{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:44:18Z","timestamp":1787755458353,"version":"build-2784847793"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS OA"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Early mobilization is an important therapeutic goal after total knee replacement and total hip replacement. Orthostatic hypotension and orthostatic intolerance can impede mobilization. Midodrine hydrochloride, an orally administered vasoconstrictor, may improve blood pressure and diminish the prevalence of adverse mobilization events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a pilot change-of-practice study. Two cohorts, each comprising 10 patients managed with total knee replacement and 10 patients managed with total hip replacement, were managed with blood pressure-adjusted midodrine, which was administered 3 times daily for the first 72 hours postoperatively at either a low dose (2.5 or 5 mg) or a higher dose (5 or 10 mg). These patients were then matched with an equivalent preintervention cohort of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The midodrine protocol was instituted effectively and with high compliance. Hypotension was uncommon across all groups, with the mean lowest systolic blood pressure ranging from 110 to 121 mm Hg. Moreover, adverse mobilization events were uncommon across all groups (prevalence, 9.6% in the control group, 5.6% in the low-dose group, and 2.9% in the high-dose group) (p = 0.046 for the high-dose group versus the control group). A midodrine dose of 10 mg generated a significant mean dose-related systolic blood pressure increase of 14 mm Hg at 2 hours after administration (p &lt; 0.001). There were no significant differences between the groups in terms of mean systolic blood pressure, biochemical markers, or intravenous therapy administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A dose of 10 mg was found to achieve a significant systolic blood pressure response at 2 hours after administration and, in patients who received higher-dose midodrine, adverse mobilization events appeared less common. Additional investigation with a blinded randomized controlled trial, utilizing 10 mg of midodrine 2 hours before mobilization, would be needed to confirm the efficacy of midodrine therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.18.00048","type":"journal-article","created":{"date-parts":[[2019,5,14]],"date-time":"2019-05-14T18:54:57Z","timestamp":1557860097000},"page":"e0048","source":"Crossref","is-referenced-by-count":10,"title":["Blood Pressure and Early Mobilization After Total Hip and Knee Replacements"],"prefix":"10.2106","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3840-0478","authenticated-orcid":false,"given":"Michael","family":"Smits","sequence":"first","affiliation":[{"name":"Departments of Surgery (M.S., S.L., and J.R.), Intensive Care (R.B.), and Orthopaedic Surgery (A.H.), Austin Health, Austin Hospital, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8959-1828","authenticated-orcid":false,"given":"Sandra","family":"Lin","sequence":"additional","affiliation":[{"name":"Departments of Surgery (M.S., S.L., and J.R.), Intensive Care (R.B.), and Orthopaedic Surgery (A.H.), Austin Health, Austin Hospital, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8623-5673","authenticated-orcid":false,"given":"Jessica","family":"Rahme","sequence":"additional","affiliation":[{"name":"Departments of Surgery (M.S., S.L., and J.R.), Intensive Care (R.B.), and Orthopaedic Surgery (A.H.), Austin Health, Austin Hospital, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5551-1401","authenticated-orcid":false,"given":"Michael","family":"Bailey","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1650-8939","authenticated-orcid":false,"given":"Rinaldo","family":"Bellomo","sequence":"additional","affiliation":[{"name":"Departments of Surgery (M.S., S.L., and J.R.), Intensive Care (R.B.), and Orthopaedic Surgery (A.H.), Austin Health, Austin Hospital, Heidelberg, Victoria, Australia"},{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"School of Medicine, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1036-9974","authenticated-orcid":false,"given":"Andrew","family":"Hardidge","sequence":"additional","affiliation":[{"name":"Departments of Surgery (M.S., S.L., and J.R.), Intensive Care (R.B.), and Orthopaedic Surgery (A.H.), Austin Health, Austin Hospital, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,4]]},"reference":[{"issue":"11","key":"R1-20230714","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1111\/j.1532-5415.1988.tb04375.x","article-title":"Physiology and complications of bed rest","volume":"36","author":"Harper","year":"1988","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"R2-20230714","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/SLA.0b013e31817f2c1a","article-title":"Evidence-based surgical care and the evolution of fast-track surgery","volume":"248","author":"Kehlet","year":"2008","journal-title":"Ann Surg"},{"issue":"7","key":"R3-20230714","doi-asserted-by":"crossref","first-page":"600","DOI":"10.3928\/01477447-20120621-07","article-title":"Prevention and treatment of orthostatic hypotension in the orthopedic patient population. 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