|
1
|
İmrek AK, Yilmaz M. The effect of preoperative education on fear of first mobilization experienced after total knee arthroplasty in individuals. Int J Orthop Trauma Nurs 2025; 57:101189. [PMID: 40367643 DOI: 10.1016/j.ijotn.2025.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 05/03/2025] [Accepted: 05/06/2025] [Indexed: 05/16/2025]
Abstract
OBJECTIVE Total knee arthroplasty is a surgical intervention performed to reduce pain and movement restriction resulting from advanced joint deformity in individuals diagnosed with osteoarthritis, and to improve their quality of life and functionality. Meeting the preoperative educational needs of individuals undergoing total knee arthroplasty positively impacts postoperative recovery, mobilization, and rehabilitation. In this context, this study was conducted to determine the effect of preoperative education on fear of mobilization experienced after surgery in individuals who have undergone total knee arthroplasty. MATERIALS AND METHODS This study, was conducted using a single-group pre-test-post-test model, included 36 individuals who underwent total knee arthroplasty. Data were collected preoperatively and postoperatively using a questionnaire, a fear of falling and fall history assessment form, a Visual Analog Scale-10 (VAS-10), and a fall information exchange form. RESULTS The average age of the 36 participants (27 women [75 %]; 9 men [25 %]) was 65.56 ± 4.39 years. The pre-education level of fear was 5.09 ± 1.57, the post-education level of fear was 3.73 ± 0.68, and the level of fear of pre-mobilization was 4.08 ± 0.81. A statistically significant difference was found between the pre-education and post-education level of fear of mobilization (t = 8.324, p = 0.000), between the post-education level and the level of fear before the first mobilization (t = -22.293, p = 0.000). However, it should be noted that fear of mobilization slightly increased during the postoperative first mobilization compared to after education; this may be related to patients' fear of mobilization, pain or anxiety. CONCLUSION The results of this study show that preoperative education provided to individuals undergoing total knee arthroplasty has positive effects on reducing fear of first mobilization experienced after surgery.
Collapse
Affiliation(s)
- Ayşegül Kaya İmrek
- Suşehri Health College, Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Meryem Yilmaz
- Faculty of Health Science, Surgical Diseases Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
|
2
|
Kenney SG, Shah KS, Tabbaa JM, Evans AS, Bugbee WD, Copp SN. Effectiveness of a Supervised Patient Ambulation Program in Reducing Fall Risk Following Total Joint Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2025; 9:01979360-202503000-00002. [PMID: 40029994 PMCID: PMC11875583 DOI: 10.5435/jaaosglobal-d-24-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 12/26/2024] [Indexed: 03/05/2025]
Abstract
BACKGROUND Total hip arthroplasty and total knee arthroplasty rank among the most prevalent orthopaedic procedures performed globally. Early mobilization postarthroplasty reduces complications, shortens length of stay, and optimizes recovery. However, the incidence of falls remains high, leading to complications and increased costs. Ensuring patient safety during mobilization is critical to minimizing fall risks. METHODS In 2014, our institution created a supervised patient ambulation program called "No One Walks Alone" (NOWA). A retrospective review of patients undergoing total knee arthroplasty or total hip arthroplasty between 2011 and 2017 was conducted. The inclusion criteria spanned the preimplementation group (2011 to 2013) (N = 3069) and the postimplementation group (2015 to 2017) (N = 3947). Patients in the postimplementation group were enrolled in the "No One Walks Alone" supervised ambulation program. Data on patient demographics, procedures, hospital stay, fall rates, and postfall complications were collected. A logistic regression analysis was done to identify fall risk factors, and statistical analyses were used to compare outcomes between the patient groups. RESULTS Inpatient fall rates decreased from 2.5 to 1.0 per 1000 inpatient days between the preimplementation and postimplementation groups, respectively. The difference in fall rates between the two periods was statistically significant (P value < 0.002). Fall-related complications were notably reduced in the postimplementation group. In addition, the postimplementation group saw a statistically and clinically notable reduction in average length of stay in the hospital compared with the preimplementation group by 0.75 days (P value < 0.001). CONCLUSION Implementation of a supervised ambulation program was found to markedly reduce fall rates, length of stay, and fall-related complications, demonstrating the importance of proactive interventions to improve patient safety following arthroplasty.
Collapse
Affiliation(s)
- Steven G. Kenney
- From the Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (Dr. Kenney, Dr. Bugbee, and Dr. Copp); the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, CA (Mr. Shah, Dr. Tabbaa, Ms. Evans); and the Georgetown University School of Medicine, Washington, DC (Mr. Shah)
| | - Kishan S. Shah
- From the Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (Dr. Kenney, Dr. Bugbee, and Dr. Copp); the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, CA (Mr. Shah, Dr. Tabbaa, Ms. Evans); and the Georgetown University School of Medicine, Washington, DC (Mr. Shah)
| | - Jenna M. Tabbaa
- From the Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (Dr. Kenney, Dr. Bugbee, and Dr. Copp); the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, CA (Mr. Shah, Dr. Tabbaa, Ms. Evans); and the Georgetown University School of Medicine, Washington, DC (Mr. Shah)
| | - Audree S. Evans
- From the Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (Dr. Kenney, Dr. Bugbee, and Dr. Copp); the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, CA (Mr. Shah, Dr. Tabbaa, Ms. Evans); and the Georgetown University School of Medicine, Washington, DC (Mr. Shah)
| | - William D. Bugbee
- From the Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (Dr. Kenney, Dr. Bugbee, and Dr. Copp); the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, CA (Mr. Shah, Dr. Tabbaa, Ms. Evans); and the Georgetown University School of Medicine, Washington, DC (Mr. Shah)
| | - Steven N. Copp
- From the Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (Dr. Kenney, Dr. Bugbee, and Dr. Copp); the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, CA (Mr. Shah, Dr. Tabbaa, Ms. Evans); and the Georgetown University School of Medicine, Washington, DC (Mr. Shah)
| |
Collapse
|
|
3
|
Hung LL, Chen YC, Wang YT, Wang SP. The factors determining early mobilization in elderly patients undergoing total knee replacement. BMC Geriatr 2025; 25:118. [PMID: 39979824 PMCID: PMC11844050 DOI: 10.1186/s12877-025-05772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 02/07/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Postoperative early mobilization after total knee replacement (TKR) is essential for preventing complications and offers numerous benefits. The purpose of this study was to evaluate the factors determining early mobilization (EM) after primary TKR and the effects on risk of falls and length of stay (LOS). METHODS This retrospective study recruited elder participants undergoing primary TKR. All patients were classified as EM(+), early mobilization (EM) within 24 h, or EM(-), delayed mobilization over 24 h. Demographic data, pain Visual Analog Scale (VAS), American Society of Anesthesiologists (ASA) score, perioperative blood pressure, postoperative pain control mode, medical catheters, dizziness or nausea/vomiting (PONV), falls during admission, and the LOS were collected. RESULT A total of 1759 elder participants undergoing primary TKR were enrolled. Mean age was 73.00 ± 8.11 years. Among them, there were 1260 EM(-) and 499 EM(+) cases, with no significant differences in sex, BMI, PONV, postoperative Patient Controlled Analgesia (PCA) mode, or the use of medical catheters, but age, higher ASA score, VAS, muscle strength, postoperative nausea, and substantial changes of blood pressure were significantly different between the two groups. A greater reduction in systolic blood pressure, when compared to the preoperative baseline blood pressure, was found in EM(-) patients than EM(+) patients on the operative day (13 vs. 4 mmHg, P < 0.001) and first day post-TKR (20 vs. 17 mmHg, P = 0.005). LOS in EM(-) patients was significant longer than that in EM(+) patients, but risk of falls was not significantly different. CONCLUSIONS Multiple factors influence patients' willingness to mobilize or ambulate earlier. However, more blood pressure reduction impeding early mobilization after TKR should be addressed. Maintaining post-TKR blood pressure without significant decreases is recommended for the successful mobilization after surgery. Early mobilization within 24 h after TKR may be beneficial in reducing the LOS and did not increase risk of falls.
Collapse
Affiliation(s)
- Li-Ling Hung
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Yong-Chuan Chen
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Yu-Ting Wang
- Department of Nursing, China Medical University, Taichung, 404327, Taiwan
| | - Shun-Ping Wang
- Department of Orthopaedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40227, Taiwan.
| |
Collapse
|
|
4
|
Hoveidaei AH, Taghavi SP, Ghaseminejad-Raeini A, McClellan C, Ferrua P, Geurts J, Wassilew G, Bosco J, Citak M. Do Outpatient Knee or Hip Arthroplasties Improve Patient Outcomes? J Arthroplasty 2025; 40:S30-S35. [PMID: 39437865 DOI: 10.1016/j.arth.2024.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 10/11/2024] [Accepted: 10/14/2024] [Indexed: 10/25/2024] Open
Affiliation(s)
- Amir Human Hoveidaei
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | | | | | - Paolo Ferrua
- Prima Clinica Ortopedica ASST Gaetano Pini - CTO Università degli Studi di Milano
| | - Jan Geurts
- Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Georgi Wassilew
- Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Joseph Bosco
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| |
Collapse
|
|
5
|
Karmakar V, Chain M, Majie A, Ghosh A, Sengupta P, Dutta S, Mazumder PM, Gorain B. Targeting the NLRP3 inflammasome as a novel therapeutic target for osteoarthritis. Inflammopharmacology 2025; 33:461-484. [PMID: 39806051 DOI: 10.1007/s10787-024-01629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 12/07/2024] [Indexed: 01/16/2025]
Abstract
Osteoarthritis, the most common arthritic condition, is an age-related progressive disease characterized by the loss of cartilage and synovial inflammation in the knees and hips. Development of pain, stiffness, and considerably restricted mobility of the joints are responsible for the production of matrix metalloproteinases and cytokines. Although several treatments are available for the management of this disease condition, they possess limitations at different levels. Recently, efforts have focused on regulating the production of the NLRP3 inflammasome, which plays a critical role in the disease's progression due to its dysregulation. Inhibition of NLRP3 inflammasome has shown the potential to modulate the production of MMP-13, caspase-1, IL-1β, etc., which has been reflected by positive responses in different preclinical and clinical studies. Aiming inhibition of this NLRP3 inflammasome, several compounds are in different stages of research owing to bring a novel agent for the treatment of osteoarthritis. This review summarizes the mechanistic pathways linking NLRP3 activation to osteoarthritis development and discusses the progress in new therapeutics aimed at effective treatment.
Collapse
Affiliation(s)
- Varnita Karmakar
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India
| | - Mayukh Chain
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India
| | - Ankit Majie
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India
| | - Arya Ghosh
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India
| | - Pallav Sengupta
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Sulagna Dutta
- Basic Medical Sciences Department, College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - Papiya Mitra Mazumder
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India
| | - Bapi Gorain
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India.
| |
Collapse
|
|
6
|
Lex JR, Koucheki R, Abbas A, Wolfstadt JI, McLawhorn AS, Ravi B. Predicting 30-Day Venous Thromboembolism Following Total Joint Arthroplasty: Adjusting for Trends in Annual Length of Stay. Arthroplast Today 2024; 30:101491. [PMID: 39484089 PMCID: PMC11526050 DOI: 10.1016/j.artd.2024.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/11/2024] [Accepted: 07/23/2024] [Indexed: 11/03/2024] Open
Abstract
Background Venous thromboembolism (VTE) following total hip arthroplasty and total knee arthroplasty (TKA) is linked to immobility, and preoperative prediction remains difficult. We aimed to evaluate whether annual mean length of stay (LOS) is associated with the incidence of VTE and develop a generalizable machine learning model to preoperatively predict the incidence of symptomatic VTE following total hip and TKA using National Surgical Quality Improvement Program. Methods Annual incidence of 30-day postoperative VTE, deep vein thrombosis, and pulmonary embolism was calculated over 6 years and tested for trend. Correlation between annual VTE rates and mean LOS was calculated. Predictive models (logistic regression, random forest, and XGBoost) were trained and tested based on year of surgery with different oversampling algorithms used to address data imbalance. Results A total of 498,314 patients were included, with 0.88% developing a VTE within 30 days. VTE rates decreased from 1.11% in 2014 to 0.76% in 2019 (P < .001). There was a strong correlation between the yearly incidence of VTE, pulmonary embolism, and deep vein thrombosis and mean LOS (r = 0.96, 0.87, and 0.98, respectively). Univariate analysis demonstrated that TKA, inpatient setting, American Society of Anesthesiologists classification, and various patient comorbidities were significantly associated with VTE. The logistic regression model trained on all data with a balanced loss scoring function performed the best (area under the curve = 0.600). Conclusions This study revealed declining VTE rates strongly correlated to decreasing postoperative LOS and identified patient and surgery-specific factors associated with VTE risk. Development of more accurate machine learning models for VTE prediction may improve risk stratification, prevention, and monitoring for arthroplasty patients.
