Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER.2 study

Mobilização precoce após artroplastia total de quadril ou joelho: um subestudo do estudo POWER.2

Javier Ripollés-Melchor, César Aldecoa, Raquel Fernández-García, Marina Varela-Durán, Norma Aracil-Escoda, Daniel García-Rodríguez, Lucia Cabezudo-de-la-Muela, Lucía Hormaechea-Bolado, Beatriz Nacarino-Alcorta, Rolf Hoffmann, Juan V. Lorente, José M. Ramírez-Rodríguez, Ane Abad-Motos, POWER2 Study Investigators Group for the Spanish Perioperative Audit and Research Network (RedGERM-SPARN)

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Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization.

This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery.

A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16–30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72–0.90); p = 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55–0.60); p < 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92–0.93); p < 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96–0.98); p < 0.001] were associated with shorter time to mobilization.

Most THA and TKA patients mobilize in the first postoperative day, Early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.


Total hip arthroplasty; Total knee arthroplasty; Enhanced Recovery After Surgery (ERAS); Early mobilization; Local anesthesia



A mobilização precoce após a cirurgia é a pedra angular dos programas Enhanced Recovery After Surgery (ERAS) na artroplastia total do quadril (ATQ) ou artroplastia total do joelho (ATJ). Nosso objetivo foi determinar o tempo de mobilização após esta cirurgia e os fatores associados à mobilização precoce.


Este foi um subestudo predefinido do estudo POWER.2, um estudo de coorte prospectivo conduzido em pacientes submetidos a ATQ e ATJ em 131 hospitais espanhóis. O desfecho primário foi o tempo até a mobilização após a cirurgia, bem como a determinação dos fatores perioperatórios associados à mobilização precoce após a cirurgia.


Um total de 6.093 pacientes foram incluídos. O tempo médio para conseguir a mobilização após o término da cirurgia foi de 24 horas [16-30]. 4.222 (69,3%) pacientes se mudaram em ≤ 24 horas após a cirurgia. Anestesia local [OR = 0,80 (intervalo de confiança [IC] de 95%: 0,72–0,90); p = 0,001], cirurgia realizada em centro ERAS autodeclarado [OR = 0,57 (IC 95%: 0,55–0,60); p < 0,001], adesão média aos itens do ERAS [OR = 0,93 (IC 95%: 0,92–0,93); p < 0,001] e hemoglobina pré-operatória [OR = 0,97 (IC 95%: 0,96–0,98); p < 0,001] foram associados a menor tempo de mobilização.


A maioria dos pacientes ATQ e ATJ se mobiliza no primeiro dia de pós-operatório. O tempo de mobilização precoce foi associado ao cumprimento dos protocolos ERAS, hemoglobina pré-operatória e anestesia local e à ausência de sonda vesical, drenos cirúrgicos, analgesia peridural e complicações pós-operatórias . Os elementos perioperatórios associados à mobilização precoce são em sua maioria modificáveis, portanto, há espaço para melhorias.


Artroplastia total do quadril; Artroplastia total do joelho; Recuperação melhorada após a cirurgia (ERAS); Mobilização precoce; Anestesia local


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