What is the multifactorial efficacy of day-zero ambulation post-total hip replacement surgery: A systematic review.

Objective: To examine the multi-factorial efficacy of day-zero ambulation following primary total hip arthroplasty. Data sources: MEDLINE, CINAHL, AMED, EMBASE and APA PsychInfo in accordance with PRISMA guidelines. Review methods: Studies were classified for study design and ranked in a hierarchy of evidence. Studies ranked excellent or good who followed a treatment pathway inclusive of day-zero ambulation were appraised using the appropriate content checklist (PRISMA, CONSORT, STROBE), CASP checklist and where possible for risk of bias using the appropriate tool (RoB 2.0, ROBINS-1). Results were produced using a narrative synthesis. Results: A total of 8 studies met inclusion criteria. Studies reported a consensus of a reduced length of hospital stay in pathways where day-zero ambulation was included, but with varying effect sizes. Findings suggested that day-zero ambulation may speed up return to function following THR. There was not enough evidence to provide synthesised results on financial efficiency, post-operative pain, or safety of day-zero ambulation via post-operative complications. Conclusions: This systematic review reveals limitations within the literature base on day zero-ambulation. There are problems of concomitant interventions, methodological heterogeneity, and an abundance of research low in the evidence hierarchy. Day zero-ambulation shows promise in reducing length of hospital stay and there is suggestion that it accelerates functional recovery. However, to establish this with rigor, there is further need for high quality, prospective studies such as RCTs to examine the multi-factorial effect of day-zero ambulation, challenge existing theories and contribute to confident synthesised findings more useful to clinical decision makers.