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COPENHAGEN, Denmark — A patient’s length of stay following total hip arthroplasty depends on a number of factors, but that length of stay could be significantly reduced through regular review of and incremental changes to the hip replacement care pathway, according to a recent presentation.

Michalis Panteli, MD, who presented his team’s findings at the 12th EFORT Congress 2011, noted that close management of patient expectations could also be a significant factor.

“It is very important to identify the factors that prolong hospital stay following total hip arthroplasty (THA),” Panteli said. “At the same time we have to make sure the practice remains safe.”

Panteli’s team performed two prospective studies of factors that delayed discharge following THA in 2006 and 2010. One hundred consecutive primary cemented total hip replacements were studied, with data being collected daily on a prospective basis. Any reasons for discharge delay or variation from the patient pathway were identified and addressed.

Mean lengths of stay in 2006 and 2010, Panteli reported, were 4.8 days and 3.6 days respectively. Thirty-one patients from the 2006 cohort experienced a stay longer than 4 days, with the delay being attributed to inadequate physiotherapy provision in 17 patients, medical reasons in 10 patients and other reasons in 4 patients. In the 2010 cohort, 29 patients stayed for longer than 3 days — with 15 staying longer than 4 days — with 2 patients experiencing the delay because of inadequate physiotherapy provision, 11 for catheterization and 7 for a blood transfusion.

For both studies, preadmission Joint Group education sessions were found to help decrease risk for delayed discharge.

“The patient length of stay is multifactorial,” Panteli concluded. “It can be reduced both by close management of patient expectations and incremental improvements in the patient’s pathway.”


  • Panteli M, McRoberts J, Habeeb S, Porteous M. Factors affecting length of hospital stay post primary hip arthroplasty. Paper #1139. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.