OBJECTIVE: This study aimed to investigate the impact of failure mode and effects analysis (FMEA)-based proactive nursing combined with individualized functional exercise on hip function in patients undergoing total hip arthroplasty (THA). METHODS: This was a prospective, single-center, randomized controlled trial. Using a consecutive sampling approach, 100 patients who underwent THA at the Affiliated Hospital of Xuzhou Medical University between October 2022 and January 2024 were enrolled and randomly assigned (random number table method) to either a control group (n = 50) or an intervention group (n = 50). The control group received routine nursing plus standard functional exercise, whereas the intervention group received FMEA-based proactive nursing combined with individualized functional training in addition to routine care. Both groups were followed continuously for 3 months. The primary outcome was hip function, assessed using the Harris hip score (HHS) before and after the intervention. Secondary outcomes included the time to first ambulation, pain during ambulation, and length of hospital stay. Psychological status (anxiety and depression) and quality of life were evaluated before and after the intervention using the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and the Short Form-36 questionnaire (SF-36). Postoperative complications were recorded, and nursing satisfaction at discharge was assessed using the Newcastle Satisfaction with Nursing Scale (NSNS). RESULTS: After nursing care, HHS in both the control and intervention groups were higher than before care. Post-intervention, the intervention group showed significantly higher scores than the control group in function (34.62 +/- 2.97 versus 27.94 +/- 2.87), range of motion (3.64 +/- 0.63 versus 2.28 +/- 0.45), pain (28.98 +/- 4.29 versus 23.52 +/- 3.83), and deformity (2.78 +/- 0.55 versus 2.02 +/- 0.25) (p < 0.05). Patients in the intervention group ambulated for the first time earlier than those in the control group (29.12 +/- 3.29 h versus 42.20 +/- 4.16 h), with lower pain scores during activity (4.46 +/- 0.86 versus 6.06 +/- 1.27) and shorter hospital stays (11.40 +/- 1.93 days versus 14.84 +/- 2.71 days) (p < 0.05). SF-36 scores in both groups improved after nursing care, with the intervention group demonstrating higher post-care scores in physical function (70.92 +/- 6.50 versus 60.06 +/- 5.88), mental health (67.88 +/- 6.17 versus 58.92 +/- 5.71), social function (70.92 +/- 6.66 versus 62.84 +/- 6.11), and bodily pain (67.82 +/- 6.68 versus 59.64 +/- 5.24) compared with the control group (p < 0.05). Anxiety and depression scores (SAS and SDS) decreased in both groups after nursing care, with the intervention group showing lower scores than the control group (SAS 39.02 +/- 3.66 versus 46.88 +/- 4.52; SDS 38.98 +/- 3.89 versus 49.58 +/- 4.05) (p < 0.05). The incidence of postoperative complications was lower in the intervention group (6.00%) than in the control group (22.00%) (p < 0.05), and nursing satisfaction was higher (98.00versus 82.00%) (p < 0.05). CONCLUSION: FMEA-based proactive nursing combined with individualized functional exercise accelerates recovery, improves hip function, reduces pain and negative emotions, enhances quality of life, and lowers complication rates while increasing patient satisfaction.

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