retrospective, observational, comparative cohort study evaluated 250 patients receiving THA with a standard table DAA approach under an early discharge protocol at a medical center in Japan between 2016 and 2017 (intervention). Patients were propensity score-matched to a standard care control group comprised of THA patients within the Japan Medical Data Center database. A generalized linear model (GLM) using gamma distribution with log-link compared hospital length of stay (LOS) and total cost. Post-operative function and pain (Japanese Orthopaedic Association hip score [JOA] and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire [JHEQ]) were assessed for DAA patients.ResultsAfter propensity score matching, 239 patients were included in each cohort. The patients in the intervention and control group were comparable in regard to age, gender, comorbidities, and procedure year. Adjusted hospital LOS for DAA as part of an early discharge protocol was significantly shorter than for control patients (4.76 vs. 25.36 days). Adjusted total costs were significantly lower (29%) for the intervention group ( yen 1,613,800 vs. yen 2,254,757; US$14,390 vs. US$20,105). The 3-month follow-up complication rate was 0.42% (superficial infection) for intervention vs. 3.35%. The intervention group had no readmissions and post-operative function and pain scores significantly improved (JHEQ pain score 7.2 +/- 5.0 to 24.2 +/- 4.6, JOA 48.4 +/- 12.8 to 94.3 +/- 7.0; p-value < .001).LimitationsThe study is not randomized and EMR and administrative claims data may lack information (i.e. some clinical variables) required for inference. Also, the data may not represent the whole Japanese population.ConclusionsAn early discharge protocol demonstrated compatibility with standard table DAA in a Japanese hospital, providing cost savings, while maintaining reliable clinical outcomes.