Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial

Abstract

Background: With the substantially growing trend of the aging populations in China and the rest of the world, the number of total hip and total knee arthroplasty (THA and TKA) cases are increasing dramatically. It’s important to develop practical strategies to improve the quality of healthcare and better outcome for patients undergoing THA and TKA. Enhanced recovery after surgery (ERAS) pathways have been reported to promote earlier recovery and be beneficial for patients. We propose the hypothesis that ERAS pathway could provide better recovery for patients undergoing primary THA or TKA. Methods/Design: This trial is a prospective, open-labelled, randomized controlled trial that will evaluate the length of stay (LOS) in hospital, and other end points of interest for the patients undergoing ERAS pathway as compared to current non-ERAS clinical practice. A total of 640 patients undergoing primary THA or TKA will be randomly allocated to either ERAS pathway (ERAS group) or conventional care according to individual participating center (non-ERAS group). The primary outcome is the total LOS in hospital, the secondary outcomes include Postoperative LOS, all-cause mortality by 30 days after operation, in-hospital complications, early mobilization, postoperative pain control, total in-hospital cost, and readmission rate by 30 days after discharge from the hospital. Discussion: This trial is designed to evaluate the superiority of the ERAS pathway to conventional non-ERAS clinical practice in reducing the LOS without increasing the incidence of complications or medical cost. The results will provide new insight into the clinical applications of ERAS pathway for total hip and total knee arthroplasty. Trial registration: The National Institutes of Health Clinical Trials Registry, NCT03517098. Registered 04, May, 2018. https://register.clinicaltrials.gov/prs/app/action/ SelectProtocol?sid=S0007YV7&selectaction=Edit&uid=U0001B4E&ts=2&cx=97eyz9

A new cocktail formula with diprospan of local infiltration analgesia in primary total hip arthroplasty: A prospective, randomized, controlled, observer‐blinded study

“…The inclusion criteria were as follows: (i) patients aged 18–80 years; (ii) patients with American Society of Anesthesiologists Physical Status I–III; and (iii) patients undergoing primary unilateral THA. The perioperative management of surgery was built on a widely recognized multimodal enhanced recovery strategy, including venous thromboembolism (VTE) prevention, pain control, 12,13 blood loss management, 14 and rehabilitation training 15 …”

“…The inclusion criteria were as follows: (i) patients aged 18-80 years; (ii) patients with American Society of Anesthesiologists Physical Status I-III; and (iii) patients undergoing primary unilateral THA. The perioperative management of surgery was built on a widely recognized multimodal enhanced recovery strategy, including venous thromboembolism (VTE) prevention, pain control, 12,13 blood loss management, 14 and rehabilitation training. 15 The exclusion criteria were as follows: (i) patients with diagnoses other than osteoarthritis or osteonecrosis of the femoral head; (ii) patients with a known allergy to the drugs used in this study; (iii) patients with uses of spinal anesthesia; (iv) patients unable to tolerate general anesthesia or the surgery; (v) patients with mental illnesses or an inability to complete the visual analogue scale (VAS); (vi) diabetes patients; (vii) patients with operative side hip joints who had previous surgery history or limb shortening more than 4 cm than the normal side; (viii) patients who could not cooperate with the completion researcher for various reasons; and (ix) for facilitating the recording and statistics of the pain score, patients in which the surgeries were completed after 5 p.m.…”

The Comparison between Mini‐Subvastus Approach and Medial Parapatellar Approach in TKA: A Prospective Double‐Blinded Randomized Controlled Trial

“…With the popularization of the concept of enhanced recovery after surgery (ERAS), rapid rehabilitation after TKA has become one of the focuses that people pay more and more attention to. ERAS can shorten hospitalization duration, shorten rehabilitation time, improve economic benefits and so on 2 . Surgical approach is also one of the factors affecting ERAS after TKA.…”

Effect of discharge teaching quality on readiness for hospital discharge in total knee arthroplasty patients: the role of depression and self-efficacy for rehabilitation

“…With the increase of the aging and obese population, the number of Total Knee Arthroplasty (TKA) has been increasing year by year, while bringing a heavy healthcare economic burden [1,2]. To solve this problem, the United States has adopted TKA as day surgery [3], and China is actively taking measures such as rapid recovery surgery to shorten the length of stay of patients [4,5]. In this scenario, Chinese patients after TKA have a shorter time to prepare for discharge, thus their readiness for discharge requires our attention.…”