Enhanced recovery principles applied to revision hip and knee arthroplasty leads to better patient outcomes

Calvert, Nicholas; Salmon, M; Harper, Matthew; Swann, Alex; Tan, Roger C. E.; Blades, Kevin; Yates, Piers

doi:10.1016/j.jor.2020.11.004

Cited by 6 publications

(6 citation statements)

References 25 publications

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“…The mean LOS of 3.7 days in our study (the whole study period) was lower than 5 days reported from Joseph et al [5], but higher compared to 1-2 days achieved in the studies by Costales et al and Husted et al [4,17]. A longer LOS is expected when reporting data from a much larger consecutive multicenter cohort.…”

Section: Discussioncontrasting

confidence: 67%

“…Previous data on fast-track revision knee arthroplasty is limited. To our knowledge, only 4 specific studies on this subject exist and they all report on smaller single-center cohorts (n = 30, 40, 67 and 142) [4,5,17,18]. Hence, the present study is the first multicenter study specifically reporting prospectively collected data on a consecutive cohort of revision knee arthroplasties performed in a well-established fast-track setting.…”

Section: Discussionmentioning

confidence: 99%

“…The primary objective was to investigate LOS, risk of complications within 90 days postoperatively by analyzing causes of prolonged LOS (>5 days) and readmissions. A LOS > 5 days was considered prolonged based on median LOS of 5 days found by Joseph et al in the largest cohort of fast-track aseptic revision knee arthroplasties reported on so far [5]. We obtained information on LOS (number of postoperative overnight stays, including transferals to other departments and hospitals) and readmissions within 90 days postoperatively (requiring 1 overnight stay and being potentially related to index procedure).…”

Section: Discussionmentioning

confidence: 99%

“…A recent single-center case-control study on 40 aseptic full-component revision TKA's versus 40 primary TKA's [4], showed the feasibility of a fast-track approach in revision TKA with short LOS (1.4 days), low risk of readmissions and similar early functional outcome compared to primary TKA [4]. Another recent study on fast fast-track revision knee arthroplasty reported on 142 mixed types of septic/aseptic knee revision procedures with LOS of 5 days after the aseptic procedures [5].…”

Section: Introductionmentioning

confidence: 99%

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Fast-track revision knee arthroplasty.

et al. 2022

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Background: Limited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of LOS > 5 days and readmission 90 days after revision knee arthroplasty in centers with a wellestablished fast-track protocol in both primary and revision surgery. Methods: An observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Knee Arthroplasty Register. We included elective aseptic major component revision knee arthroplasties consecutively from 6 dedicated fast-track centers from 2010 to 2018. Results: 1439 revision knee arthroplasties were analyzed, including 900 total revisions, 171 large partial revisions (revision of either femoral or tibia component) and 368 revisions of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). Mean age was 65 years (SD 10.9) and 66% were females. Mean LOS was 3.7 days (SD 3.9) in the study period, but decreased to 2.4 days (SD 1.3) in 2018. Risk factors for LOS > 5 days was 1 previous revision, use of walking aid, BMI > 35, ages < 50, 70-79 and 80 years, whereas revision of UKA to TKA and large partial revision were negatively associated. The 90-day readmission and mortality risk was 9.1% and 0.5%. Cardiac disease and use of walking aid were associated with increased risk of readmission 90 days. Conclusion: Elective aseptic major component revision knee arthroplasty using similar fast-track protocols as in primary TKA is safe with short and decreasing LOS.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fast-track revision knee arthroplasty.

et al. 2022

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“…Enhanced recovery pathways have already been implemented for revision surgery and for patients undergoing other complex surgical procedures. 36,37 Further robust research is required to demonstrate the most effective pathways for these areas.…”

Section: Eras: the Futurementioning

confidence: 99%