Enhanced recovery protocol and hidden blood loss in patients undergoing total knee arthroplasty

Dhawan, Rohit; Rajgor, Harshadkumar Dhirajlal; Yarlagadda, Rathan; John, John; Graham, N.

doi:10.4103/ortho.ijortho_46_16

Cited by 9 publications

(7 citation statements)

References 21 publications

(24 reference statements)

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“…19 Dhawan et al in their consecutive study found female predominance in both group but average age 72 for males and 69 for females in group 1(NON ERP) and in group 2 (ERP) average age for male and female was 71 years, which is different from our study. 20 Hertog et al in their randomized prospective study had predominace of female in both groups and average age of 68.25 in control group and 66.58 in fast track group. 21 The minimum length of stay of our study was 4 days and maximum length of stay was 9 days for group I with mean length of stay 5.69.…”

Section: Discussionmentioning

confidence: 93%

Comparison of functional outcome at three month follow up using knee society score in patients undergoing total knee replacement by ERP and non ERP

2018

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Background: Comparison of functional outcome at three month follow up using knee society score in patients undergoing total knee replacement by ERP and Non ERP.Methods: In this prospective study of 29 patients in group (II) who underwent total knee arthroplasty using Enhanced recovery protocol and compared with 29 patients in control group (I) whose data was obtained from hospital database in Lilavati Hospital & Research Centre, Mumbai.Results: The majority of the patients were from the age group of 61-70 years in both group I & II. There was female predominance in our study. The mean length of stay for group I was 5.69 days and for group II 3.28 days. The average knee clinical score in group I was pre op 33.52 which improved to an average post-op score of 82.62 at 3 months and for group II it improved from 34.21 to 84.66 at 3 months. The average pre-op knee functional score was 43.28 which improved to an average post-op score of 85.00 at 3 months in study group II. The average pre-op Knee Society Score was 77.14 which improved to an average post-op score of 169.66 at 3 months follow up for group II.Conclusions: The results of the present study showed that patients who underwent TKA using ERP protocol has reduced length of stay in hospital, significantly improved KSS proving TKA as an effective procedure that is associated with substantial functional improvement.

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Section: Discussionmentioning

confidence: 93%

Comparison of functional outcome at three month follow up using knee society score in patients undergoing total knee replacement by ERP and non ERP

2018

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“…This study is in contrast with the finding that a solution of bupivacaine with epinephrine similar to the one used in the current study reduce blood loss in total knee arthroplasty [ 18 ]. Generally, solutions containing adrenaline were found to reduce perioperative blood loss in total knee arthroplasty [ 10 , 19 , 20 ], with some exceptions [ 11 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Local infiltration analgesia with bupivacaine and adrenaline does not reduce perioperative blood loss in total hip arthroplasty

et al. 2021

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This study evaluates the effect of local infiltration analgesia with bupivacaine and adrenaline on perioperative blood loss in total hip arthroplasty. Patients who had primary total hip arthroplasty were retrospectively assigned to two groups. One group had 100 ml of bupivacaine/adrenaline solution injected into periarticular soft tissues at the end of the procedure. There were 55 patients in the infiltrated hip group and 44 patients in the not infiltrated group. Patients’ hemoglobin level (Hb), hematocrit (HTC), red blood count (RBC), platelet count (PLT) and International Normalized Ratio (INR) as well as the need for blood transfusions were compared statistically between groups preoperatively and postoperatively. There were no significant differences between Hb, HTC or RBC levels as well as the rate and amount of blood transfusions on the 1st, 4th postoperative days or at patients’ discharge between infiltrated and not infiltrated groups. This study does not support the hypothesis that the use of local infiltration analgesia with adrenaline may reduce perioperative blood loss in total hip arthroplasty.

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“…The study and participant characteristics of the 49 included studies as well as a description of the shortstay and usual care groups are shown in Table 1. They were published from 2005 to 2023 and originated from sixteen countries: thirteen from the United Kingdom (UK) [25][26][27][28][29][30][31][32][33][34][35][36][37], seven from the United States (US) [38][39][40][41][42][43][44], four from China [45][46][47][48], three studies each from France [49][50][51], Italy [52][53][54] and the Netherlands [55][56][57], two studies each from Canada [58,59], Denmark [60,61], New Zealand [62,63], and Sweden [64,65], and one study each from Australia [66], Brazil [67], Germany [68], India [69], Ireland …”

Section: Trial Design Setting and Characteristicsmentioning

confidence: 99%

A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection

Berkovic,

Vallance,

Harris

et al. 2023

BMC Med

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Background Short-stay joint replacement programmes are used in many countries but there has been little scrutiny of safety outcomes in the literature. We aimed to systematically review evidence on the safety of short-stay programmes versus usual care for total hip (THR) and knee replacement (KR), and optimal patient selection. Methods A systematic review and meta-analysis. Randomised controlled trials (RCTs) and quasi-experimental studies including a comparator group reporting on 14 safety outcomes (hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, neurovascular injury, other complications, periprosthetic fractures, postoperative falls, venous thromboembolism, wound complications, dislocation, stiffness) within 90 days postoperatively in adults ≥ 18 years undergoing primary THR or KR were included. Secondary outcomes were associations between patient demographics or clinical characteristics and patient outcomes. Four databases were searched between January 2000 and May 2023. Risk of bias and certainty of the evidence were assessed. Results Forty-nine studies were included. Based upon low certainty RCT evidence, short-stay programmes may not reduce readmission (OR 0.95, 95% CI 0.12–7.43); blood transfusion requirements (OR 1.75, 95% CI 0.27–11.36); neurovascular injury (OR 0.31, 95% CI 0.01–7.92); other complications (OR 0.63, 95% CI 0.26–1.53); or stiffness (OR 1.04, 95% CI 0.53–2.05). For registry studies, there was no difference in readmission, infection, neurovascular injury, other complications, venous thromboembolism, or wound complications but there were reductions in mortality and dislocations. For interrupted time series studies, there was no difference in readmissions, reoperations, blood loss volume, emergency department visits, infection, mortality, or neurovascular injury; reduced odds of blood transfusion and other complications, but increased odds of periprosthetic fracture. For other observational studies, there was an increased risk of readmission, no difference in blood loss volume, infection, other complications, or wound complications, reduced odds of requiring blood transfusion, reduced mortality, and reduced venous thromboembolism. One study examined an outcome relevant to optimal patient selection; it reported comparable blood loss for short-stay male and female participants (p = 0.814). Conclusions There is low certainty evidence that short-stay programmes for THR and KR may have non-inferior 90-day safety outcomes. There is little evidence on factors informing optimal patient selection; this remains an important knowledge gap.

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Enhanced recovery protocol and hidden blood loss in patients undergoing total knee arthroplasty

Cited by 9 publications

References 21 publications

Comparison of functional outcome at three month follow up using knee society score in patients undergoing total knee replacement by ERP and non ERP

Comparison of functional outcome at three month follow up using knee society score in patients undergoing total knee replacement by ERP and non ERP

Local infiltration analgesia with bupivacaine and adrenaline does not reduce perioperative blood loss in total hip arthroplasty

A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection

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