Enhanced Recovery After Primary Total Hip and Knee Arthroplasty

Morrell, Aidan T.; Layon, Daniel R.; Scott, Michael J.; Kates, Stephen L.; Golladay, Gregory J.; Patel, Nirav K.

doi:10.2106/jbjs.20.02169

Cited by 79 publications

(63 citation statements)

References 57 publications

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“…Patients in both groups received the same treatment, which included an intravenous injection and topical infusion of tranexamic acid [ 12 ]. Postoperatively, both groups adopted the clinical pathway of Enhanced Recovery After Surgery (ERAS) [ 13 ]. Anti-infectives, analgesics and anticoagulants were administered to patients in both groups.…”

Section: Methodsmentioning

confidence: 99%

Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients

et al. 2022

BMC Musculoskelet Disord

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Background The purpose of this study was to compare the serum inflammatory indicators and radiographic results of conventional manual total knee arthroplasty (CM-TKA) with those of MAKO-robotic assisted total knee arthroplasty (MA-TKA). Methods We retrospectively analysed 65 patients with knee osteoarthritis who underwent unilateral TKA from December 2020 to November 2021 in our department, which included 34 patients who underwent MA-TKA and 31 patients who underwent CM-TKA. The tourniquet time and estimated blood loss (EBL) were compared between the two groups. Knee function was evaluated using range of motion (ROM), functional score and pain score. Leukocytes, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), creatine kinase (CK), and neutrophil-to-lymphocyte ratio (NLR) were recorded at 3 time points (preoperative, and on the first and third postoperative days). The hip-knee-ankle angle (HKA) and the femoral and tibial component angles in the coronal and sagittal planes were used for postoperative radiographic evaluation. Results The postoperative MA-TKA group had less EBL (496.9 ± 257.8 vs. 773.0 ± 301.3 ml, p < 0.001). There was no significant difference in knee function scores at 6 weeks postoperatively (p > 0.05). IL-6 levels were significantly lower in the MA-TKA group on the 1st postoperative day (11.4 (5.2, 21.0) vs. 24.6 (86.3, 170.8), p = 0.031). This difference in inflammatory indices became more pronounced at 72 hours after the operation because CRP, ESR, IL-6, and CK values were significantly lower in the MA-TKA group on the 3rd postoperative day (72 h) (p < 0.05). Postoperative radiographic examinations performed 2 days after the MA-TKA group suggested that only 2 cases of HKA had outlier values, which was remarkably better than the 12 cases found in the CM-TKA group (5.9% vs. 38.7%, p < 0.001). The frontal femoral component was significantly closer to the expected value of 90° in the MA-TKA group (90.9 (90.5, 92.3) vs. 92.4 (91.3, 93.7), p = 0.031). The remaining imaging evaluation parameters were not significantly different between the two groups (p > 0.05). Conclusions In Chinese patients with OA, there was a milder systemic inflammatory response in the early postoperative period after MA-TKA compared to that of CM-TKA, as well as better radiographic outcomes. However, the tourniquet time was prolonged, and no advantages were observed in terms of functional score or pain score in the short-term follow-up.

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Section: Methodsmentioning

confidence: 99%

Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients

et al. 2022

BMC Musculoskelet Disord

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“… 4 5 A 2016 systematic review and meta-analysis of ER in total hip arthroplasty (THA) and total knee arthroplasty (TKA) showed significantly reduced LOS without significantly impacting 30-day readmission rates or complication rates. 6 A more recent systematic review and narrative synthesis in 2021 7 of THA and TKA also found that adherence to ER protocols consistently reduced LOS. Moderate confidence in the results of these reviews is suggested using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews-2).…”

Section: Introductionmentioning

confidence: 99%

Introduction of an enhanced recovery programme for total shoulder arthroplasty: report of a novel pathway

