The rising prevalence of osteoarthritis has led to a significant increase in the volume of total joint surgery, including total hip arthroplasty and total knee arthroplasty, particularly among the elderly. Early mobilization has become an important goal in the perioperative care of elderly patients after total joint surgery, frequently integrated into Enhanced Recovery After Surgery (ERAS) protocols. Defined as sitting out of bed or walking as soon as possible following surgery—often within the first 24 hours—early mobilization aims to counteract the physiological risks associated with prolonged bed rest, such as deep vein thrombosis, pulmonary embolism, and pneumonia.
Evidence from systematic reviews indicates that mobilizing patients within one day of surgery significantly reduces the acute hospital length of stay by an average of 1.8 days. This reduction in hospitalization is achieved without increasing the incidence of adverse events or affecting discharge destinations, suggesting that the clinical benefits of early activity do not come at the expense of patient safety.
In the specific context of elderly total joint surgery patients (those older than 65 years), the efficacy and safety of early mobilization protocols remain a subject of clinical scrutiny due to the higher prevalence of comorbidities such as hypertension, diabetes, and respiratory disease. However, prospective controlled studies involving elderly cohorts demonstrate that ERAS programs featuring early mobilization are both safe and highly effective. These programs have been shown to significantly relieve perioperative pain, as evidenced by lower Visual Analogue Scale (VAS) scores on the first and fifth postoperative days.
Furthermore, elderly patients undergoing early mobilization exhibit improved joint function, reflected in higher Knee Society Scores (KSS) and increased range of motion (ROM) during the immediate postoperative period. Crucially, research indicates that these protocols do not increase short-term mortality rates in older patients, reinforcing the feasibility of early ambulation even in populations with complex medical histories.
Despite the potential benefits of early mobilization, it is not widely applied in this patient group. Observational data from high-volume arthroplasty centers show that fewer than 10% of patients actually mobilize on the day of surgery, even when operations are completed early in the day. This discrepancy is largely driven by treatment-related factors rather than patient-related characteristics. For instance, the presence of an indwelling catheter (IDC) and the occurrence of acute complications, such as symptomatic hypotension or excessive pain, are significant predictors of delayed mobilization in total hip patients.
Research in total knee patients identified the requirement for donor blood transfusions as a common cause of delay in the initiation of walking. Interestingly, factors such as age, body mass index, and the specific surgical approach—including the anterior hip approach—do not appear to independently dictate the timing of first mobilization when multivariate analyses are applied.
To optimize outcomes, clinicians should focus on mitigating these modifiable treatment barriers. Using multimodal analgesia, including periarticular injections, and updating fasting guidelines can reduce postoperative nausea and pain, thereby facilitating earlier movement. Furthermore, the standardization of protocols is essential, as some data found that the facility itself is one of the strongest predictors of when a patient first walks postoperatively. By prioritizing early mobilization within the first 24 postoperative hours, surgical teams can improve medical efficiency, reduce the financial burden on healthcare institutions, and enhance functional recovery in elderly patients undergoing total joint surgery.
References
- Guerra, M. L., Singh, P. J. & Taylor, N. F. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: A systematic review. Clinical Rehabilitation 29, 444-454 (2015). https://doi.org/10.1177/0269215514558641
- Jiang, H. et al. Effects of Enhanced Recovery After Surgery in Total Knee Arthroplasty for Patients Older Than 65 Years. Orthopaedic Surgery 11, 190-198 (2019). https://doi.org/10.1111/os.12435
- Chua, M. J. et al. Early mobilisation after total hip or knee arthroplasty: A multicentre prospective observational study. PLOS ONE 12, e0179820 (2017). https://doi.org/10.1371/journal.pone.0179820
