Table 2.

Peri-operative optimisation and post-operative care in a ‘fast-track‘ patient pathway

• Careful selection for simultaneous bilateral total hip arthroplasty (THA)

• Spinal analgesia may not be superior to general anaesthesia in a fast-track set-up

• Local wound infiltration analgesia may be superior to peripheral nerve block in terms of pain reduction combined with preventing falls during early mobilisation

• Oral treatment should be a combination of NSAID, paracetamol and short-acting opioids for breakthrough pain

• Consider using a single dose of methylprednisolone 125 mg to reduce the peri-operative stress inflammatory response as adjuvant pain treatment

• Mobilisation on the day of THA surgery is mandatory

• Thromboprophylaxis until discharge from hospital after THA is sufficient in patients without elevated risk of thromboembolic events

• Only severe post-operative anaemia should be correct in patients without severe co-morbidity

• Intermittent catheterisation should be used instead of permanent catheterisation

• A fast-track pathway with early mobilisation may reduce post-operative dizziness, delirium and cognitive dysfunction

• Well-defined functional discharge criteria

• Physiotherapy after discharge is not indicated in all patients