Collapse
Affiliation(s)
- Johnathan R. Lex
- Temerty Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Robert Koucheki
- Temerty Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Aazad Abbas
- Temerty Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jesse I. Wolfstadt
- Temerty Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Granovsky Gluskin Division of Orthopaedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, Canada
| | | | - Bheeshma Ravi
- Temerty Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| |
Collapse
|
|
7
|
Hafeez K, Umar M, Desai V. Factors delaying mobilization after hip and knee arthroplasty. Int J Health Sci (Qassim) 2024; 18:4-7. [PMID: 39282131 PMCID: PMC11393389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Objective Arthroplasty patients undergo pre-operative assessment and medical optimization before surgery with the objective to mobilize and discharge home as soon as deemed fit to reduce hospital stay. This study was aimed to investigate factors delaying mobilization after hip and knee arthroplasty in our hospital. Methods This observational study was conducted in our hospital between August 2021 and October 2021. We included all elective orthopedic patients who were admitted for hip and knee arthroplasty during this period. Patients admitted for revision arthroplasty were excluded from the study. We collected data prospectively on a pro forma including patient demographics and different other variables. All patients were reviewed on the first post-operative day by one of the authors and pro formas were completed. We used SPSS to analyze data. Results Sixty patients were included; 32 females and 28 males with a mean age of 69.62 years. Primary knee arthroplasty was done in 30 patients while 30 underwent primary hip arthroplasty. Most of the patients (n = 50) were mobilized on the 1st day; however, ten patients were unable to mobilize. Orthostatic hypotension, dizziness, and pain were statistically significant factors responsible for failed mobilization on day one. Patients who failed to mobilize on day one had longer hospital stay (P = 0.018). Conclusion Orthostatic intolerance and post-operative pain were independent factors delaying mobilization after hip and knee arthroplasty thereby increasing the length of stay in these patients.
Collapse
Affiliation(s)
- Kamran Hafeez
- Department of Trauma and Orthopedics, Kings Mill Hospital, Sutton in Ashfield, Nottinghamshire, NG17 4JL, United Kingdom
| | - Muhammad Umar
- Clinical Fellow T&O, Department of Trauma and Orthopedics, Kings Mill Hospital, Sutton in Ashfield, Nottinghamshire, NG17 4JL, United Kingdom
| | - Vikram Desai
- Department of Trauma and Orthopedics, Kings Mill Hospital, Sutton in Ashfield, Nottinghamshire, NG17 4JL, United Kingdom
| |
Collapse
|
|
8
|
Zhou G, Yao Y, Shen Y, You X, Zhang X, Xu Z. Early ambulation after total knee arthroplasty: a retrospective single-center study. J Orthop Surg Res 2024; 19:446. [PMID: 39075550 PMCID: PMC11285134 DOI: 10.1186/s13018-024-04883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
PURPOSE Early ambulation is an important step in accelerating post-joint replacement surgery recovery. However, there is limited research on populations who are unable to walk immediately after the operation. The purpose of this study was to determine the factors influencing postoperative ambulation in total knee arthroplasty (TKA) patients. METHODS Primary TKA patients were included in this retrospective study. All patients were divided into two groups. Patients who began walking within 24 h were categorized as the early ambulation group, while patients who began walking after 24 h were classified as the late ambulation group. Recorded demographic data included age, gender, body mass index (BMI), clinical diagnosis, and comorbidities. Hematological parameters potentially affecting patients' preoperative physical condition were also documented. Additionally, intraoperative metrics such as surgical time, surgical side, tourniquet time, intraoperative blood loss, the placement of drains, and prosthetic model were recorded. RESULTS A total of 453 patients (79.0% female, 21.0% male) were included in this study. The average age of all patients was 68.5±7.9 years, ranging from 36 to 87 years, with an average BMI of 27.2±9.9 kg/ m 2 . The mean postoperative ambulation time was 1.6 days, with a range of 0-4 days. In univariate group comparisons, an increase in postoperative time to ambulation was significantly associated with a history of heart disease ( P < 0.001 ), stroke history ( P = 0.003 ), and prior surgeries ( P = 0.003 ). Patients who delayed ambulation also exhibited significantly higher coagulation-related parameters including PT ( P < 0.001 ), APTT ( P = 0.002 ), TT ( P = 0.039 ) before surgery compared to those who mobilized early. Furthermore, prolonged surgical time ( P = 0.030 ), increased intraoperative blood loss ( P < 0.001 ), and the placement of intraoperative drains ( P < 0.001 ) also significantly extended the time to postoperative ambulation. However, after multivariate logistic regression analysis, only PT (OR 1.86, 95% CI 1.32 - 2.61, P < 0.001 ), TT (OR 1.30, 95% CI 1.09 - 1.55, P = 0.004 ) intraoperative blood loss (OR 1.01, 95% CI 1.00 - 1.01, P = 0.008 ) and the placement of intraoperative drains (OR 11.39, 95% CI 6.59 - 19.69, P < 0.001 ) were identified as predictive factors for late ambulation in patients after TKA. CONCLUSION In this study, preoperative coagulation function, intraoperative blood loss and the placement of intraoperative drains were factors contributing to delay ambulation time. Therefore, it is believed that properly improving preoperative coagulation function, effective intraoperative hemostasis, and reducing the placement of drains have a positive impact on early postoperative ambulation in patients undergoing TKA.
Collapse
Affiliation(s)
- Guanjie Zhou
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, People's Republic of China
| | - Yao Yao
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, People's Republic of China
| | - Ying Shen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, People's Republic of China
| | - Xiaokang You
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, People's Republic of China
| | - Xiaofeng Zhang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, People's Republic of China.
| | - Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, People's Republic of China.
| |
Collapse
|
|
9
|
Yu J, Jia Y, Su J, He J, Ji Y, Zhao F, Wu H. Prevention and control of venous thromboembolism after major orthopedic surgery through doctor-to-patient cultivation of musculoskeletal ability based on King's theory of goal attainment. Am J Transl Res 2024; 16:1721-1730. [PMID: 38883378 PMCID: PMC11170611 DOI: 10.62347/heqe4868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/02/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES To explore the prevention and management of venous thromboembolism (VTE) following major orthopaedic surgery (MOS) by fostering doctor-to-patient cultivation of musculoskeletal ability, guided by King's theory of goal attainment. METHODS A cohort of patients (n = 116) undergoing MOS was selected for the study, and were divided into two groups: the regular group and the observation group, with patients in the regular group experiencing routine nursing care and management and those in the observation group undergoing musculoskeletal ability cultivation based on King's theory of goal attainment. Baseline data, limb vascular ultrasonography, coagulation function, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, VTE prevention efficacy, Exercise of Self-care Ability Scale (ESCA) score, and nursing satisfaction were analysed comparatively. RESULTS There was no significant within-group difference in baseline data (P > 0.05). Following the interventions, the observation group demonstrated statistically significant reductions in the Musculoskeletal-Integrated Imaging Score, various dimensions of WOMAC scores, and D-dimer (D-D) levels (P < 0.05) both in comparison to their levels before interventions and to those observed in the regular group (P < 0.05). Additionally, the observation group exhibited increases in prothrombin time levels and various dimensions of ESCA scores (P < 0.05) post-intervention, surpassing the pre-intervention levels and those obtained in the regular group (P < 0.05). Furthermore, the observation group exhibited a significantly lower incidence of VTE (P < 0.05) and higher nursing satisfaction (P < 0.05) compared to the regular group. CONCLUSIONS Nursing intervention measures, utilizing doctor-to-patient cultivation of musculoskeletal ability based on King's theory of goal attainment, have demonstrated a significant clinical benefit for VTE prevention and control in post-MOS patients. This approach not only effectively prevented VTE in post MOS patients but also enhanced their satisfaction towards nursing care.
Collapse
Affiliation(s)
- Jing Yu
- Department of Nursing, Affiliated Hospital of Hebei University of Engineering Handan 056000, Hebei, China
| | - Yancai Jia
- Department of Gynaecology and Obstetrics, Affiliated Hospital of Hebei University of Engineering Handan 056000, Hebei, China
| | - Jun Su
- Respiratory Medicine, Handan Seventh Hospital Handan 056005, Hebei, China
| | - Juan He
- Department of Fifth Orthopedic, The City Central Hospital of Handan Handan 057150, Hebei, China
| | - Yanping Ji
- Clinical Laboratory, Handan Hospital of Traditional Chinese Medicine Handan 056001, Hebei, China
| | - Fangyun Zhao
- Orthopaedic Center, Affiliated Hospital of Hebei University of Engineering Handan 056000, Hebei, China
| | - Hongfang Wu
- Department of Vascular Surgery, Affiliated Hospital of Hebei University of Engineering Handan 056000, Hebei, China
| |
Collapse
|
|
10
|
Pai P, Amor D, Lai YH, Echevarria GC. Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty: A Systematic Review and Meta-analysis. Clin J Pain 2024; 40:320-332. [PMID: 38268183 DOI: 10.1097/ajp.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Ultrasound-guided pericapsular nerve group (PENG) block is an emerging regional anesthesia technique that may provide analgesia for patients undergoing total hip arthroplasties (THA). There are clinical studies comparing this fascial plane block to other established methods; however, evidence on the actual efficacy of this block for THA continues to evolve. OBJECTIVE Available clinical studies conducted over the past 4 years were reviewed to evaluate the analgesic efficacy and effectiveness of PENG block in patients undergoing THAs. METHODS A meta-analysis of randomized controlled trials (RCTs) in patients undergoing THA, where PENG block was compared to no block, placebo/sham block (injection with saline), or other analgesic techniques including suprainguinal fascia iliaca block (FIB), or periarticular infiltration (PAI) was performed. Our primary outcome was opioid consumption during the first 24 hours. Secondary outcomes were postoperative rest and dynamic pain scores at 6-12, 24 and 48 hours, block performance time, sensory-motor assessment, quadriceps weakness, the incidence of postoperative falls, first analgesic request, block and opioid-related complications, surgical complications, patient satisfaction scores, postanesthesia care unit length of stay, hospital length of stay, and functional and quality of life outcomes. RESULTS We included 12 RCTs with a total of 705 patients. Data showed that PENG block decreased 24-hour oral morphine milligram equivalent consumption by a mean difference (MD) of 3.75 mg (95% CI: -5.96,-1.54; P =0.0009). No statistically significant differences in rest or dynamic pain were found, except for a modest MD reduction in dynamic pain score of 0.55 points (95% CI: -0.98, -0.12; P =0.01), measured 24 hours after surgery in favor of PENG block. CONCLUSIONS Our systematic review and meta-analysis suggest that PENG block provides better analgesia, measured as MME use, in the first 24 hours after THA, with no real impact on postoperative VAS scores. Despite statistical significance, the high heterogeneity across RCTs implies that PENG's benefits may not surpass the minimal clinically important difference threshold for us to recommend PENG as best practice in THA.
Collapse
Affiliation(s)
- Poonam Pai
- Icahn School Of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West and Morningside Hospitals, NY
| | | | | | | |
Collapse
|
|
11
|
Hu CY, Wang JH, Chen TY, Wang PK. Associations of parecoxib and other variables with recovery and safety outcomes in total knee arthroplasty: insights from a retrospective cohort study. Front Surg 2024; 10:1308221. [PMID: 38239668 PMCID: PMC10794493 DOI: 10.3389/fsurg.2023.1308221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Background Early mobilization post-total knee arthroplasty (TKA) significantly affects patient outcomes. While parecoxib is known to reduce postoperative pain and morphine use with a favorable safety profile, its impact on mobilization timing post-TKA remains uncertain. This retrospective study aims to assess parecoxib's influence on postoperative mobilization timing in TKA patients without compromising safety. Methods This study included unilateral TKA patients treated for primary knee osteoarthritis under general anesthesia. We divided the study period into two intervals, 2007-2012 and 2013-2018, to evaluate temporal differences. Both the control group and parecoxib group received standard postoperative oral analgesics and as-needed intramuscular morphine. The control group did not receive parecoxib, while the parecoxib group did. Primary outcomes compared postoperative complications and mobilization timing between groups, with secondary outcomes including length of hospital stay (LOS), Visual Analog Scale (VAS) scores for pain, as-needed morphine use, and postoperative nausea/vomiting. Results Parecoxib did not increase postoperative complications. Unmatched comparison with patients in controlled group found that patients in parecoxib group had significantly shortened mobilization time (2.2 ± 1.1 vs. 2.7 ± 1.6 days, P < 0.001) and LOS (6.7 ± 2.5 vs. 7.2 ± 2.1 days, P = 0.01). Multivariate analysis linked parecoxib use with faster mobilization (β = -0.365, P < 0.001) but not LOS. Males showed increased mobilization time and LOS compared to females during the period of 2007-2018, but gender had no significant association with LOS during the period of 2013-2018. The 2013-2018 period saw significant reductions in both mobilization time and LOS. Use of a tourniquet and local infiltration analgesia showed no significant impact. ASA classification 1-2 was positively associated with faster mobilization but not LOS. Longer operation times were linked to delayed mobilization and increased LOS. Conclusion In this study, intravenous parecoxib injection, female gender, and shorter OP time had consistent positive association with shorter time to mobilization after individual multivariate analysis in 2 different period. The use of parecoxib had consistent no significant association with LOS. Only shorter OP time was consistent positive associated with shorter LOS.
