Relationship between length of stay and dislocation rate after total hip arthroplasty.

The purpose of this study was to determine if decreased postoperative inpatient time (length of stay; LOS) after total hip arthroplasty (THA) was correlated with an increase in the dislocation rate after discharge. Reduced access to physical therapy, nursing reinforcement of dislocation precautions, and medical supervision could lead to a higher rate of adverse behaviors (such as inappropriate flexion and rotation) and accidents that might have otherwise been avoided in the initial 3 -months after surgery. We examined records from 850 patients (2 surgeons) who underwent primary THA from 1993 to 1998. LOS had progressively decreased over the 4 years since implementation of a clinical pathway (CP) in late 1993. The average LOS in 1992 was 6.6 days and was lowest in 1998 at 3.9 days. The dislocation rate before the CP was 0.5%. The dislocation rate increased significantly to 3.9% after implementation of the CP (P =.015). Use of the CP offers numerous advantages but is associated with a higher dislocation rate.