Early and ultra-early mobilisation following elective hip and knee arthroplasty: Benefits, barriers, and safety considerations

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.