The "Fast Track" pathway: going home sooner and better after hip replacement surgery
Anyone about to undergo hip replacement surgery often pictures days spent in hospital, significant pain, and a long, exhausting recovery. Over the past twenty years, however, orthopedic surgery has profoundly changed the way this journey is approached, thanks to an approach called Fast Track, or ERAS (Enhanced Recovery After Surgery).
This isn't a single surgical technique, but a genuine shared method of work involving the entire team - surgeon, anesthesiologist, nurses, physiotherapists, and dietitian - who accompany the patient before, during, and after the operation, with the goal of helping them feel better, recover faster, and experience fewer complications.
Why Fast Track works
The underlying idea is simple: surgery is inevitably a stressful event for the body. Pain, prolonged fasting, immobility in bed, and anxiety all put the body under pressure and slow down healing. The Fast Track protocol works precisely on these factors, reducing them one by one, so that patients can recover sooner and with fewer complications - not simply "go home earlier."
The most recent scientific evidence, gathered from tens of thousands of patients, confirms that shortening hospital stays with this type of pathway does not increase risks: there is no rise in dislocations, infections, or complications compared to traditional pathways, while functional recovery is faster.
How it works. Three phases
1. Before surgery - Preparing at your best
Patients are actively involved from the very start. Any factors that could slow down recovery, such as anemia or poor nutrition, are corrected, and patients are encouraged to stop smoking and reduce alcohol intake in the weeks beforehand. Good information is also essential: knowing what to expect reduces anxiety and makes the patient an active participant - not just a spectator - in their own journey. Pre-operative fasting is also reduced to the minimum necessary (clear liquids can be drunk up to two hours before anesthesia), precisely to avoid unnecessarily weakening the body.
2. During surgery - Less trauma, less stress
In the operating room, techniques are used to limit tissue damage: minimally invasive surgical approaches (such as the direct anterior approach), careful attention to maintaining normal body temperature, medications to reduce bleeding, and anesthesia protocols aimed at controlling pain from the outset, avoiding routine drains and catheters wherever possible, which we now know provide no real benefit.
3. After surgery - Moving early, safely
This is perhaps the most important phase: as soon as conditions allow - often within the first few hours - the patient is helped to get up, drink, and eat normally, following the "drink, eat, move" principle on the very day of surgery. Pain is kept under control with targeted medications that reduce the need for opioids, and physiotherapy begins immediately, guiding the patient step by step: first sitting, then standing, then walking with the aid of crutches.
When you can go home
Discharge doesn't happen on a "fixed date," but once the patient reaches certain concrete milestones: walking independently with crutches without dizziness, pain well under control, no nausea or abnormal bleeding. It is the patient, together with the team, who "earns" discharge by reaching these milestones — not a pre-set calendar.
A tailored pathway, not one-size-fits-all
It's important to stress that Fast Track does not mean discharging everyone in the same way: each patient is evaluated individually, taking into account their overall health, the support they have at home, and their motivation. Age, contrary to what one might think, is no longer considered an obstacle in itself.
The Fast Track pathway for hip replacement represents today's most modern and effective standard of care: a team effort that puts the patient at the center, reduces the stress of surgery, and allows for a faster, smoother return to daily life - without compromising safety.