Enhanced recovery after surgery (ERAS) protocol in geriatric patients underwent unicompartmental knee arthroplasty: A retrospective cohort study

Abstract

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients’ perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group ( P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients ( P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.

Enhanced wound recovery after surgery care in patients with total knee arthroplasty: A meta‐analysis

“…Multiple studies have reported improved and rapid recovery through ERAS care 39–41 . Similarly, this analysis of nine studies consistently showed the implementation of ERAS care in the intervention groups.…”

“…19,37,38 Multiple studies have reported improved and rapid recovery through ERAS care. [39][40][41] Similarly, this analysis of nine studies consistently showed the implementation of ERAS care in the intervention groups. Six studies demonstrated decreased postoperative pain after TKA with ERAS protocols with significant variability.…”

Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: current concepts and future trends

“…United Kingdom, United States) PROMs are standardly recorded for patients undergoing elective hip and knee replacement procedures [4,5]. The use of national joint registries have certainly helped researchers and clinicians in carrying out relevant research on this topic [6].…”

“…It has been well reported that the demographic changes in the last few decades (significant and progressive age of the populations) make us predict that total primary hip replacements (THR) and total knee replacements (TKR) will keep increasing in numbers. Patients do not just evaluate results strictly related to the surgical procedures but their dissatisfaction could be related to chronic pain or limitation of function postoperatively [5,6]. Therefore these two aspects must be particularly looked after when performing such type of surgery and a multidisciplinary approach and interventions seem to be the perfect strategy in order to obtain the best possible objective and subjective outcomes [1,5,6].…”

“…Patients do not just evaluate results strictly related to the surgical procedures but their dissatisfaction could be related to chronic pain or limitation of function postoperatively [5,6]. Therefore these two aspects must be particularly looked after when performing such type of surgery and a multidisciplinary approach and interventions seem to be the perfect strategy in order to obtain the best possible objective and subjective outcomes [1,5,6].…”