Collapse
Affiliation(s)
- Ching-Yuan Hu
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tsung-Ying Chen
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Po-Kai Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
|
12
|
Chu C, Mu W, Wahafu T, Zou C, Xu B, Cao L. Efficacy and safety of postoperative single-dose anticoagulant treatment in preventing venous thromboembolism after revision hip arthroplasty: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2709-2716. [PMID: 37491609 DOI: 10.1007/s00264-023-05893-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE The purpose of the study is to determine the efficacy and safety of postoperative single-dose anticoagulant treatment in preventing venous thromboembolism (VTE) after revision THA, in comparison with a multiple-dose chemoprophylaxis protocol. METHODS We retrospectively compared 295 patients undergoing revision THA who received multiple-dose chemoprophylaxis protocol (40 mg low-molecular-weight heparin once and oral rivaroxaban for 10 days) or single-dose chemoprophylaxis protocol (40 mg low-molecular-weight heparin once) for VTE. The patients in both groups performed active lower limb exercises. Each group was further stratified into subgroups based on the aetiology of revision. The incidence of VTE, wound complications within three months, hidden blood loss (HBL), transfusion rate, and surgical drainage duration were recorded. RESULTS The incidence rates of VTE (P = 0.870) did not differ between the two prophylaxis protocols. However, significant differences were observed in wound complications within three months (P = 0.002), HBL (P = 0.015), transfusion rate (P = 0.028). Surgical drainage duration was also shorter in the single-dose chemoprophylaxis group (P = 0.0023). In the subgroup analysis, the use of single-dose chemoprophylaxis protocol cannot significantly reduce HBL and transfusion rate after septic revision THA. The use of multiple-dose chemoprophylaxis protocol (OR = 2.89, P = 0.002) and high BMI (OR = 1.09, P = 0.037) were independent risk factors of wound complications. CONCLUSIONS Single-dose chemoprophylaxis protocol effectively and safely prevented VTE after revision THA compared with multiple-dose chemoprophylaxis protocol. The effect in reducing HBL and postoperative transfusion rate was limited in septic revision.
Collapse
Affiliation(s)
- Chenghan Chu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Wenbo Mu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
- College of Pharmacy, Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Tuerhongjiang Wahafu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Chen Zou
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Boyong Xu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
- Ministry of Education, Key Laboratory of High Incidence Disease Research in Xinjiang(Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, 830054, Xinjiang, China.
| |
Collapse
|
|
13
|
Coyle M, Jaggi A, Weatherburn L, DanielI H, Chester R. Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review. Shoulder Elbow 2023; 15:554-565. [PMID: 37811389 PMCID: PMC10557935 DOI: 10.1177/17585732221089636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/23/2022] [Indexed: 10/10/2023]
Abstract
Background This systematic scoping review aimed to describe the content of post-operative rehabilitation programmes, and outcome measures selection following stabilisation surgery for traumatic anterior shoulder dislocation (TASD). Methods An electronic search of Medline, EMBASE, CINAHL and AMED was conducted (2000-2021). Any cohort or clinical trial of patients receiving post-operative TASD rehabilitation were included. Study selection, data extraction and quality appraisal were undertaken by two independent reviewers. Results Twelve studies including fourteen treatment programmes were eligible. Period of post-operative immobilisation ranged from 1 day to 6 weeks, with exercise introduced between 1 and 7 weeks. Strengthening exercises were introduced between 1 and 12 weeks. Two studies described "accelerated" rehabilitation programmes, differing in immobilisation period and exercise milestones. No increased recurrence was reported in professional footballers. Two studies compared rehabilitation programmes, one not randomised, the other 18 years old. There was variability in selected outcomes measures, with only 4 studies using a common measure. Discussion There is minimal evidence to guide post-operative rehabilitation, variability in immobilisation periods and when exercise is introduced. There is no consensus on the definition of accelerated rehabilitation, or outcome measure selection. Clinical consensus of standardised terminology and stages of rehabilitation is required prior to efficacy studies.
Collapse
Affiliation(s)
- Martha Coyle
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Anju Jaggi
- Physiotherapy Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Lewis Weatherburn
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Helena DanielI
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
|
14
|
Pournajaf S, Pellicciari L, Proietti S, Agostini F, Gabbani D, Goffredo M, Damiani C, Franceschini M. Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? A secondary analysis retrospective cohort study. Int J Rehabil Res 2023; 46:230-237. [PMID: 37334818 PMCID: PMC10396075 DOI: 10.1097/mrr.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
The modified Barthel Index (mBI) is a well-established patient-centered outcome measure commonly administrated in rehabilitation settings to evaluate the functional status of patients at admission and discharge. This study aimed to detect which mBI items collected on admission can predict the total mBI at discharge from first inpatient rehabilitation in large cohorts of orthopedic (n = 1864) and neurological (n = 1684) patients. Demographic and clinical data (time since the acute event 11.8 ± 17.2 days) at patients' admission and mBI at discharge were collected. Univariate and multiple binary logistic regressions were performed to study the associations between independent and dependent variables for each cohort separately. In neurological patients, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with feeding, personal hygiene, bladder, and transfers were independently associated with higher total mBI at discharge (R 2 = 0.636). In orthopedic patients, age, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with personal hygiene, dressing, and bladder were independently associated with higher total mBI at discharge (R 2 = 0.622). Our results showed that different activities in neurological (i.e. feeding, personal hygiene, bladder, and transfer) and orthopedic sample (i.e. personal hygiene, dressing, and bladder) are positively associated with better function (measured by mBI) at the discharge. Clinicians have to take into account these predictors of functionality when they plan an appropriate rehabilitation treatment.
Collapse
Affiliation(s)
- Sanaz Pournajaf
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | | | | | - Francesco Agostini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome
| | - Debora Gabbani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Carlo Damiani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- San Raffaele University, Rome, Italy
| |
Collapse
|
|
15
|
Li J, Xia R, Zhu C, Wu H, Zhang X, Li J, Ma J. Effect of Femoral Nerve Block with Different Concentrations of Chloroprocaine on Early Postoperative Rehabilitation Training After Total Knee Arthroplasty. Med Sci Monit 2023; 29:e939858. [PMID: 37608539 PMCID: PMC10461456 DOI: 10.12659/msm.939858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/06/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Patients experience severe pain in early postoperative rehabilitation after total knee arthroplasty (TKA). This study aimed to compare the effect of femoral nerve block with different concentrations of chloroprocaine on postoperative rehabilitation in patients with TKA. MATERIAL AND METHODS Ninety patients who only received unilateral TKA were randomly and equally divided into C1 (1% chloroprocaine 0.2 ml/kg), C2 (2% chloroprocaine 0.2 ml/kg), or NS (0.9% sodium chloride solution 0.2 ml/kg) groups. The patients received rehabilitation 3 times a day on days 3-6 after surgery, and femoral nerve block was performed with corresponding solution 10 min before each training session. We recorded the maximum knee flexion angles (MKFA) and maximum knee extension angles (MKEA) during active exercise on day 7 after surgery, as well as the incidence of MKFA ³100°, American knee society (AKS) scores, and postoperative rehabilitation satisfaction. Adverse effects after administration in each group were also recorded. RESULTS Compared with group NS, patients in group C1 and C2 had larger MKFA during active exercise on day 7 after TKA, and had better rehabilitation satisfaction (P<0.05). MKEA, the incidence of MKFA ≥100°, and AKS scores showed no significant differences in the 3 groups. There were more patients with decline of muscle strength in group C2 (P<0.05), and no other adverse reactions were recorded. CONCLUSIONS Chloroprocaine for femoral nerve block can be safely used in rehabilitation after TKA and to improve the knee flexion angle in the early postoperative period. Because they may have fewer adverse effects, 1% chloroprocaine 0.2 ml/kg may be preferred.
Collapse
Affiliation(s)
- Jiajia Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Ruiqiang Xia
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Chunchun Zhu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Hong Wu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Xutong Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Jun Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Jianfeng Ma
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| |
Collapse
|
|
16
|
Vosáhlo J, Salus A, Smolko M, Němcová B, Nordmeyer V, Mikles M, Rau SM, Erik Johansen O. Oral enzyme combination with bromelain, trypsin and the flavonoid rutoside reduces systemic inflammation and pain when used pre- and post-operatively in elective total hip replacement: a randomized exploratory placebo-controlled trial. Ther Adv Musculoskelet Dis 2023; 15:1759720X231186875. [PMID: 37529332 PMCID: PMC10387799 DOI: 10.1177/1759720x231186875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Background Early mobilization after total hip replacement (THR) is key for fast recovery but is often limited by pain. Oral enzyme combinations (OECs) have demonstrated anti-inflammatory and pain-relieving effects. Objectives and design This prospective, randomized, double-blind, placebo-controlled exploratory trial evaluated the effects of pre- and post-operative use of OEC (90 mg bromelain, 48 mg trypsin, 100 mg rutoside) following elective THR, on post-operative recovery. Methods Candidates for primary elective cementless THR owing to osteoarthritis were eligible for participation [age ⩾50 years, body mass index 25-35 kg/m2, C-reactive protein (CRP) ⩽6 mg/L]. Following randomization to OEC or placebo, intervention started pre-operatively and continued onwards until day 42. Main outcomes included post-operative CRP levels (days 1-7), self-reported hip pain at rest (by 0-10 cm visual analogue scale on post-operative days 1-42), post-operative analgesic use [by cumulative analgesic consumption score (CACS) days 7-42], tolerability and adverse events. Results Patients (N = 34) were recruited from a tertiary orthopaedic hospital in the Czech Republic, of whom 33 completed the study (OEC/placebo: n = 15/18). Baseline characteristics across the groups were comparable. Compared with placebo, the OEC group had numerically lower CRP levels on post-operative days 1-7, including peak level [mean (standard deviation) OEC versus placebo: 81.4 (28.3) versus 106.7 (63.3) mg/L], which translated into a significant 32% lower CRP area under the curve (p = 0.034). The OEC group reported significantly less pain during post-operative days 1-7 versus placebo (analysis of variance treatment × visit [F(4) = 3.989]; p = 0.005). Analgesic use was numerically reduced as assessed through an accumulated CACS. No deleterious effects on haemorheological parameters were observed in either group. Conclusions Pre- and post-operative use of OEC significantly reduced CRP levels and patient self-reported pain. OEC may be an efficacious and safe treatment option to facilitate post-operative recovery following THR. Trial registration EudraCT number 2016-003078-41.
Collapse
Affiliation(s)
- Jiří Vosáhlo
- Orthopaedic and Traumatology Department, Jihlava Hospital, Jihlava, Czech Republic
| | - Adam Salus
- Orthopaedic and Traumatology Department, Jihlava Hospital, Jihlava, Czech Republic
| | - Michael Smolko
- Orthopaedic and Traumatology Department, Jihlava Hospital, Jihlava, Czech Republic
| | - Barbora Němcová
- Rehabilitation Department, Jihlava Hospital, Jihlava, Czech Republic
| | - Veit Nordmeyer
- Clinical Department for Trauma Surgery, University Hospital Tulln, Tulln, Austria
| | - Milos Mikles
- Clinical Department for Trauma Surgery, University Hospital Tulln, Tulln, Austria
| | | | - Odd Erik Johansen
- Nestlé Health Science, Avenue Nestle 55, Vevey, Vaud 1800, Switzerland
| |
Collapse
|
|
17
|
Bontea M, Bimbo-Szuhai E, Macovei IC, Maghiar PB, Sandor M, Botea M, Romanescu D, Beiusanu C, Cacuci A, Sachelarie L, Huniadi A. Anterior Approach to Hip Arthroplasty with Early Mobilization Key for Reduced Hospital Length of Stay. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1216. [PMID: 37512027 PMCID: PMC10384527 DOI: 10.3390/medicina59071216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: This study aimed to explore the preoperative factors related to early mobilization and length of stay (LOS) after total hip arthroplasty and the benefits of the anterior approach over the traditional lateral approach. Materials and Methods: Every patient benefits from information regarding details of the surgery approach, possible intra, and postoperative complications, post-operator medical care, and steps in the early mobilization protocol. The patient underwent a pre-anesthetic evaluation, was checked for preoperatory vital function, and was reevaluated for mobilization at 6, 12, 24, 36, 48, and 96 h after total hip arthroplasty using the anterior versus lateral approach. Results: The result of the statistical calculations indicates the independent negative risk factors for reaching the mobilization target: age with a coefficient of -0.046, p = 0.0154 and lateral approach with a relative risk of 0.3802 (95% CI: 0.15-0.90), p = 0.0298. Statistical data concerning the length of stay (LOS) showed significant differences in the total days spent in the hospital. The patients who were operated on using the lateral approach presented a higher body mass index than those with the anterior approach, but this difference did not reach the threshold of statistical significance. Conclusions: In our study, patient mobilization is crucial to reduce LOS.
