Hip Replacement in a High Volume Community Hospital: Effect on Length of Stay and Hospital Cost

Study Overview
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Brief Summary
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The investigators propose to evaluate and compare the percentage of patients who are able to be discharged in less than 3 days after undergoing total hip arthroscopy through either a direct anterior or posterior approach, utilizing the identical post operative protocol. The investigators also propose to evaluate the costs associated with the two different approaches to hip replacement in the same group of patients. Post operative resource utilization, discharge disposition, and pain medicine requirement will also be evaluated.

Detailed Description
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The investigators hypothesize that a higher proportion of patients treated with the direct anterior approach for hip replacement will be able to leave the hospital in less than 3 days when compared with a less invasive posterior approach. Secondly, decreased length of stay associated with the procedure may reduce hospital costs.

Official Title
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Introduction of the Direct Anterior Approach to Hip Replacement Into a High Volume Community Hospital: Effect on Length of Stay and Hospital Cost

Conditions
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Hip Osteoarthritis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Consecutive single surgeon series of patients who have undergone primary uncemented hip replacement at our institution through either a posterior approach or direct anterior approach on a fracture table. Posterior approach patient - most recent patient prior to March, 2010, compared with consecutive recent anterior approach patients with minimum of 6 month follow-up. Diagnosis of osteoarthritis, inflammatory arthritis, or avascular necrosis. No previous surgery on affected hip. Age 40-90 at time of surgery Exclusion Criteria: Patient not permitted to bear full weight after the procedure, per post operative instructions Hip replacement performed for acute fracture. Previous hip surgery.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Direct Anterior Approach hip replacement<br>Single surgeon series of 105 consecutive patients who underwent hip replacement via the direct anterior approach on a fracture table | |
| Posterior Approach Hip Replacement<br>105 consecutive patients previously operated on by a less invasive posterior approach at the same institution. These surgeries occurred prior to March, 2010. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of Hospital Stay | The length of stay and proportion of patients who went home in less than 3 days will be determined for each group. To evaluate and compare the percentage of patients who are able to be discharged in less than 3 days after undergoing total hip arthroscopy through either a direct anterior or posterior approach, utilizing the identical post operative protocol. | Retrospective review of hospital discharge records | 
| Hospital cost | Hospital cost analysis will be undertaken for each group. | Retrospective review of utilization records | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post Operative Pain Medication Utilization | Analysis of post operative pain medicine requirement will be compared for the two groups. | After retrospective chart review is complete -- approximately 6 months | 
| Utilization of inpatient physical therapy resources | Utilization of inpatient physical therapy resources and post hospital discharge disposition will be compared for the two groups. | Retrospective review -- of hospital discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Total Hip replacement, Fracture table, DePuySynthes, Direct anterior approach hip replacement, Posterior approach hip replacement