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Day-Care Direct Anterior Total Hip Arthroplasty in Urban India: Patient Education, Apprehensions, and Outcomes
Kunal Aneja1,2, Supreet Bajwa3, Ravi Teja Rudraraju4,5
1Department of Orthopaedic Surgeon, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India.
Introduction:
While total hip arthroplasty (THA) has evolved toward outpatient care in many regions, its adoption in the Indian subcontinent remains limited due to cultural apprehensions, logistical barriers, and concerns regarding early discharge safety. This study evaluates the feasibility, safety, and functional outcomes of day-care direct anterior approach (DAA) THA in the urban Indian population using enhanced recovery after surgery (ERAS) protocols.
Materials And Methods:
Data of 76 American society of anesthesiologist I/II patients, aged 22-50 years, with avascular necrosis of the femoral head who underwent DAA THA under a standardized ERAS protocol were retrospectively assessed. Pre-operative education, multimodal analgesia, and early mobilization were incorporated. Data on demographics, surgical metrics, length of stay (LOS), complications, and functional outcomes using Harris Hip score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were also analyzed postoperatively at 2- and 6-weeks, 6 months and 1 year.
Result:
The mean age was 35.1±8.4 years (54 males, 22 females). The mean surgical time was 213.45±22.13 min, with an average blood loss of 201.7±20.72 mL. No intraoperative complications or transfusions were required. A total of 31 patients (40.8%) were discharged within 24 h, while 45 patients (59.2%) remained hospitalized beyond 24 h due to concerns about complications and post-operative symptoms. The longest stay was 3 days, due to post-operative nausea and vomiting. The average LOS was 1.8 days. At 1 year, the mean HHS increased from 44.6 (pre-operative) to 97.1, and the WOMAC score improved from 74.6 (pre-operative) to 10.2. No readmissions or major post-operative complications were observed.
Conclusion:
Day-care THA using DAA achieved high early functional outcomes through minimally invasive techniques, multimodal analgesia, and enhanced recovery protocols. Pre-operative counseling and structured discharge planning enabled a significant proportion of patients to opt for same-day discharge, though sociocultural apprehensions remained a barrier. Strengthening patient education, caregiver involvement, and post-operative support is essential to further improve acceptance of outpatient THA in the Indian population.