Collapse
Affiliation(s)
- Mihaela Bontea
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Erika Bimbo-Szuhai
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
| | - Iulia Codruta Macovei
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Paula Bianca Maghiar
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Mircea Sandor
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Mihai Botea
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Dana Romanescu
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Corina Beiusanu
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Adriana Cacuci
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Liliana Sachelarie
- Department of Prelinical Discipline, Apollonia University, 700511 Iasi, Romania
| | - Anca Huniadi
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| |
Collapse
|
|
18
|
Changjun C, Xin Z, Yue L, Liyile C, Pengde K. Key Elements of Enhanced Recovery after Total Joint Arthroplasty: A Reanalysis of the Enhanced Recovery after Surgery Guidelines. Orthop Surg 2023; 15:671-678. [PMID: 36597677 PMCID: PMC9977593 DOI: 10.1111/os.13623] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 01/05/2023] Open
Abstract
Recent guidelines have produced a consensus statement for perioperative care in hip and knee replacement. However, there is still a need for reanalysis of the evidence and recommendations. Therefore, we retrieved and reanalyzed the evidence of each recommended components of enhanced recovery after surgery (ERAS) based on the guidelines of total joint arthroplasty. For each one, we included for the highest levels of evidence and those systematic reviews and meta-analyses were preferred. The full texts were analyzed and the evidence of all components were summarized. We found that most of the recommended components of ERAS are supported by evidence, however, the implementation details of each recommended components need to be further optimized. Therefore, implementation of a full ERAS program may maximize the benefits of our clinical practice but this combined effect still needs to be further determined.
Collapse
Affiliation(s)
- Chen Changjun
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhao Xin
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.,Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Luo Yue
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chen Liyile
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Kang Pengde
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| |
Collapse
|
|
19
|
The Relationship Between Perioperative Care Quality and Postoperative Comfort Level in Patients With Hip Replacement Surgery. J Perianesth Nurs 2023; 38:69-75. [PMID: 35931599 DOI: 10.1016/j.jopan.2022.05.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To examine the relationship between perioperative care quality and postoperative comfort level of patients undergoing hip replacement surgery. DESIGN This is a descriptive study. METHODS This study was conducted with 90 patients between February and September 2021 in a training and research hospital in Turkey. Data were collected from Information Form, the Good Perioperative Nursing Care Scale (for Patients) (GPNCS), and the Post Hip Replacement Comfort Scale (PHRCS). FINDINGS The mean age of the patients was 65.58 ± 15.10 years. The mean total scores of the patients in GPNCS and PHRCS were 134.61 ± 16.29 and 3.58 ± 0.40, respectively. In the correlation analysis, a statistically significant and positive weak relationship was determined between GPNCS and PHRCS, and as the quality of care during the surgery increases, the postoperative comfort levels increase (r = 0.253, P < .05). CONCLUSIONS Ensuring the comfort of patients during the surgery as well as in the pre-, intra- and postoperative period is necessary and important for the quality of care. In addition, since the quality of the care during surgery is effective on the postoperative comfort levels of the patients, quality nursing care is required pre-, intra-, and postoperative periods.
Collapse
|
|
20
|
Melcher C, Gottschalk O, Mazoochian F, Pieper K, Wegener V, Pellengahr CS, Teske W, Wegener B. A new minimal-invasive approach for total hip replacement in sheep. Technol Health Care 2023; 31:1867-1874. [PMID: 37125586 DOI: 10.3233/thc-220805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Over the last 50 years arthroplasty became the gold-standard treatment for disabling conditions of the coxofemoral joint. Variations of anterior, lateral, and dorsal incision have been applied, but as each approach requires the incision and reflection of various muscles to gain adequate exposure of the joint results are still controversial. OBJECTIVE The purpose of this study was to develop a minimal-invasive, tissue-sparing approach in sheep with reduced risks in animal testing. METHODS 12 mature sheep underwent hip surgery as part of a study to evaluate a hip resurfacing system. In line with the preliminary cadaveric tests a modified, minimal-invasive, musclepreserving surgical approach was sought after. RESULTS We developed a surgical approach to the coxofemoral joint in sheep using only blunt tissue dissection after skin incision without any limitations in joint exposure or increased blood loss/duration of surgery. CONCLUSION Even though limitations occur and femoral orientation in sheep differs from man, joint forces have similar relative directions to the bone with similar bony and vascular anatomy. Therefore, this minimal-invasive muscle preserving approach might be a safe and comparable alternative in still inevitable animal testing.
Collapse
Affiliation(s)
- Carolin Melcher
- Department of Spine Surgery and Scoliosis Center, Schön Klinik Neustadt in Holstein, Neustadt, Germany
- Musculoskeletal University Center, Ludwig Maximilian University of Munich, Munich, Germany
- Department of Spine Surgery and Scoliosis Center, Schön Klinik Neustadt in Holstein, Neustadt, Germany
| | - Oliver Gottschalk
- Department of Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
- Department of Spine Surgery and Scoliosis Center, Schön Klinik Neustadt in Holstein, Neustadt, Germany
| | - Farhad Mazoochian
- Department of Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
| | - Korbinian Pieper
- Clinic of Veterinary Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | | | - Bernd Wegener
- Musculoskeletal University Center, Ludwig Maximilian University of Munich, Munich, Germany
| |
Collapse
|
|
21
|
Cheng GHM, Tan GKY, Kamarudin MFB, Lee BWW, Mei YY, Tan KG. Steroids Significantly Decrease Postoperative Postural Hypotension in Total Knee Replacement. J Knee Surg 2023; 36:208-215. [PMID: 34237779 DOI: 10.1055/s-0041-1731722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total knee replacement (TKR) is one of the most common orthopaedic procedures performed, and enhanced recovery after surgery (ERAS) has been developed and incorporated into inpatient surgical pathways to improve patient outcomes. Under ERAS recommendations, multimodal prophylaxis has been used to help manage postoperative nausea and vomiting (PONV) following TKR. Dexamethasone is one of the commonly used for this and the anti-inflammatory properties could depress vagal activity, reducing postural hypotension (PH). The hypothesis of this study is that postoperative dexamethasone use is associated with lower rates of early postoperative PH following TKR surgery. In our institution, patients who undergo elective primary TKR are admitted on the day of surgery and follow a standardized ERAS protocol. Data on patients who underwent elective primary TKR under a single adult reconstruction team from September 2017 to March 2020 were reviewed and analyzed. A review of demographic characteristics, surgical data, postoperative medications, and postoperative notes was performed. Binary logistic regression was used to assess the effect of the use of dexamethasone on PH, with an adjusted odds ratio (OR) calculated after accounting for potential confounders. Of the 149 patients were included in the study, 78 had dexamethasone postoperatively, and 71 did not. Patients who had received dexamethasone were statistically less likely to suffer from PH (OR = 0.31, p = 0.03) and less likely to develop PONV (OR = 0.21, p = 0.006). Patients who had received dexamethasone were more likely able to participate in early physiotherapy (OR = 2.42, p = 0.14), and this result was statistically insignificant. The use of postoperative intravenous dexamethasone is significantly associated with lower rates of postoperative PH after TKR. However, more studies are required to assess the optimal dosing amount and frequency, as well as to assess other factors which can enhance early postoperative patient mobilization as part of our goals for ERAS. This therapeutic study reflects level of evidence III.
Collapse
Affiliation(s)
- Gloria H M Cheng
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gabriel K Y Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Bryan W W Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yap Yan Mei
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore
| | - Kelvin G Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| |
Collapse
|
|
22
|
Is inpatient rehabilitation a predictor of a lower incidence of persistent knee pain 3-months following total knee replacement? A retrospective, observational study. BMC Musculoskelet Disord 2022; 23:855. [PMID: 36096816 PMCID: PMC9465848 DOI: 10.1186/s12891-022-05800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Moderate to severe levels of persistent knee pain have been estimated to affect up to 25% of people 3-months or more after a total knee replacement. It is unknown whether the type of rehabilitation pathway is associated with persistent high pain after surgery. Using a prospectively followed Australian cohort who underwent total knee replacement for knee osteoarthritis, this study aimed to i) report the incidence of high-intensity knee pain (defined as a score ≤ 15 on the Oxford Knee Score pain subscale) across time and ii) identify whether referral to inpatient rehabilitation was one of the predictors of persistent pain at 3-months post-surgery.
Methods
A retrospective analysis of a large prospective study was conducted using the Oxford Knee Score pain subscale to determine if participants had high pain at 3-months, 12-months and 36-months post-surgery. Relative risks for high pain at 3-, 12- and 36-months between the type of rehabilitation pathway were determined using Poisson multivariable regression with robust standard errors. The same technique was also employed to determine potential predictors, including rehabilitation pathway, of high pain at 3 months.
Results
The incidence of high pain in all participants was 73% pre-surgery and 10, 5 and 6% at 3-, 12- and 36-months respectively following knee replacement. There was a significant interaction between time and rehabilitation pathway, suggesting that the effect of the rehabilitation pathway varied across time. The incidence of high pain at 3-months did not significantly differ between those who attended inpatient rehabilitation (11.6%) and those discharged directly home (9.5%). Multivariable Poisson regression analysis identified the pre-surgical presence of high pain, co-morbid low back pain or other lower limb problem, younger age and having a major complication within 3-months following surgery as significant predictors of persistent pain whilst discharge to inpatient rehabilitation was not.
Conclusion
A small but clinically significant minority of people continued to have high pain levels at 3-, 12- and 36-months following a primary total knee replacement for osteoarthritis. Participation in an inpatient rehabilitation program does not appear to be an important predictor of ongoing knee pain.
Trial registration
The data were collected in the Evidence-based Processes and Outcomes of Care (EPOC) study, ClinicalTrials.gov Identifier: NCT01899443
Collapse
|
|
23
|
Mepivacaine Versus Bupivacaine Spinal Anesthesia for Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2022; 37:1396-1404.e5. [PMID: 35306162 DOI: 10.1016/j.arth.2022.03.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mepivacaine is an intermediate acting amide local anesthetic that can be used for neuraxial anesthesia in total joint arthroplasty (TJA) with a shorter duration of action (1.5-2 hours) compared to the more commonly used local anesthetic bupivacaine. The purpose of this study was to perform a systematic review and meta-analysis comparing bupivacaine and mepivacaine spinal anesthesia during elective TJA and the surgical outcomes of the time to full neurologic motor return, pain, mobility, length of stay (LOS), and complications including transient neurologic symptoms and urinary function. METHODS PubMed, Ovid MEDLINE, and Ovid Embase were screened for "arthroplasty, spinal anesthesia, bupivacaine, and mepivacaine," in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 159 studies were screened and 5 studies were evaluated. Data were compared regarding motor function return, mobility (distance ambulated), pain (visual analog scale [VAS]), LOS, and postoperative complications. RESULTS Full-text screening yielded 5 studies (3 randomized controlled trials and 2 retrospective cohort studies), with a total of 1,550 patients. Mepivacaine spinals had an earlier return to motor function (154 minutes vs 170 minutes, 95% CI: [-31.6, -0.9], P = .04), shorter LOS (25.95 hours vs 29.96 hours, 95% CI: [-6.8, -1.2], P = .01), and decreased urinary retention (7.15% vs 10.58%, 95% CI: [-6.3%, -0.6%], P = .02) with no differences in pain (VAS 3.57 vs 3.68, 95% CI: [-2.1, 1.9], P = .90) or distance ambulated (94.2 ft vs 89.1 ft, 95% CI: [-15, 25.2], P = .60) compared to bupivacaine spinal anesthesia. CONCLUSIONS The method of anesthesia administration has been an increasing area of focus for quicker and safer recovery to allow for early ambulation and facility discharge. The rapid recovery facilitated by mepivacaine may further enable outpatient TJA and enhance patient recovery. LEVEL OF EVIDENCE III.
