BACKGROUND: Total hip replacement (THR) is currently the most successful orthopaedic operation worldwide. This success is, however, dependent on the quality and efficiency of postoperative rehabilitation programs following it. METHODS: In a randomized controlled trial (RCT), sixty patients (32 females, 28 males, mean age 68.4 years) undergoing THR for hip arthritis having either a conventional rehabilitation after a normal hospital stay (30 patients) or a fast track rehabilitation program (30 patients) were compared. RESULTS: The mean length of stay in the conventional group was 7.8 (range 6 to 11) days compared to 4.5 (range 3 to 5) days in the fast track group (p = < 0.001). Complications included one dislocation in either group, a case of heart failure and a readmission in the conventional group. As regards functional outcome, patients in the conventional group had a mean Harris Hip Score of 69.3 six weeks and 82 twelve weeks postoperatively in comparison to 79 and 91 in the fast track group respectively. The differences were statistically significant (p = 0.013 and 0.002 respectively). CONCLUSIONS: Fast track rehabilitation after THR allows early patient's mobilization and shorter hospital stay with better functional outcome and without increasing the risk of complications or the readmission rate.

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