Improved Health-Related Quality of Life after Knee Arthroplasty Following an Outpatient Surgery Pathway: an Observational Comparative Case Study

Abstract

Purpose: Enhanced recovery pathways after knee arthroplasty have been introduced worldwide with positive results. The present study investigated the improvements of health-related quality of life and functional outcome in patients operated for knee arthroplasty who followed an Outpatient Surgery (OS) or Enhanced Recovery (ER) pathway. Methods:We reviewed our institutional database of 361 consecutive patients undergoing knee arthroplasty (total and partial) who followed either the OS-pathway (n=94; 26.1%) or ER-pathway (n=267; 73.9%). Recorded outcomes included 4 different patient reported outcome measures (PROMs; EuroQol-5D (both index and VAS), Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index and the Pain-Numerical Rating Scale) obtained pre-and during the 3-and 12-months postoperative follow-up.Results: 93 patients (99%) in the OS-group were discharged on the day of surgery as scheduled, whereas in the ER-group 70% of the patients were discharged<3 days postoperatively. At 12-month follow-up, the EQ-5D (both index and VAS) and other PROMs improved significantly (p<0.000) within each pathway. There were no significant differences between both pathways. Conclusion:One year after knee arthroplasty, patients who were included in an Outpatient Surgery pathway had comparable quality of life and PROMs as patients operated in an Enhanced Recovery pathway. Level of evidence:Case control study, Level III.

Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty: A systematic review and meta-analysis

“…We included five RCTs[ 7 , 28 , 30 , 35 , 38 ], six prospective cohort studies[ 31 , 33 , 37 , 41 , 50 , 52 ], thirteen retrospective cohort studies[ 36 , 42 - 44 , 46 , 51 , 53 , 54 , 57 - 59 , 62 , 63 ], five observational cohort studies[ 27 , 34 , 45 , 47 , 60 ], four case control studies[ 3 , 48 , 49 , 56 ], four comparative studies with prospective[ 32 , 61 ] and retrospective designs for the standard CPs[ 39 , 55 ], and one each prospective pilot study[ 26 ], prospective follow-up study[ 29 ], and propensity score matched study[ 40 ]. Nine articles studied THA[ 26 , 29 , 38 , 41 , 50 , 52 , 54 , 60 , 63 ], nineteen studied TKA[ 3 , 7 , 30 - 33 , 36 , 37 , 39 , 42 , 44 , 48 , 49 , 51 , 55 , 58 , 59 , 61 , 62 ], six studied UKA[ 3 , 43 , 45 , 48 , 55 ,…”

“…Nine articles studied THA[ 26 , 29 , 38 , 41 , 50 , 52 , 54 , 60 , 63 ], nineteen studied TKA[ 3 , 7 , 30 - 33 , 36 , 37 , 39 , 42 , 44 , 48 , 49 , 51 , 55 , 58 , 59 , 61 , 62 ], six studied UKA[ 3 , 43 , 45 , 48 , 55 , 56 ], and eleven studied both hip and knee arthroplasty[ 27 , 28 , 34 , 35 , 40 , 43 , 46 , 47 , 53 , 56 , 57 ]. Of the included studies, which were published between 1999 and 2018, eighteen were conducted in the United States[ 26 , 30 , 31 , 36 , 38 , 40 , 42 - 46 , 51 , 53 - 55 , 59 , 60 , 63 ], five in the Netherlands[ 3 , 27 , 48 , 50 , 56 ], three each in the United Kingdom[ 34 , 37 , 41 ], Germany[ 7 , 32 , 33 ], and Canada[ 35 , 49 , 61 ], two in Spain[ …”

“…Of the included studies, which were published between 1999 and 2018, eighteen were conducted in the United States[ 26 , 30 , 31 , 36 , 38 , 40 , 42 - 46 , 51 , 53 - 55 , 59 , 60 , 63 ], five in the Netherlands[ 3 , 27 , 48 , 50 , 56 ], three each in the United Kingdom[ 34 , 37 , 41 ], Germany[ 7 , 32 , 33 ], and Canada[ 35 , 49 , 61 ], two in Spain[ 29 , 57 ], and one each in Australia[ 28 ], Malaysia[ 39 ], Italy[ 58 ], New Zealand[ 47 ], Denmark[ 52 ], and Finland[ 62 ]. The setting varied from a hospital[ 3 , 26 , 27 , 34 , 41 , 47 , 48 , 50 , 56 , 57 , 60 - 62 ] to a medical[ 36 , 40 , 42 , 43 - 46 , 53 , 54 , 59 ] or orthopedic center[ 7 , 35 , 37 , 38 , 51 , 52 , 55 , 58 , 63 ], a tertiary[ 28 , 30 , 49 ] or a university hospital[ 29 , …”

“…The Harris Hip Score, Range of Motion, and scores from the American Knee Society were mostly reported. Four articles studied THA[ 38 , 41 , 50 , 52 ], six studied TKA[ 7 , 31 , 33 , 36 , 56 , 61 ], and three each studied UKA[ 3 , 48 , 56 ] and both THA and TKA[ 27 , 35 , 47 ] regarding the PROMs, using similar measurement types. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, EuroQual, Oxford Knee Score, and pain scales were mostly used as PROMs.…”

“…The follow-up time differed from the first postoperative day up to 24 mo postoperatively. In view of the clinician-derived outcomes and PROMs, the results in the ERP were similar or improved for THA[ 41 , 50 , 52 ], TKA[ 31 - 33 , 58 , 61 ], UKA[ 48 ], and the combined group THA and TKA[ 27 ], or were statistically significant better than those in the regular pathways for TKA[ 7 , 36 , 56 ], UKA[ 3 ], and the combined group THA and TKA[ 35 , 47 ]. Moderate quality for functional recovery and PROMs is presented in GRADE (Table 3 ).…”