Collapse
|
|
24
|
Demeulenaere M, Janssens GPL, van Beek N, Cannaerts N, Tengrootenhuysen MMF. Optimizing Rapid Recovery After Anterior Hip Arthroplasty Surgery: A Comparative Study of Fascia Iliaca Compartment Block and Local Infiltration Analgesia. J Arthroplasty 2022; 37:1338-1347. [PMID: 35306161 DOI: 10.1016/j.arth.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Multimodal pain therapy combining analgesics, local infiltration analgesia (LIA) and peripheral nerve blocks, such as fascia iliaca compartment block (FICB), can improve postoperative pain, nausea and vomiting (PONV) and ambulation in patients undergoing total hip arthroplasty (THA). We hypothesized that addition of FICB would decrease opioid requirements and length of stay (LOS) but could create a motor block. METHODS This is a single center, prospective, blinded randomized controlled study of 152 patients undergoing elective THA via direct anterior approach from October 2019 till August 2021. Three patient groups were defined: patients receiving only spinal anesthesia (control group, n = 53); spinal anesthesia with LIA perioperatively (n = 50); and spinal anesthesia with FICB on the recovery unit (n = 49). Outcome measures consisted of postoperative pain scores, PONV, length of hospital stay, opioid requirements and mobility. RESULTS Overall pain scores were low for all patient groups, with a lower pain score for LIA in comparison to the control group until 4 hours postoperatively (P < .05). Length of hospital stay, postoperative pain, nausea and vomiting (PONV) scores and quadriceps muscle strength did not differ significantly between groups. The control group showed higher scores at 12 hours postoperatively in comparison to FICB regarding rehabilitation potential, use of walking aids and activities of daily living (P < .05), but all groups reached the same endpoint 48 hours postoperatively. The LIA and FICB groups required less opioids until 24 hours postoperatively. CONCLUSION LIA is a beneficial adjuvant therapy to spinal anesthesia in THA patients as it may decrease pain scores and the need for opioid consumption. Adjuvant FICB only provided lower opioid requirements.
Collapse
|
|
25
|
Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol. J Clin Med 2022; 11:jcm11123293. [PMID: 35743363 PMCID: PMC9224899 DOI: 10.3390/jcm11123293] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 12/28/2022] Open
Abstract
Pressure to reduce healthcare costs, limited hospital availability along with improvements in surgical technique and perioperative care motivated many centers to focus on outpatient pathway implementation. However, in many short-stay protocols, the focus has shifted away from aiming to reduce complications and improved rehabilitation, to using length of stay as the main factor of success. To improve patient outcomes and maintain safety, the best way to implement a successful outpatient program would be to combine it with the principles of enhanced recovery after surgery (ERAS), and to improve patient recovery to a level where the patient is able to leave the hospital sooner. This article delivers a case for modernizing total hip arthroplasty perioperative pathways by implementing ERAS-outpatient protocols.
Collapse
|
|
26
|
Novack TA, Mazzei CJ, Patel JN, Poletick EB, D'Achille R, Wittig JC. Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty. J Knee Surg 2022; 35:750-756. [PMID: 33111274 DOI: 10.1055/s-0040-1718597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.
Collapse
Affiliation(s)
- Thomas A Novack
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center/Hackensack Meridian School of Medicine at Seton Hall University, Paterson, New Jersey
| | | | - Jay N Patel
- Department of Orthopaedic Surgery, Morristown Medical Center, Morristown, New Jersey
| | - Eileen B Poletick
- Department of Orthopaedic Surgery, Morristown Medical Center, Morristown, New Jersey
| | - Roberta D'Achille
- Department of Physical Therapy, Morristown Medical Center, Morristown, New Jersey
| | - James C Wittig
- Department of Orthopaedics, Morristown Medical Center, Morristown, New Jersey
| |
Collapse
|
|
27
|
Bulut A, Vatansever NA. Determination of Factors Affecting Early Mobilization of Patients Who Have Undergone Knee and Hip Arthroplasty. J Perianesth Nurs 2022; 37:646-653. [PMID: 35525826 DOI: 10.1016/j.jopan.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was conducted in order to determine the factors that affected the early mobilization after surgery of patients who had undergone knee and hip arthroplasty. DESIGN This study is descriptive correlational. METHODS The study population consists patients who met the inclusion criteria and were hospitalized in a State Hospital Orthopedics and Traumatology Clinic in Turkey in order have the knee or hip arthroplasty surgery between the dates of November 7, 2017 and September 21, 2018. While selecting the sample, the purposive sampling method was used. The sample consists of 60 patients who were in the universe of the study, who meet the inclusion criteria and who voluntarily agreed to participate in the study. FINDINGS The mean time of the first mobilization of the patients was 19 (9.15-72) hours. There were statistically significant relationships between mobilization time and age, gender, marital status, body mass index, past surgical history, chronic pain, blood transfusion before surgery, medical diagnosis, surgical procedure, bone cement usage, the score for American society of Anesthesiologists, surgical intervention time, post-operation nutrition, and defecation time. CONCLUSION The early mobilization time of the great majority of the patients who underwent knee and hip arthroplasty was in conformity with the enhanced recovery after surgery protocol.
Collapse
Affiliation(s)
- Akif Bulut
- Institute of Health Science, Bursa Uludag University, Bursa, Turkey.
| | | |
Collapse
|
|
28
|
|
|
29
|
Abstract
Variation in care is associated with variation in outcomes after total joint arthroplasty (TJA). Accordingly, much research into enhanced recovery efficacy for TJA has been devoted to linking standardization with better outcomes. This article focuses on recent advances suggesting that variation within a set of core protocol elements may be less important than providing the core elements within enhanced recovery pathways for TJA. Provided the core elements are associated with benefits for patients and health care system outcomes, variation in the details of their provision may contribute to a pathway's success. This article provides an updated review of the literature.
Collapse
Affiliation(s)
- Ellen M Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, 89 Holdenhurst Road, Bournemouth, Dorset BH8 8FT, UK
| |
Collapse
|
|
30
|
Joo B, Marquez J, Model G, Fan B, Osmotherly PG. Impact of a new post-operative care model in a rural hospital after total hip replacement and total knee replacement. Aust J Rural Health 2021; 30:115-122. [PMID: 34932241 DOI: 10.1111/ajr.12826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/19/2021] [Accepted: 10/29/2021] [Indexed: 11/27/2022] Open
Abstract
PROBLEM The predicted global trend of increasing total hip replacement and total knee replacement numbers leads to a direct and growing impact on health care services. Models of care including 'fast-track' mobilisation after total hip replacement and total knee replacement have been reported to reduce length of stay. This has not been verified in rural settings. SETTING Armidale Rural Referral Hospital. KEY MEASURES FOR IMPROVEMENT The new post-operative care included early discharge planning with or without Day 0 mobilisation with aims to decrease hospital length of stay without affecting complication rates, compared to the conventional model of care. STRATEGIES FOR CHANGE Consistent communication and planning for early discharge occurred before and throughout admission and Day 0 mobilisation. EFFECTS OF CHANGE There was a statistically significantly less median length of stay following implementation of the new post-operative care model (3.24 vs 2.29 days [P < .01]). There was no statistically significant difference in complications or readmissions following the change. Those who were allocated to mobilise on Day 0 had a lesser median length of stay than those who did not (2.40 vs 2.27 days, P = .03). LESSONS LEARNT Our results indicate that the new post-operative care model is safe and feasible for total knee replacement or total hip replacement patients in a rural setting and might reduce length of stay without compromising clinical outcomes.
Collapse
Affiliation(s)
- Baeho Joo
- Physiotherapy Department, Armidale Rural Referral Hospital, Armidale, NSW, Australia
| | - Jodie Marquez
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Gemma Model
- Physiotherapy Department, Armidale Rural Referral Hospital, Armidale, NSW, Australia
| | - Bo Fan
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
|
31
|
Manfredi VM, Machado MB, Barbato NG, Takata ET, Dobashi ET. EFFECTIVENESS OF DEEP VENOUS THROMBOSIS PREVENTION IN TOTAL HIP ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2021; 29:293-296. [PMID: 34849092 PMCID: PMC8601383 DOI: 10.1590/1413-785220212906243045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the efficacy of Deep Venous Thrombosis (DVT) prophylaxis protocol in patients undergoing total hip arthroplasty (THA), and to verify differences in the rates of this complication when comparing primary replacement surgeries with revision surgeries. METHODS We conducted a retrospective study of patients operated between 2012 and 2018, with inclusion and non-inclusion criteria determined by the researchers. A protocol was created to compile data including 92 patients, amounting to 110 operated hips, divided by gender, age, laterality, among other criteria. For THA cases, low molecular weight heparin chemoprophylaxis was used, associated with the use of pneumatic and elastic compression, concomitant to deambulation as soon as possible. The detection of DVT was determined by clinical evaluation and imaging exams such as: simple radiographs, ultrasound, arterial and venous color doppler, and laboratory tests. RESULTS The use of the protocol was very effective in our study. Only one (1.09%) case of deep venous thrombosis was found. CONCLUSION The use of thromboprophylaxis for DVT is indispensable, as was clearly demonstrated by these cases. We observed only one (1.09%) case of DVT in our series. Level of Evidence III, Retrospective Study.
Collapse
Affiliation(s)
- Victor Martins Manfredi
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
| | | | - Nícolas Giorgini Barbato
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
| | - Edmilson Takehiro Takata
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
- Federal University of São Paulo, São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Eiffel Tsuyoshi Dobashi
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
- Federal University of São Paulo, São Paulo School of Medicine, São Paulo, SP, Brazil
| |
Collapse
|
|
32
|
Choi CI, Kim JK, Choo MS, Lee SH, Chang JD, Han JH. Preventive effects of tamsulosin for postoperative urinary retention after lower limb arthroplasty: A randomized controlled study. Investig Clin Urol 2021; 62:569-576. [PMID: 34387038 PMCID: PMC8421999 DOI: 10.4111/icu.20200523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/12/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This prospective, randomized, controlled study investigated the use of tamsulosin, a selective alpha-blocker, as a prophylactic medication to prevent postoperative urinary retention (POUR) following lower limb arthroplasty. MATERIALS AND METHODS The criterion for diagnosing POUR was used a postoperative bladder volume over 400 mL with incomplete emptying. Patients who underwent primary total hip or knee arthroplasty were randomly assigned at a 1:1 ratio to tamsulosin treatment and non-treatment groups at a single center from September 2018 to November 2018. The treatment group received 0.2 mg of tamsulosin orally once at night for 3 days starting on postoperative day 1. During this 3-day period, an indwelling Foley catheter was maintained. The incidence of POUR according to tamsulosin treatment following lower limb arthroplasty was the primary outcome. RESULTS In total, 100 patients were enrolled, of whom 5 discontinued participation. POUR was diagnosed in 20 of the remaining 95 patients (21.1%). The treatment group contained 48 patients, of whom 6 (12.5%) developed POUR, whereas POUR occurred in the 14 of the 47 patients (29.8%) in the non-treatment group. Tamsulosin treatment reduced the risk of POUR by two-thirds (odds ratio [OR], 0.337; 95% confidence interval [CI], 0.117-0.971; p=0.044). The risk reduction associated with tamsulosin treatment remained robust post-adjustment for potential covariates (OR, 0.250; 95% CI, 0.069-0.905; p=0.038). CONCLUSIONS Tamsulosin administration immediately after lower limb arthroplasty reduced the incidence of urinary retention and diminished the need for long-term catheterization.
Collapse
Affiliation(s)
- Chang Il Choi
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong Keun Kim
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Min Soo Choo
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seong Ho Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jun-Dong Chang
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jun Hyun Han
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
| |
Collapse
|
|
33
|
Seagrave KG, Lewin AM, Harris IA, Badge H, Naylor J. Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 29:2309499021992605. [PMID: 33596736 DOI: 10.1177/2309499021992605] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While elective primary total hip (THA) and knee (TKA) arthroplasty are effective procedures for addressing the symptoms associated with advanced osteoarthritis, there is evidence to suggest that patient anxiety and depression are linked to poorer outcomes following surgery. METHODS A secondary analysis of prospectively-collected data of people undergoing primary elective THA or TKA for osteoarthritis across 19 hospitals was performed. We assessed outcomes at 1 year post-surgery for people with and without medically treated anxiety and/or depression at the time of surgery (A/D and no-A/D). We used unadjusted and adjusted analyses to compare improvement in Oxford Hip or Knee Scores, the incidences of major post-operative complications, satisfaction and index joint improvement by A/D status. RESULTS 15.2% (254/1669) of patients were identified with anxiety and/or depression at time of surgery. In the unadjusted analysis, the A/D group had greater mean Oxford score improvement by 2.1 points (95% CI 0.8 to 3.4, p = 0.001), increased major complications (OR 1.39, 95% CI 1.05 to 1.85, p = 0.02), were less likely to report a "much better" global improvement for index joint (OR 0.56, 95% CI 0.38 to 0.83, p = 0.003), and there was no statistically significant difference in the rate of satisfaction with the results of surgery (OR 0.64, 95% CI 0.37 to 1.10, p = 0.10). The adjusted analysis found no significant associations between A/D vs. no-A/D and any of the reported outcomes. CONCLUSION After adjustment for confounding variables, people with anxiety and/or depression pre-operatively, compared to those without, have similar outcomes following hip or knee arthroplasty.
