Day case total hip arthroplasty is associated with excellent functional outcomes, patient satisfaction and net promoter score: One-year outcomes for the first 50 patients using the Fife Protocol

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Ms. Katie Hughes BSc, MRCS
Mr. N.D. Clement MD, PhD, FRCS Ed (Tr & Orth)
Mr. E Dunstan FRCS (Tr & Orth)


The primary aim of this study was to assess outcomes after day case THA using the Fife protocol. Secondary aims were to assess (1) improvements in health-related quality of life, (2) factors associated with outcomes, (3) patient satisfaction, and (4) postoperative complications.
A prospective study of 50 patients undergoing day case THA was undertaken. Patient demographics, pre and postoperative (1-year) outcomes [Oxford hip score (OHS) and EuroQol 5-dimensional 3-level (EQ-5D)] were assessed. Perioperative complications, readmissions and patient satisfaction at one-year were recorded. The study was powered to the OHS.
33 male and 17 female patients, mean age 62 (41 to 76), mean BMI of 27.7 (18 to 37). The majority were ASA grade II (n=38). There were significant improvements in the OHS (24.1, 95% CI 21.9 to 26.4, p<0.001) and EQ-5D (0.414, 95% CI 0.332 to 0.495, p<0.001). Regression modelling identified that preoperative OHS and EQ-5D were independently associated with one-year postoperative change in OHS (p<0.001) and EQ-5D (p<0.001) respectively. All patients were satisfied (n=3) or very satisfied (n=47). Five patients stated they were "likely" and 45 stated they were "extremely likely" to go through surgery again. All were "likely" (n=4) or "extremely likely" (n=46) to recommend surgery to friends or family, with a Net Promoter Score® of 92%. No complications were reported at mean 26 month follow up.
Day case THA was associated with improvement in hip-specific and health related quality of life at one-year. Day case THA has an exceptional Net Promotor Score.


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How to Cite
Hughes, K., Clement, N. D., & Dunstan, E. (2023). Day case total hip arthroplasty is associated with excellent functional outcomes, patient satisfaction and net promoter score: One-year outcomes for the first 50 patients using the Fife Protocol. The Journal of One-Day Surgery, 33(3). Retrieved from
Original Articles
Author Biographies

Ms. Katie Hughes BSc, MRCS, 1.Department of Orthopaedics, Victoria Hospital, Kirkcaldy, UK 2.Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK

Speciality Trainee

Mr. N.D. Clement MD, PhD, FRCS Ed (Tr & Orth), 2. Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK

Orthopaedic Consultant

Mr. E Dunstan FRCS (Tr & Orth) , 1.Department of Orthopaedics, Victoria Hospital, Kirkcaldy, UK

Orthopaedic Consultant


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