Comparison of a fast track protocol and standard care after hip arthroplasty in the reduction of the length of stay and the early weight-bearing resumption: study protocol for a randomized controlled trial

Background: To date, hip arthroplasty is one of the most commonly performed surgical procedures, with growing worldwide demand. In recent decades, major progress made in terms of surgical technique, biomechanics, and tribology knowledge has contributed to improve the medical and functional management of the patient. This study aims to assess if the application of a fast track protocol, consisting of a preoperative educational intervention, adequate postoperative pain control, and intensive rehabilitation intervention, reduces the length of stay (LOS) and allows the early functional recovery compared to standard clinical practice for patients undergoing hip arthroplasty. Methods: The study population consists of 90 patients with primary arthrosis of the hip with an anterior indication of hip arthroplasty. The exclusion criteria are older than 70 years, a contraindication to performing spinal anesthesia, and bone mass index (BMI) greater than 32. Participants, 45 for each group, are randomly allocated to one of two arms: fast track clinical pathway or standard care protocol. During allocation, baseline parameters such as Harris Hip Score (HHS) and Western Ontario and McMaster Universities (WOMAC) index are collected. On the third postoperative day, the functional autonomy for each patient is assessed by the Iowa Level of Assistance (ILOA) scale, and it is expected the discharge for patients in the fast track group (primary outcome). On the other hand, standard care patient discharge is expected after 5–7 days after surgery. During follow-up fixed at 6 weeks and 3, 6, and 12 months, HHS and WOMAC scores are collected for each patient (secondary outcomes). Discussion: Although total hip replacement has become a widespread standardized procedure, to the authors’ knowledge, only few randomized controlled trials were performed to evaluate the effectiveness of fast track pathway vs. standard care procedure in the reduction of the LOS after hip arthroplasty. It is expected that our results collected by the application of minimally invasive surgical interventions with concomitant management of perioperative pain and bleeding and early functional rehabilitation will contribute to enriching the understanding of clinical and organizational aspects linked to fast track arthroplasty. Trial registration: ClinicalTrials.gov NCT03875976. Registered on 15 March 2019—“retrospectively registered”

On board processing procedures for the Solar Orbiter METIS coronagraph

Solar Orbiter is an ESA space mission devoted to improve the knowledge of those effects nowadays still not fully understood on the physical mechanisms underlying the behaviour of our star. The mission has a peculiar trajectory that will bring the S/C close to the Sun up to 0.28 AU, exploiting the opportunity to follow up our star as close as never before. METIS, one of the instruments selected to be part of the Solar Orbiter payload, is a coronagraph that will investigate the inner part of the heliosphere performing imaging in the visible band and in the hydrogen Lyman \u3b1 line @ 121.6 nm. METIS will be able to simultaneously operate the two detectors: an Intensified APS for the UV channel and an APS for the visible light, and a Liquid Crystal Variable Retarder (LCVR) plate, for broadband visible polarimetry. They will be operated by means of the centralised management unit of the instrument, the METIS Processing and Power Unit. This payload subsystem hosts a microprocessor that implements, thanks to the application software, all the needed functionalities to fully control the instrument subsystems and its own processing capabilities. Both sensors will be readout at high rate and the acquired data shall undergo through a preliminary on-board processing to maximize the scientific return and to provide the necessary information to validate the results on ground. Being Solar Orbiter a deepspace mission, some METIS procedures have been designed to provide to the instrument an efficient autonomous behaviour in case of an immediate reaction is required as for arising transient events or occurrence of safety hazards condition. METIS will implement an on-board algorithm for the automatic detection of this kind of events in order to promptly react and autonomously adapt the observing procedure