Collapse
Affiliation(s)
- Kurt G Seagrave
- 4334The University of Sydney School of Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Adriane M Lewin
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Helen Badge
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,276979Australian Catholic University, North Sydney, New South Wales, Australia
| | - Justine Naylor
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Local Health District, Sydney, New South Wales, Australia
| |
Collapse
|
|
34
|
Haffer H, Popovic S, Martin F, Hardt S, Winkler T, Damm P. In vivo loading on the hip joint in patients with total hip replacement performing gymnastics and aerobics exercises. Sci Rep 2021; 11:13395. [PMID: 34183711 PMCID: PMC8239021 DOI: 10.1038/s41598-021-92788-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023] Open
Abstract
A further increase in the number of total hip arthroplasty (THA) is predicted, in particular the number of young THA patients has raised and with it their demands. There is no standardized evidence-based rehabilitation program and no reliable guidelines for sports activities after THA. Stretching and strengthening gymnastics are routinely performed in rehabilitation and aerobics as a sport after THA. The aim of the investigation was to determine the in vivo force and moments acting on the hip prosthesis during gymnastics and aerobic exercises to provide a source for evidence-based recommendations. Hip joint loads were measured in six patients with instrumented hip implants. The resulting force FRes, bending moment MBend at the neck and torsional moment MTors at the stem were examined during seven strengthening (with two different resistance bands) and four stretching gymnastic exercises and seven aerobic exercises with and without an aerobic step board compared to the loads during the reference activity walking. The stretching and strengthening gymnastics exercises and the aerobic exercises with and without a board demonstrated in their median peak force and moments mostly lower or similar values compared to walking. Significantly increased loads were recorded for the flexor stretching exercise in monopod stand (Fres and MBend), the strengthening abduction exercise on the chair (MTors) and the strengthening flexion exercise with the stronger resistance band (MTors). We also found a significant increase in median peak values in aerobic exercises with a board for the "Basic Step" (ipsilateral started Fres and MTors; contralateral started MTors), "Kickstep ipsilateral started" (Fres and MTors) and "Over the Top contralateral started" (Fres). The in vivo loads in THA patients during frequently performed stretching, strengthening and aerobic exercises were demonstrated for the first time. It was proved that stretching gymnastic exercises are safe in terms of resulting force, bending and torque moments for THA patients, although an external assistance for stabilization may be considered. Strengthening gymnastics exercises are reliable in terms of Fres, MBend and MTors, but, based on our data, we recommend to adhere to the communicated specific postoperative restrictions and select the resistance bands with lower tension. Aerobic exercises without an aerobic board can be considered as reliable activity in terms of force and moments for THA patients. Aerobic exercises with a board are not recommended for the early postoperative period and in our opinion need to be adapted to the individual muscular and coordinative resources.
Collapse
Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Srdan Popovic
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Franziska Martin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Winkler
- Berlin-Institute of Health, Center for Regenerative Therapies, Center for Musculoskeletal Surgery, Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
| |
Collapse
|
|
35
|
Bourazani M, Asimakopoulou E, Magklari C, Fyrfiris N, Tsirikas I, Diakoumis G, Kelesi M, Fasoi G, Kormas T, Lefaki G. Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery. World J Orthop 2021; 12:346-359. [PMID: 34189073 PMCID: PMC8223725 DOI: 10.5312/wjo.v12.i6.346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team. ERAS pathways include pre-operative patient counselling, regional anesthesia and analgesia techniques, post-operative pain management, early mobilization and early feeding. Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty, compared with those who followed a traditional care approach. ERAS protocols reduce post-operative stress, contribute to rapid recovery, shorten length of stay (LOS) without increasing the complications or readmissions, improve patient satisfaction and decrease the hospital costs. We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement. These programs require good organization and handling by the multidisciplinary team. ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment. The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis, with a view to improving the surgical outcomes.
Collapse
Affiliation(s)
- Maria Bourazani
- Department of Anesthesiology, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
- Department of Nursing, University of West Attica, Athens 12243, Attica, Greece
| | - Eleni Asimakopoulou
- Department of Anesthesiology, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
| | - Chrysseida Magklari
- Department of Anesthesiology, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
| | - Nikolaos Fyrfiris
- Department of Anesthesiology, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
| | | | - Giakoumis Diakoumis
- Orthopedic Clinic, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
| | - Martha Kelesi
- Department of Nursing, University of West Attica, Athens 12243, Attica, Greece
| | - Georgia Fasoi
- Department of Nursing, University of West Attica, Athens 12243, Attica, Greece
| | - Theodoros Kormas
- Orthopedic Clinic, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
| | - Gunhild Lefaki
- Department of Anesthesiology, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
| |
Collapse
|
|
36
|
Castle H, Dragovic M, Waterreus A. Mobilization after joint arthroplasty surgery: who benefits from standing within 12 hours? ANZ J Surg 2021; 91:1271-1276. [PMID: 33851511 DOI: 10.1111/ans.16795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early mobilization following joint arthroplasty surgery has been shown to be beneficial for patients, but it is unclear whether it is associated with a shorter length of stay (LOS) for both hip and knee arthroplasty (KA) patients. METHODS We undertook a retrospective observational study, reviewing the case notes of 386 patients admitted to an enhanced recovery programme for total hip (THA) or total/unicompartmental KA. We evaluated the influence of early mobilization on LOS, adjusting for possible confounders, stratifying by surgery type. RESULTS THA patients first mobilized within 12 h of returning to the acute orthopaedic ward following surgery had a significantly shorter mean LOS (mean = 3.6, standard deviation = 1.1) than THA patients who first mobilized 12 or more hours (mean = 4.1, standard deviation = 1.2), P = 0.004. There was no statistical significant difference in the mean LOS between the KA patients mobilized earlier or later. CONCLUSION Early mobilization as part of an enhanced recovery programme was associated with decreased LOS for patients having THA; however, this was not the case for KA patients.
Collapse
Affiliation(s)
- Hannah Castle
- Department of Physiotherapy, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Milan Dragovic
- Clinical Research Centre, North Metropolitan Health Services, Mental Health, Public Health and Dental Services, Perth, Western Australia, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia.,Centre for Clinical Research in Neuropsychiatry, Medical School, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
|
37
|
Kelly M, Turcotte J, Aja J, MacDonald J, King P. Impact of Intrathecal Fentanyl on Hospital Outcomes for Patients Undergoing Primary Total Hip Arthroplasty With Neuraxial Anesthesia. Arthroplast Today 2021; 8:200-203. [PMID: 33937458 PMCID: PMC8076614 DOI: 10.1016/j.artd.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/21/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intrathecal opioids have been used to reduce pain after total joint arthroplasty; however, the utility of these drugs is disputed. We examined the impact of eliminating intrathecal fentanyl on outcomes for patients undergoing direct anterior approach total hip arthroplasty (THA). METHODS Retrospective review of 376 THA patients from a single institution was conducted. Univariate analysis was used to compare intraoperative medication usage and postoperative outcomes for THA patients receiving intrathecal fentanyl compared with those who did not receive intrathecal fentanyl. RESULTS Recovery room pain scores were significantly lower for patients who received intrathecal fentanyl (intrathecal fentanyl 1.4 vs no 2.2, P = .001), but no difference in opioid consumption was observed (intrathecal fentanyl 9.3 milligram morphine equivalent vs no 10.5 milligram morphine equivalent, P = .200). Intraoperative use and dose of intravenous morphine, hydromorphone, and dexamethasone did not differ significantly between groups. There were no significant differences in length of stay between the groups (intrathecal fentanyl 1.1 days vs 1.1 days, P = .973), 90-day readmission, or recatherization rates between groups (readmission, intrathecal fentanyl 4.8% vs no 5.8%, P = .709; recatherization, intrathecal fentanyl 0% vs no 0.7%, P = 1.00). CONCLUSION The administration of intrathecal fentanyl does not have a significant effect on early postoperative narcotic consumption, length of stay, 90-day readmissions, or recatheterization after THA with neuraxial anesthesia. Intrathecal fentanyl does not appear to improve outcomes and should not be included as a standard element of THA rapid recovery protocols.
Collapse
Affiliation(s)
| | | | - Jacob Aja
- Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Paul King
- Anne Arundel Medical Center, Annapolis, MD, USA
| |
Collapse
|
|
38
|
Lei YT, Xie JW, Huang Q, Huang W, Pei FX. Benefits of early ambulation within 24 h after total knee arthroplasty: a multicenter retrospective cohort study in China. Mil Med Res 2021; 8:17. [PMID: 33673879 PMCID: PMC7934453 DOI: 10.1186/s40779-021-00310-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/25/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Postoperative care has been evolving since the concept of enhanced recovery after surgery (ERAS) was introduced in China. This study aimed to evaluate the effects of early ambulation within 24 h after unilateral total knee arthroplasty (TKA) on postoperative rehabilitation and costs in a Chinese population. METHODS This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24 h (Group A) and 3761 who began ambulating later than 24 h (Group B). The outcome measurements, such as length of stay (LOS), total hospitalization costs, dynamic pain level, knee flexion range of motion (ROM), results of the 12-Item Short Form Survey (SF-12), incidence of thromboembolic events and other complications, were recorded and compared. RESULTS The early ambulation group (Group A) had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group (Group B). There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B. In Group A, patients had significantly higher postoperative SF-12 scores than those in Group B. The incidence of deep venous thrombosis (DVT) and pulmonary infection was significantly lower in Group A than in Group B. The incidence of pulmonary embolism (PE) and other complications did not differ between the two groups. CONCLUSION Early ambulation within 24 h after TKA was associated with reduced LOS, improved knee function, lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.
Collapse
Affiliation(s)
- Yi-Ting Lei
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 China
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041 China
| | - Jin-Wei Xie
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041 China
| | - Qiang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041 China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 China
| | - Fu-Xing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041 China
| |
Collapse
|
|
39
|
Recent Updates of Diagnosis, Pathophysiology, and Treatment on Osteoarthritis of the Knee. Int J Mol Sci 2021; 22:ijms22052619. [PMID: 33807695 PMCID: PMC7961389 DOI: 10.3390/ijms22052619] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
Osteoarthritis (OA) is a degenerative and chronic joint disease characterized by clinical symptoms and distortion of joint tissues. It primarily damages joint cartilage, causing pain, swelling, and stiffness around the joint. It is the major cause of disability and pain. The prevalence of OA is expected to increase gradually with the aging population and increasing prevalence of obesity. Many potential therapeutic advances have been made in recent years due to the improved understanding of the underlying mechanisms, diagnosis, and management of OA. Embryonic stem cells and induced pluripotent stem cells differentiate into chondrocytes or mesenchymal stem cells (MSCs) and can be used as a source of injectable treatments in the OA joint cavity. MSCs are known to be the most studied cell therapy products in cell-based OA therapy owing to their ability to differentiate into chondrocytes and their immunomodulatory properties. They have the potential to improve cartilage recovery and ultimately restore healthy joints. However, despite currently available therapies and advances in research, unfulfilled medical needs persist for OA treatment. In this review, we focused on the contents of non-cellular and cellular therapies for OA, and briefly summarized the results of clinical trials for cell-based OA therapy to lay a solid application basis for clinical research.
Collapse
|
|
40
|
Albertz M, Whitlock P, Yang F, Ding L, Uchtman M, Mecoli M, Olbrecht V, Moore D, McCarthy J, Chidambaran V. Pragmatic comparative effectiveness study of multimodal fascia iliaca nerve block and continuous lumbar epidural-based protocols for periacetabular osteotomy. J Hip Preserv Surg 2021; 7:728-739. [PMID: 34377516 PMCID: PMC8349585 DOI: 10.1093/jhps/hnab010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/25/2022] Open
Abstract
Perioperative pain management protocols have a significant impact on early surgical outcomes and recovery. We hypothesized that multimodal protocol including fascia iliaca compartment nerve block (MM-FICNB) would decrease the length of hospital stay (LOS) by facilitating earlier mobilization, without compromising analgesia, compared to a traditional lumbar epidural-based protocol (EP). Demographics/comorbidities, surgical/block characteristics and perioperative pain/mobilization data were collected from a prospectively recruited MM-FICNB group (N = 16) and a retrospective EP cohort (N = 16) who underwent PAO using similar surgical techniques, physical therapy/discharge criteria. Association of MM-FICNB group with LOS (primary outcome), postoperative pain, postoperative opioid requirements in morphine equivalent rates (MER) (mcg/kg/h) and time to complete physical therapy were tested using multivariable and survival regression. Patient and surgical characteristics were similar between groups. Median time for FICNB performance was significantly less than epidural (6 versus 15 min; P < 0.001). LOS was significantly decreased in the MM-FICNB group (2.88 ± 0.72 days) compared to the EP group (4.38 ± 1.02 days); P < 0.001. MM-FICNB group had significantly lower MER on POD1 (P = 0.006) and POD2 (P < 0.001), with similar pain scores on all POD. MM-FICNB group was associated with decreased LOS and earlier mobilization (P < 0.001) by covariate-adjusted multivariate regression. Cox proportional hazard regression model showed MM-FICNB subjects had 63 (95% CI 7–571, P < 0.001) times the chance of completing physical therapy goals, compared to EP. Compared to EP, MM-FICNB protocol allowed earlier mobilization and decreased post-surgical hospitalization by 1.5 days, without compromising analgesia, with important implications for value-based healthcare and cost-effectiveness.
