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Randomized controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty.

AIMS AND OBJECTIVES
The purpose of this study is to evaluate the efficacy and safety of a comprehensive protocol for constipation prevention.


BACKGROUND
Constipation is a common problem for patients undergoing total hip arthroplasty (THA), yet sparse evidence is available to guide constipation prevention after THA.


DESIGN
Randomized controlled superiority clinical trial.


METHODS
This randomized controlled study was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). A total of 80 THA patients were randomized to receive only preoperative education about lifestyle, or the combination of education with postoperative abdominal massage and polyethylene glycol 4000 (Forlax®). Efficacy outcomes included rates of postoperative constipation and enema rescue, as well as time to first postoperative defecation and readmission within 30 days. Safety outcomes were number and type of adverse events.


RESULTS
Patients who received combination treatment showed a significantly lower rate of postoperative constipation during hospitalization than patients who received only preoperative education (25% vs 55%), and they showed a significantly lower rate of enema rescue (12.5% vs 40%). Many more patients receiving combination treatment experienced their first defecation within two postoperative days than patients who received only preoperative education (62.5% vs 35.9%). In contrast, the two groups were similar in terms of constipation rate on postoperative days 15 and 30, rate of readmission within 30 days, and rate of postoperative adverse events.


CONCLUSIONS
These results suggest that our comprehensive protocol can relieve constipation after THA, reduce the need for enema rescue and shorten time to first defecation without sacrificing safety. More work is needed to optimize and develop this protocol further.


TRIAL REGISTRATION
This study was registered on the web of Research Registry (No. researchregistry4791).


RELEVANCE TO CLINICAL PRACTICE
Constipation is a distressing problem that frequently occurs after THA. This study confirmed that a comprehensive protocol including preoperative education, postoperative abdominal massage and polyethylene glycol 4000 can effectively relieve constipation after THA without sacrificing safety.