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This scoping review examines early (within 24 hours) and ultra-early (within 12 hours) mobilisation protocols following elective hip and knee arthroplasty. The review of available literature suggests that ultra-early mobilisation reduces length of stay without increasing adverse events compared to early or standard mobilisation. Barriers to implementation include staffing, hypotension, analgesia, and scheduling.
Ultra-early mobilisation protocols following hip and knee arthroplasty appear to offer reduced length of stay without compromising patient safety.
BACKGROUND Hip and knee arthroplasty are amongst the most performed elective orthopaedic surgeries. Enhanced recovery after surgery is a vital practice in orthopaedic surgery, of which early mobilisation is a key component. As these protocols become more refined with evolving evidence, they advocate for ultra-early mobilisation, defined here as ambulation within 12 h following surgery, or Day 0 postoperatively. AIM This scoping review collates the available evidence on early and ultra-early mobilisation after hip and knee arthroplasty, highlighting perioperative benefits, barriers to implementation, clinical outcomes, and safety considerations. The secondary aim was to investigate the additional benefit to ultra-early mobilisation compared with early mobilisation. FINDINGS Evidence from available publications suggests that ultra-early mobilisation is a superior method of rehabilitation compared with early and standard mobilisation protocols. Ultra-early mobilisation distinctly leads to a reduction in length of hospital stays without increasing adverse events. Limitations to conducting these protocols have been identified, including staffing availability, orthostatic hypotension, inefficient analgesia, and operative scheduling. CONCLUSION Ultra-early mobilisation appears feasible, safe, and worth implementing into clinical practice. Future research should consider standardising definitions, evaluating patient-reported outcomes for ultra-early versus early comparison, and exploring incorporation of ultra-early protocols into ERAS pathways.
