Fast-Track Surgery for Hip and Knee Replacement

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Maisonneuve-Rosemont Hospital

Must not be taking: Corticosteroids, CYP3A4 inhibitors

Disqualifiers: BMI over 40, Pregnancy, Diabetes, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if patients can safely return home on the same day after hip or knee replacement surgery. Researchers will evaluate the benefits and risks of a fast-track approach (fast-track total hip and knee arthroplasty) compared to traditional recovery methods. This trial is for individuals needing a primary hip or knee replacement who have support at home post-surgery. As an unphased trial, it offers patients the chance to contribute to innovative recovery methods that could improve future surgical experiences.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it excludes those on long-term anticoagulation therapy, systemic corticotherapy, or treatment with certain medications affecting liver enzymes. It's best to discuss your specific medications with the trial team.

What prior data suggests that this fast-track surgery is safe for hip and knee replacement?

Studies have shown that fast-track total hip and knee replacement surgeries are generally safe for patients. Research indicates that patients who go home the same day do not experience higher complication rates compared to those who stay overnight in the hospital. One study found no difference in complications within 90 days between these two groups. Another study showed that same-day discharge for knee replacements did not increase complications and reduced hospital stay time. Overall, these findings suggest that fast-track surgery is well-tolerated and does not compromise patient safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about fast-track total hip and knee arthroplasty because it allows patients to return home on the same day as their surgery. Unlike traditional methods, which typically require a hospital stay for recovery, this approach emphasizes quicker rehabilitation and discharge. This method could significantly reduce hospital costs and improve patient comfort by allowing them to recover in their own homes. Additionally, the fast-track approach might lead to faster overall recovery times, getting patients back to their daily activities sooner.

What evidence suggests that fast-track surgery is effective for hip and knee replacement?

Research has shown that fast-track plans for hip and knee replacements, studied in this trial, can speed up recovery. Studies have found that patients experience less pain and improved mobility just one week after surgery. For knee replacements, this fast-track method results in significantly lower pain levels and better outcomes compared to traditional methods. In hip replacements, these plans reduce hospital stays without increasing complications. Patients typically recover faster and can return home sooner, making this approach both effective and efficient. ^{4 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for adults aged 18-75 needing a primary total hip or knee replacement, without severe psychiatric issues, inflammatory joint diseases, obesity (BMI over 40), recent serious blood clots, or special perisurgical care. Participants must live near Maisonneuve-Rosemont Hospital and have support at home post-surgery.

Inclusion Criteria

I need a standard hip or knee replacement without special procedures.

Patient able to give their informed consent

I have someone to support me before, during, and after my surgery for a week.

Exclusion Criteria

Psychiatric disease limiting participation in the study

I have a joint disease like rheumatoid arthritis or lupus.

I am currently taking medication that affects CYP3A4 enzyme activity.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

up to 3 months

1 visit (in-person)

Surgery and Immediate Recovery

Participants undergo total hip or knee replacement surgery and are monitored for immediate recovery outcomes

1 day

1 visit (in-person)

Post-Surgery Monitoring

Participants are monitored for complications, pain management, and recovery progress

1 year

Multiple visits (in-person and virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 year

What Are the Treatments Tested in This Trial?

Interventions

• Fast-track Total Hip and knee arthroplasty

Trial Overview The study tests a 'Fast-track' surgery program for patients undergoing total hip or knee replacements. It aims to evaluate how this approach affects recovery times and overall outcomes compared to traditional surgical methods.

How Is the Trial Designed?

Group I: Fast-track total hip or knee arthroplasty Experimental Treatment 1 Intervention

Be able to return patient home on the same day of a total hip or knee surgery.

Who Is Running the Clinical Trial?

Maisonneuve-Rosemont Hospital

Lead Sponsor

Trials

102

Recruited

38,300+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6096572/

Fast-track total knee arthroplasty improved clinical and ... Fast-track protocol for primary TKA showed significantly lower knee pain scores and improved functional outcome in the first 7 days after TKA compared to a ...

2. arthroplastyjournal.org arthroplastyjournal.org/article/S0883-5403(24)00991-4/fulltext

Critical Analysis of “Complication Rates are not Higher ... Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5 ...

3. eor.bioscientifica.com eor.bioscientifica.com/view/journals/eor/2/5/2058-5241.2.160060.pdf

Fast track in hip arthroplasty The overall complication rate was 22% and 55% of the complications were considered to be caused by fail- ures in surgical technique, indicating that bilateral ...

4. nature.com nature.com/articles/s41598-020-77127-6

Improvement in fast-track hip and knee arthroplasty “Fast-track” protocols has improved surgical care with a reduction in length of hospital stay (LOS) in total hip (THA) and knee arthroplasty (TKA).

5. sciencedirect.com sciencedirect.com/science/article/pii/S1877056821000633

Implementation and results of an enhanced recovery (fast- ... 6. Conclusion. The fast-track program led to no increase in morbidity or mortality in knee replacement surgery. Mean length of stay was drastically shortened.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6366461/

Fast-track hip and knee arthroplasty – have we reached the ... Although there is general agreement that fast-track THA and TKA decreases the risk of “medical” complications, the concern that early discharge may lead to ...

7. arthroplastyjournal.org arthroplastyjournal.org/article/S0883-5403(24)00583-7/abstract

Complication Rates Are Not Higher After Outpatient Versus ... The present study revealed that there were no differences in 90-day postoperative complication rates between outpatient and inpatient FT TKA and ...

8. bjanaesthesia.org.uk bjanaesthesia.org.uk/article/S0007-0912(20)30820-5/fulltext

Fast-track hip and knee arthroplasty...how fast? In contrast, in Denmark and the USA, mean LOS has been reduced to about 2 days for both total hip arthroplasty and total knee arthroplasty, and ...

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10204442/

Fast Track Protocols and Early Rehabilitation after Surgery ... By implementing the ERAS protocol in the THA setting, an increase in patient satisfaction can be obtained while retaining safety and improving ...