Collapse
Affiliation(s)
- Megan Albertz
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Patrick Whitlock
- Department of Orthopedics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Fang Yang
- Division of Biostatistics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Lili Ding
- Division of Biostatistics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Molly Uchtman
- Department of Orthopedics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Marc Mecoli
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Vanessa Olbrecht
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - David Moore
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - James McCarthy
- Department of Orthopedics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| |
Collapse
|
|
41
|
Chua H, Brady B, Farrugia M, Pavlovic N, Ogul S, Hackett D, Farag D, Wan A, Adie S, Gray L, Nazar M, Xuan W, Walker RM, Harris IA, Naylor JM. Implementing early mobilisation after knee or hip arthroplasty to reduce length of stay: a quality improvement study with embedded qualitative component. BMC Musculoskelet Disord 2020; 21:765. [PMID: 33218326 PMCID: PMC7678277 DOI: 10.1186/s12891-020-03780-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/09/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Models of care for managing total knee or hip arthroplasty (TKA, THA) incorporating early mobilisation are associated with shorter acute length-of-stay (LOS). Few studies have examined the effect of implementing early mobilisation in isolation, however. This study aimed to determine if an accelerated mobilisation protocol implemented in isolation is associated with a reduced LOS without undermining care. METHOD A Before-After (quasi-experimental) study was used. Standard practice pre-implementation of the new protocol was physiotherapist-led mobilisation once per day commencing on post-operative Day 1 (Before phase). The new protocol (After phase) aimed to mobilise patients four times by end of Day 2 including an attempt to commence on Day 0; physiotherapy weekend coverage was necessarily increased. Poisson regression modelling was used to determine associations between study period and LOS. Additional outcomes to 12 weeks post-surgery were monitored to identify unintended consequences of the new protocol. Time to first mobilisation (hours) and proportion mobilising Day 0 were monitored to assess protocol compliance. An embedded qualitative component captured staff perspectives of the new protocol. RESULTS Five hundred twenty consecutive patients (n = 278, Before; n = 242, After) were included. The new protocol was associated with no change in unadjusted LOS, a small reduction in adjusted LOS (8.1%, p = 0.046), a reduction in time to first mobilisation (28.5 (10.8) vs 22.6 (8.1) hrs, p < 0.001), and an increase in the proportion mobilising Day 0 (0 vs 7%, p < 0.001). Greater improvements were curtailed by an unexpected decrease in physiotherapy staffing (After phase). There were no significant changes to the rates of complications or readmissions, joint-specific pain and function scores or health-related quality of life to 12 weeks post-surgery. Qualitative findings of 11 multidisciplinary team members highlighted the importance of morning surgery, staffing, and well-defined roles. CONCLUSION Small reductions in LOS are possible utilising an early mobilisation protocol in isolation after TKA or THA although staff burden is increased likely undermining both sustainability and the magnitude of the change. Simultaneous incorporation of other changes within the pathway would likely secure larger reductions in LOS.
Collapse
Affiliation(s)
- Happy Chua
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia.
| | - Bernadette Brady
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Melissa Farrugia
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Natalie Pavlovic
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Shaniya Ogul
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Danella Hackett
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Dimyana Farag
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Anthony Wan
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Sam Adie
- St George and Sutherland Clinical School, St George Hospital, Short St, Kogarah, NSW, 2217, Australia
| | - Leeanne Gray
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Michelle Nazar
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Wei Xuan
- Ingham Institute Applied Medical Research, 2 Campbell St, Liverpool, NSW, 2170, Australia
| | - Richard M Walker
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, BC 1871, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute Applied Medical Research, 2 Campbell St, Liverpool, NSW, 2170, Australia.,South Western Sydney Clinical School UNSW Sydney, Locked bag 7103, Liverpool BC, NSW, Australia
| | - Justine M Naylor
- South West Clinical School UNSW, Locked bag 7103, Liverpool BC, NSW, Australia
| |
Collapse
|
|
42
|
Patient satisfaction and perception of success after total knee arthroplasty are more strongly associated with patient factors and complications than surgical or anaesthetic factors. Knee Surg Sports Traumatol Arthrosc 2020; 28:3156-3163. [PMID: 31907553 DOI: 10.1007/s00167-019-05804-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/12/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE A proportion of TKA recipients following TKA are dissatisfied with their outcome. Our hypothesis is that patient satisfaction with TKA and perception of success of surgery are associated with patient comorbidities and overall health status, surgical and anaesthetic techniques as well as processes of post-operative care after TKA. The aims were to (i) measure the incidence of patient unfavourable outcomes-defined as dissatisfaction with the surgery or lack of joint-specific global improvement-1 year after TKA, and to explore the differences between these two outcomes of interest; (ii) assess the relationship between the development of these unfavourable outcomes and patient-reported knee function and overall quality of life; (iii) explore the associations between pre- and peri-operative variables and the development of these unfavourable outcomes 1 year after TKA. METHODS This study includes analysis of data from a prospective cohort of 1017 TKA recipients. Pre-operative patient variables, surgical and acute-care data were collected. The Oxford knee score and the global perception of improvement were used to assess satisfaction and success 365 days post-surgery. RESULTS From 1017 patients (56% female), mean age 68 years and BMI 32, 68 pts (7%) were dissatisfied with the outcome of surgery, 141 pts (14%) believed surgery was unsuccessful 1 year after TKA. A negative outcome was noted in 151 (15%) patients for either satisfaction or success, and 58 (6%) of patients reported neither good satisfaction nor success after surgery. Dissatisfied patients reported worse mean OKS (26.4 [SD 8.03] vs 42.3 [SD 5.21], p < 0.001) and mean EQ VAS (64.9 [SD 19.49] vs 81.8 [SD 14.38], p < 0.001) than satisfied patients. Patients who reported unsuccessful surgery also showed significantly lower mean OKS (30.9 [SD 9.29] vs 42.9 [SD 4.39], p < 0.001) and mean EQ VAS (68.2 [SD 18.61] vs 82.7 [SD 13.77], p < 0.001). Univariate analysis of predictors of unfavourable outcome post-TKA showed that financial status, obstructive sleep apnoea (OSA), ASA class > 2 and not resurfacing the patella were factors associated with the development of dissatisfaction with TKA and with patient perceived unsuccessful results of TKA. Multivariable logistic regression of patient satisfaction and success of TKA showed that compensation cases (OR 26.91, p < 0.001 for dissatisfaction and OR 11.49, p = 0.001 for unsuccessful TKA), obstructive sleep apnoea (OR 2.18, p = 0.04 for dissatisfaction and OR 1.82, p = 0.04 for unsuccessful TKA), ASA grade > 2 (OR 1.83, p = 0.04 for dissatisfaction and OR 1.57, p = 0.03 for unsuccessful TKA)and the development of a complication after TKA (OR 3.4, p < 0.001 for dissatisfaction and OR 2.39, p < 0.001 for unsuccessful TKA) were associated with the development of a negative outcome in both groups. Patella preservation (OR 1.96, p = 0.03) was associated with dissatisfaction, whereas the use of cruciate retaining femoral prosthesis was associated with less successful results of TKA (OR 1.78, p = 0.009). CONCLUSIONS An unfavourable outcome occurs in approximately 7-15% of patients following TKA. The incidence varies with how an unfavourable result is defined and many factors are associated with this outcome though prosthetic design or patella resurfacing do not appear to be important.
Collapse
|
|
43
|
Vichainarong C, Kampitak W, Tanavalee A, Ngarmukos S, Songborassamee N. Analgesic efficacy of infiltration between the popliteal artery and capsule of the knee (iPACK) block added to local infiltration analgesia and continuous adductor canal block after total knee arthroplasty: a randomized clinical trial. Reg Anesth Pain Med 2020; 45:872-879. [DOI: 10.1136/rapm-2020-101396] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022]
Abstract
BackgroundA combination of motor-sparing analgesia with local infiltration analgesia (LIA) and continuous adductor canal block (CACB) may improve postoperative pain and functional recovery for total knee arthroplasty (TKA). We hypothesized that the addition of a novel technique for posterior knee block, known as the infiltration between the popliteal artery and capsule of the knee (iPACK) block, to LIA with CACB would reduce opioid requirements.MethodsIn this double-blinded randomized controlled trial, 72 patients were assigned to receive either LIA with CACB (LIA+CACB group) or iPACK block with LIA and CACB (iPACK+LIA+CACB group). The primary outcome was cumulative postoperative intravenous morphine consumption within 24 hours. The secondary outcomes included numerical rating scale pain scores, incidence of posterior knee pain, performance test results, patient satisfaction, length of stay, and adverse events.ResultsMorphine consumption within 24 hours postoperatively showed no significant intergroup difference (LIA+CACB; 1.31±1.85 mg vs iPACK+LIA+CACB; 0.61±1.25 mg, p=0.08). There were no clinically significant differences in the overall pain scores between the groups. The lower Timed Up and Go test scores on postoperative days 1 and 2, along with a shorter duration of hospitalization, were found in the iPACK+LIA+CACB group (p<0.05).ConclusionThe addition of an iPACK block to the LIA and CACB does not reduce the postoperative opioid consumption nor improve analgesia. However, it may improve immediate functional performance and reduce the length of hospitalization after TKA.Trial registration numberTCTR20180702001.
Collapse
|
|
44
|
Mazzei CJ, Yurek JW, Patel JN, Poletick EB, D'Achille RS, Wittig JC. Providing Patient Mobilization With a Mobility Technician Improves Staff Efficiency and Constrains Cost in Primary Total Hip Arthroplasty. J Arthroplasty 2020; 35:1973-1978. [PMID: 32389412 DOI: 10.1016/j.arth.2020.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mobility technicians (MTs) demonstrate value in constraining the cost of total joint replacement procedures. MTs are certified medical assistants with specialized ambulation/gait training who work under the direction of the nursing staff to meet patient mobilization demands in hospital wards. This study analyzed their impact on primary total hip arthroplasty (THA). METHODS Data were retrospectively reviewed from both the time before and the time after MTs were introduced to the hospital for demographic information (ie, age, gender, race, and payer) and clinical measures (ie, length of stay and discharge disposition). The control group was treated and mobilized according to standard physical therapy and nursing staff protocols. Study group subjects had access to the MTs at the direction of their registered nurse. Included subjects underwent a primary THA procedure for arthritic conditions or hip fractures, or for conversion from a previous hip surgery. Excluded were subjects who underwent procedures for revision, bilateral, or hip resurfacing procedures. RESULTS The study and control groups included 542 and 1297 subjects, respectively. They shared a median length of stay of 2 days (P = .121). More study group subjects were discharged home than were their control group counterparts (91.51%-87.43%, P = .012). Cost analysis revealed an annual savings of $119,794.50 in total first post-acute care (ie, the period spent at a patient's initial discharge disposition level) costs to the institution. Therefore, MTs would need to successfully treat only 5 patients annually to recoup a savings equivalent to their salary. CONCLUSION MTs support the recovery of THA patients in the hospital, in turn optimizing their discharge disposition. Institutions may experience a financial benefit in a bundled payment system, in which avoiding costly rehab facilities may result in savings over the episode.