et al. 2021

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BackgroundEnhanced recovery (ER) programmes are well established in hip and knee arthroplasty, but are not yet commonplace for total shoulder arthroplasty (TSA). This study analyses the effect of implementing an ER programme with TSA, on length of stay (LOS), functional outcome and patient satisfaction.Local problemNo established programme applying ER to the specifics of upper-limb arthroplasty existed at our unit.MethodsA three-cycle plan–do–study–act quality improvement methodology was applied, involving development of our multifactorial programme, a pilot phase and wider roll-out. A consecutive series of patients who underwent TSA and were enrolled in an ER programme were compared with a matched control group of consecutive patients who underwent TSA in the year before the programme started. For all patients, LOS as well as mean Oxford Shoulder Score (OSS) and Constant Score (CS) were quantified and patient satisfaction assessed.InterventionsA dedicated multidisciplinary team led preoperative class involving patient education, advice and occupational therapy assessment. A standardised perioperative anaesthetic regime based on regional anaesthetic techniques with preoperative analgesic and nutritional loading was introduced. Postoperative rehabilitation was also standardised with slings for comfort only and early safe-zone mobilisation. New patient information was developed.Results71 patients were included in matched cohorts. Mean LOS was reduced from 2.4 nights to 1.9 nights. The single night stay rate improved from 40% to 49%. Across the ER cohort, 15 less nights were required to complete same volume of surgeries as in the non-ER cohort.Parity in OSS and CS measured at 3 and 12 months after surgery were observed in both cohorts.Satisfaction was already high before ER but scores stayed the same or improved across all areas surveyed.Absolute complication rates of 9.9% in the non-ER group and 7% in the ER group were recorded.ConclusionOur ER programme benefited patients and the Trust by reducing time in hospital and improving patient satisfaction without an adverse effect on complication rate.

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“…10-14 Thus, some studies have investigated pre-operative interventions that aim to optimise THR/TKR outcomes via targeting known modifiable risk factors. 15-17…”

Section: Introductionmentioning

confidence: 99%

“…29 30 A recent systematic review has shown that ERAS protocols significantly reduce the length of hospital stay after THR and TKR, and treatment costs, although the effect on mortality rate remains unclear. 15 However, pre-operative optimisation was not embedded in all included studies and the intervention details (i.e., type, duration, frequency of interventions) were not clearly revealed. Similarly, a recent consensus statement for perioperative care in THR and TKR provided recommendations for pre-operative optimisation but the details of the interventions were absent, 31 and some recommendations (i.e., cessation of alcohol consumption and smoking) were not based on data from fully implemented ERAS for THR/TKR.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13][14] Thus, some studies have investigated pre-operative interventions that aim to optimise THR/TKR outcomes via targeting known modifiable risk factors. [15][16][17] The concept of pre-operative multimodal/multidisciplinary optimisation is not new, and the scope has expanded to incorporate principles of shared decision making. [18][19][20][21][22][23] Although relatively sparse compared with other surgical specialities, optimisation programs for THR and TKR, such as pre-operative rehabilitation (prehabilitation), fast-track or enhanced recovery after surgery (ERAS) protocols have been developed and tested.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative optimisation in fast-track and enhanced recovery after surgery (ERAS) programs for total hip and knee joint replacement: a systematic review protocol

Chang

Naylor

Liu

et al. 2021

Preprint

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Introduction: Emerging evidence suggests that fast-track and enhanced recovery after surgery (ERAS) targeting modifiable risk factors reduce complications after total hip (THR) and knee replacement (TKR). However, what constitutes an effective preoperative optimisation protocol for THR and TKR remains unclear. The aims are to: (1) describe pre-operative optimisation protocols for THR and TKR; (2) evaluate the effects of pre-operative optimisation protocols for THR and TKR on morbidity, and patient-reported outcomes. Methods and analysis: Systematic review and meta-analysis. Electronic databases will be searched using pre-determined search terms to identify relevant studies and evaluate the study eligibility and risks of bias. Two independent reviewers will select the eligible studies and any disagreement will be resolved through a third reviewer. We will include studies investigated pre-operative optimisation protocols administered prior to participants receiving primary THR or TKR to improve post-operative outcomes. Primary outcomes are hospital readmission, complications and patient-reported pain and function. Risk of bias will be assessed using the Cochrane RoB 1 tool and strength of evidence will be examined using the GRADE approach. Pre-operative optimisation protocols will be summarised qualitatively. Meta-analyses on the effects of included protocols will be conducted if appropriate. Ethics and dissemination: This systematic review does not require ethics approval. The findings will be disseminated in a peer-reviewed journal and presented at relevant conferences. Registration: This protocol has been submitted to the International Prospective Register of Systematic Reviews on 30 August 2021.

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Enhanced Recovery After Primary Total Hip and Knee Arthroplasty

Cited by 79 publications

References 57 publications

Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients

Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients

Introduction of an enhanced recovery programme for total shoulder arthroplasty: report of a novel pathway

Preoperative optimisation in fast-track and enhanced recovery after surgery (ERAS) programs for total hip and knee joint replacement: a systematic review protocol

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