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Early ambulation within 24 h after joint arthroplasty: a retrospective cohort study
Dongdong Xie1,2, Guorui Cao2, Rui Chen2
1School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Background:
This study aimed to evaluate the association of early ambulation (within 24 h after surgery) with clinical outcomes in patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) in China.
Methods:
This was a retrospective cohort study that included patients who received primary unilateral TKA and THA from February 2020 to December 2022 at our institution. Patients ambulating within 24 h postoperatively were defined as the early ambulation group, and those after 24 h as the late ambulation group. Univariate analysis, multivariate regression, and propensity score matching (PSM) were performed. The incidence of postoperative deep vein thrombosis (DVT), length of stay (LOS), hospitalization costs, range of motion (ROM), and other complications between the two groups was analyzed. In addition, we evaluated differences between TKA and THA in both the associations of early ambulation with postoperative outcomes and the overall postoperative outcomes.
Results:
Among 4,517 patients, 2,284 underwent TKA and 2,233 THA. Overall DVT incidence was 0.8%. Univariate analyses showed significantly lower DVT with early ambulation in both TKA (0.2% vs. 1.6%, P < 0.001) and THA (0% vs. 0.7%, P = 0.037). Early ambulation was also associated with shorter LOS, lower hospitalization costs, and greater ROM, with no difference in other complications (P > 0.05). Multivariate regression confirmed these associations. Early ambulation was independently associated with lower DVT risk (TKA and THA: odds ratios are both in the protective direction). The association between early ambulation and shorter LOS was stronger in TKA than THA (3.2 vs. 0.5 days), which was supported by PSM. TKA patients had longer LOS but lower costs than THA patients.
Conclusion:
Early ambulation was associated with lower DVT incidence, lower hospitalization costs, and better ROM. A significantly shorter LOS was associated with early ambulation in TKA patients, whereas in THA only a downward trend was observed after PSM, without statistical significance. The association between early ambulation and shorter LOS was stronger in TKA patients than in THA patients. In the overall cohort, regardless of ambulation timing, TKA patients exhibited longer LOS but lower hospitalization costs relative to THA patients.