Physiotherapy in an advanced rehabilitation pathway for patients after hip and knee arthroplasty: A proposal.

Background: Accelerated rehabilitation pathway (ARP) decrease patients' hospital length of stay (LOS). A lack of evidence exists on physiotherapy management and outcome as part of ARP in South Africa (SA). Our study will aim to determine whether early mobilisation and increased frequency of physiotherapy treatments for participants after hip or knee arthroplasty surgery on post-operative day 0 (POD 0) affect outcome.

Methods/design: A quantitative prospective cohort study incorporating ARP on (n = 60) non-randomised elective hip and knee arthroplasty participants will be compared with a more conservatively managed historical control group (n = 60). The physiotherapy protocol includes early mobilisation and exercises 1-3 h post-operatively on POD 0 and a second mobilisation and exercise session, 1-2 h later. Outcomes measures are as follows: hours for LOS, the WOMAC measured pre-operatively, 6 weeks and 3 months post-operatively, 30-day readmission for safety and cost comparison between the prospective and historical cohorts. Descriptive statistics will be undertaken. A paired t-test will be used to analyse each of the outcome measures across the time periods if data are normally distributed. Length of stay, WOMAC score and cost data will be compared between the groups, using a Mann-Whitney U test. The occurrence of adverse events will be compared between the groups using Pearson's chi-square tests. The confidence interval will be set at 95% and p = 0.05 will be considered statistically significant.

Discussion: Globally, ARP's are successfully implemented to manage patients presenting with hip and knee osteoarthritis (OA). Research investigating physiotherapy protocols in an ARP is lacking in the literature.

Conclusion: Achieving the same-day discharge after hip and knee arthroplasty surgeries may help elective surgery backlogs and waiting lists in a more cost-effective manner.

Clinical implications: The same day discharge after arthroplasty may be a cost-effective management option in the future.

Protocol identification: Pan African Clinical Trial Registry, PACTR202103637993156.