Enhanced recovery programmes for lower limb arthroplasty in the UK

Abstract

Introduction Enhanced recovery programmes (ERPs) reduce patient morbidity and mortality, and provide significant cost savings by reducing length of stay. Currently, no uniform ERP guidelines exist for lower limb arthroplasty in the UK. The aim of this study was to identify variations in ERPs and determine adherence to local policy. Methods Hospitals offering elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) (23 and 22 centres respectively) contributed details of their ERPs, and performed an audit (15 patients per centre) to assess compliance. Results Contrasting content and detail of ERPs was noted across centres. Adherence to ERPs varied significantly (40-100% for TKA, 17-94% for THA). Analysis identified perioperative use of dexamethasone, tranexamic acid and early mobilisation for TKA, and procedures performed in teaching hospitals for THA as being associated with a reduced length of stay. Conclusions This study highlights variation in practice and poor compliance with local ERPs. Given the proven benefits of ERPs, evidence-based guidelines in the context of local skillsets should be established to optimise the patient care pathway.

Enhanced recovery programmes in knee arthroplasty: current concepts

“…However, there exists a lack of consensus in ERPs in lower limb arthroplasty 30. There is no agreed definition of what constitutes an ERP in KA or the specific interventions it should contain.…”

“…For example, an audit of UK centres demonstrated inclusion in 30% of ERPs 30. However, it is unclear if such interventions are of significant benefit 31 32…”

“…The use of gabapentinoids in ERPs for KA is common in the UK, with one audit demonstrating inclusion in 48% of centres 30. However, the use of gabapentinoids following KA is controversial.…”

Enhanced recovery following hip and knee arthroplasty: a systematic review of cost-effectiveness evidence

“…Recognising that factors other than surgical technique affect patient outcomes, Kehlet7 considered how to optimise the preoperative, intraoperative and postoperative phases of patient care. These principles have been further developed specifically within the context of hip and knee arthroplasty 8–15. Common components of an enhanced recovery pathway for hip and knee arthroplasty are listed in box 1.…”

Study of Peri-Articular Anaesthetic for Replacement of the Knee (SPAARK): study protocol for a patient-blinded, randomised controlled superiority trial of liposomal bupivacaine

“…However, up to 50% of patients experience significant side effects, such as nausea, vomiting and drowsiness [4]. Opioid-sparing techniques have been associated with enhanced patient satisfaction post-surgery [5]. There is increasing evidence about their longer term benefits, with studies reporting a lowered incidence of chronic post-surgical pain, though the full effect on long-term patient-reported outcome measures is unknown [6–8].…”