Collapse
Affiliation(s)
| | - John W Yurek
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, NJ
| | - Jay N Patel
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| | - Eileen B Poletick
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| | | | - James C Wittig
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| |
Collapse
|
|
45
|
Ling SKK, Wu YM, Li C, Lui TH, Yung PSH. Randomised control trial on the optimal duration of non-weight-bearing walking after hallux valgus surgery. J Orthop Translat 2020; 23:61-66. [PMID: 32489861 PMCID: PMC7256050 DOI: 10.1016/j.jot.2020.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 10/25/2022] Open
Abstract
Introduction Hallux valgus surgery is one of the most commonly performed operations in Orthopaedics. Multiple surgical techniques have been described including arthrodesis, osteotomies and soft tissue procedures. The endoscopic-assisted distal soft tissue procedure is one of the minimally invasive surgical options with a good long-term outcome. The rehabilitation protocol for this soft tissue procedure consists of 6-weeks of non-weight bearing walking. This prolonged period of non-weight-bearing walking may ensure a good stabilization of the alignment but is difficult for the patient from a social-economical perspective. In addition, earlier mobilisation has other theoretical advantages including less atrophy and better range of motion. The objective of this trial is to investigate the effect of an earlier weight-bearing regime at 2-weeks post-surgery. Methods Randomised control trial of patients undergoing the endoscopic-assisted distal soft tissue procedure. Allocation and randomization of subjects were performed immediately after completion of surgery to avoid intra-operative biases. The control group underwent the usual protocol of 6-weeks of non-weight-bearing walking while the intervention group underwent 2-weeks of post-operative non-weight-bearing walking. Foot function was measured using the Foot and Ankle Outcome Score (FAOS) at the baseline, 12-week post-surgery and 26-weeks post-surgery. The hallux valgus angle, 1,2 inter-metatarsal angle and tibial sesamoid position were also measured during those time-points. Results A total of 51 participants completed the study, 29 in the control group and 22 in the early weight-bearing group. 1 patient form the early weight-bearing group was complicated with hallux varus requiring revision surgery. All the patients had significantly improved radiological angles and foot function in both the control and early weight-bearing group. At the 12-week time point, the radiological angles were the same for both groups but foot function was significantly better in the early weightbearing group. Discussion Early postoperative weight-bearing did not lead to pre-mature implant failures or increased recurrence rates. It actually resulted in fewer symptoms like stiffness, lessened pain, better performance in daily activities and a better quality of life. Conclusion Early weight-bearing walking at 2-week after distal soft tissue reconstruction of hallux valgus is not only safe, it may help accelerate the rehabilitation process and allow patients to return their usual life faster.The translational potential of this article: Being a clinical trial, our results are directly translatable to hallux valgus patients. The results of this study show that a shortened non-weight bearing duration after hallux valgus surgery improves foot function at 12 weeks while not affecting recurrence risks.
Collapse
Affiliation(s)
- Samuel K K Ling
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - Yuen-Man Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - Charles Li
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong
| | | |
Collapse
|
|
46
|
Martin J, Barker K. The Hierarchical Assessment of Balance and Mobility (HABAM): a useful tool to estimate length of hospital stay following hip and knee replacement. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The Hierarchical Assessment of Balance and Mobility is a measure of balance and mobility that can detect recovery of physical function, and can be used to identify patients at risk of delayed discharge. The aim of this study was to investigate the use of Hierarchical Assessment of Balance and Mobility scores as a predictor of length of hospital stay in patients following hip and knee replacement. Methods Hierarchical Assessment of Balance and Mobility scores were collected on 191 patients following primary total joint replacement. Regression and receiver operating characteristic curve analyses were conducted to assess the relationship between Hierarchical Assessment of Balance and Mobility and length of stay. Results Hierarchical Assessment of Balance and Mobility scores of <31 on the first post-operative day predicted longer than mean length of stay (4 days) with sensitivity and specificity of 79% and 83%. Receiver operating characteristic curve analyses showed that a Hierarchical Assessment of Balance and Mobility score of 50 was the optimal cut-off point for discharge. Conclusions Hierarchical Assessment of Balance and Mobility offers a practical way to quantify and objectively track patients' physical function, and can help identify patients at risk of an increased length of stay on post-operative day one.
Collapse
Affiliation(s)
- Jack Martin
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| |
Collapse
|
|
47
|
Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, Sánchez-Martín R, Logroño-Egea M, Catalá-Bauset JC, García-Orallo S, Bisbe E, Martín N, Suárez-de-la-Rica A, Cuéllar-Martínez AB, Gil-Trujillo S, Estupiñán-Jiménez JC, Villanova-Baraza M, Gil-Lapetra C, Pérez-Sánchez P, Rodríguez-García N, Ramiro-Ruiz A, Farré-Tebar C, Martínez-García A, Arauzo-Pérez P, García-Pérez C, Abad-Gurumeta A, Miñambres-Villar MA, Sánchez-Campos A, Jiménez-López I, Tena-Guerrero JM, Marín-Peña O, Sánchez-Merchante M, Vicente-Gutiérrez U, Cassinello-Ogea MC, Ferrando-Ortolá C, Berges-Gutiérrez H, Fernanz-Antón J, Gómez-Ríos MA, Bordonaba-Bosque D, Ramírez-Rodríguez JM, García-Erce JA, Aldecoa C. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA Surg 2020; 155:e196024. [PMID: 32049352 DOI: 10.1001/jamasurg.2019.6024] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. Objective To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design, Setting, and Participants This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Exposures Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. Main Outcomes and Measures The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. Results During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). Conclusions and Relevance An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.
Collapse
Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | - Ane Abad-Motos
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | - Yolanda Díez-Remesal
- Department of Anaesthesia and Critical Care, Ramón y Cajal University Hospital, Madrid, Spain
| | - Marta Aseguinolaza-Pagola
- Department of Anaesthesia, Donostia University Hospital/Donostia Unibertsitate Ospitalea, San Sebastián, Spain
| | - Lidia Padin-Barreiro
- Department of Anaesthesia, Complejo Hospitalario Universitario De Vigo-Eoxi Vigo, Vigo, Spain
| | - Rubén Sánchez-Martín
- Department of Anaesthesia, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Juan C Catalá-Bauset
- Department of Anaesthesia, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Silvia García-Orallo
- Department of Anaesthesia, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Elvira Bisbe
- Department of Anaesthesia, Hospitales del Parc de Salut Mar, Barcelona, Spain
| | - Nuria Martín
- Department of Anaesthesia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alejandro Suárez-de-la-Rica
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Critical Care, La Paz University Hospital, Madrid, Spain
| | - Ana B Cuéllar-Martínez
- Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Silvia Gil-Trujillo
- Department of Anaesthesia, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Cristina Gil-Lapetra
- Department of Anaesthesia, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | - Alvaro Ramiro-Ruiz
- Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carla Farré-Tebar
- Department of Anaesthesia, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | | | | | | | - Alfredo Abad-Gurumeta
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | | | | | | | | | - Oliver Marín-Peña
- Department of Orthopedia, Infanta Leonor University Hospital, Madrid, Spain
| | | | | | | | - Carlos Ferrando-Ortolá
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Jesús Fernanz-Antón
- Department of Anaesthesia, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - Manuel A Gómez-Ríos
- Department of Anaesthesia, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | | | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.,Department of Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
| | - José Antonio García-Erce
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Perioperative Medicine, Río Hortega University Hospital, Valladolid, Spain
| | | |
Collapse
|
|
48
|
Skraastad EJ, Borchgrevink PC, Nilsen TIL, Ræder J. Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study. Acta Anaesthesiol Scand 2020; 64:301-308. [PMID: 31608431 DOI: 10.1111/aas.13492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Postoperative pain, side-effects and time to mobilisation are indicators for the quality of postoperative recovery. The aim of this randomised controlled study was to investigate if efficacy safety score (ESS) combined with a wireless patient monitoring system would improve these clinical outcomes for patients at a general surgical ward. METHODS The trial included 195 patients randomised to a standard care group (SC-Group) or intervention group (INT-Group) receiving continuous wireless monitoring of vital signs combined with ESS during the first 24 postoperative hours. The primary outcome was time to mobilisation. Secondary outcomes were average pain, doses of postoperative opioids, unscheduled interventions, side-effects, patient satisfaction and length of hospital stay (LOS). RESULTS Mean time to postoperative mobilisation was 10.1 hours for patients in the INT-Group compared to 14.2 hours in the SC-Group; this corresponds to an adjusted hazard ratio of 1.54 (95% confidence interval 1.04-2.28). INT-Group patients received a higher dose of oral morphine equivalents; 26 mg vs 15 mg, P < .001; reported lower intensity of pain on a 0-10 scale; 2.1 vs 3.3, P < .001; and had higher patient satisfaction on a 5-point scale; 4.9 vs 4.3, P < .001. The LOS was similar between the groups; 71 hours in INT-Group vs 77 hours in SC-Group, P = .58. No serious side-effects were registered in INT-Group, whereas two were registered in SC-Group. CONCLUSIONS Introducing ESS as a decision tool combined with a wireless monitoring system resulted in less pain, increased satisfaction and more rapid mobilisation for patients in this study. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03438578.
Collapse
Affiliation(s)
- Erlend Johan Skraastad
- Clinic of Anaesthesia and Intensive care St. Olavs hospitalTrondheim University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| | - Petter Christian Borchgrevink
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
- Unit on Complex Symptom Disorders St. Olavs hospital, Trondheim University Hospital Trondheim Norway
| | - Tom Ivar L. Nilsen
- Clinic of Anaesthesia and Intensive care St. Olavs hospitalTrondheim University Hospital Trondheim Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
| | - Johan Ræder
- Department of Anaesthesia and Intensive Care Medicine Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine, Medical Faculty University of Oslo Oslo Norway
| |
Collapse
|
|
49
|
One-Stage Sequential Bilateral Total Knee Arthroplasty: An Effective Treatment for Advanced Bilateral Knee Osteoarthritis Providing High Patient Satisfaction. J Arthroplasty 2020; 35:401-406. [PMID: 31635904 DOI: 10.1016/j.arth.2019.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The mortality and risks of bilateral total knee arthroplasty (BTKA) have been reported to be far greater than in unilateral total knee arthroplasty (UTKA). This study aimed to determine whether this remains the case using contemporary anesthetic and surgical techniques for one-stage single anesthetic sequential BTKA. METHODS Two cohorts of 394 patients were created by propensity matching for gender, age, body mass index, American Society of Anesthesiologists grade, and Veterans Rand-12 health survey scores. Primary outcome was morbidity and mortality, with satisfaction measures using patient-reported outcome measures. RESULTS The mortality rate was low with one case after BTKA. Major complications were also low; however, a pulmonary embolism rate of 2% in BTKA patients was significantly higher than 0.3% after UTKA (P < .05), and associated with an American Society of Anesthesiologists grade ≥3. The rate of minor complications between the 2 cohorts was comparable (P = .95). Blood transfusions were uncommon and not significantly different between cohorts (2.5% vs 1.3%, P = .3). BTKA patients stayed in hospital a mean 1.3 days longer with greater rehabilitation requirements. At final follow-up, patient satisfaction was high with all patient-reported outcome measures significantly improved and comparable between cohorts. CONCLUSION BTKA is safe and effective in the majority of patients. Transfusion rates were far lower than historically reported and major complications were rare after both UTKA and BTKA. A significant increase in the rate of pulmonary embolism after BTKA was observed, especially in high risk patients. At minimum 1-year postoperatively, cohorts had the same significant clinical improvement and high level of satisfaction.
Collapse
|
|
50
|
Donovan GH, Gatziolis D, Douwes J. Relationship between exposure to the natural environment and recovery from hip or knee arthroplasty: a New Zealand retrospective cohort study. BMJ Open 2019; 9:e029522. [PMID: 31542746 PMCID: PMC6756456 DOI: 10.1136/bmjopen-2019-029522] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Determine whether patients who live in greener and more walkable neighbourhoods live longer, and take fewer opioids, following hip or knee arthroplasty. DESIGN Retrospective cohort study. SETTING Residential environment following surgery at one of 54 New Zealand hospitals. PARTICIPANTS All people who received a total hip or knee arthroplasty at a publicly-funded hospital in New Zealand in 2006 and 2007 (7449 hip arthroplasties and 6558 knee arthroplasties). PRIMARY AND SECONDARY OUTCOME MEASURE Time to all-cause mortality and number of postsurgical opioid prescriptions. RESULTS Patients who lived in greener neighbourhoods, as measured by the Normalised Difference Vegetation Index, lived longer following hip or knee arthroplasty (standardised OR: 0.95, 95% CI 0.92 to 0.99). However, when we estimated separate hip-arthroplasty-only and knee-arthroplasty-only models, greenness was only significantly associated with greater longevity following hip arthroplasty. Similarly, patients who lived in greener neighbourhoods took fewer opioids in the 12 months following hip or knee arthroplasty (standardised OR: 0.97, 95% CI 0.95 to 0.99), but in separate hip-arthroplasty-only and knee-arthroplasty-only models, greenness was only significantly associated with lower opioid use following hip arthroplasty. Walkability was not significantly associated with postsurgical opioid use or postsurgical longevity. All ORs were adjusted for sex, ethnicity, age, presurgical chronic health conditions, presurgical opioid use, social deprivation and length of hospital stay. CONCLUSIONS Consistent with the literature on enhanced-recovery programme, people who lived in greener neighbourhoods took fewer opioids, and lived longer, following hip arthroplasty. Improving access to the natural environment may therefore be an effective component of postsurgical recovery programme.
Collapse
Affiliation(s)
- Geoffrey H Donovan
- Goods, Services and Values Program, Pacific Northwest Research Station, USDA Forest Service, Portland, Oregon, USA
| | - Demetrios Gatziolis
- Goods, Services and Values Program, Pacific Northwest Research Station, USDA Forest Service, Portland, Oregon, USA
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| |
Collapse
|