Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017

Xie

Evidence-Based Complementary and Alternative Medicine

et al. 2021

Objective. To observe the effect of Shou Hui Tong Bian capsule (polygonum multiflorum and aloe-based herbal capsule for cathartic effect) in rapid rehabilitation of joint surgery. Methods. A total of 98 patients undergoing perioperative joint surgery in our hospital from July 2019 to March 2020 were included in the study. According to the situation of arthroscopy and joint replacement therapy, the patients were randomly divided into a control group and an observation group, with 49 cases in each group. The control group was treated with conventional therapy. On the basis of the control group, the patients in the observation group were orally administrated with Shou Hui Tong Bian capsule, 2 capsules/time, 3 times/day. Both groups received continuous treatment for 14 days. The clinical effects, awakening time, postoperative exhaust time, and the number of patients with different degrees of abdominal distension in the four groups before and after treatment were observed and compared. Results. After treatment, the total effective rate of arthroscopy in the control group was 66.7%, which was significantly lower than 83.3% in the observation group ( P < 0.05 ). The total effective rate of joint replacement in the control group was 64.0%, which was significantly lower than 84.0% in the observation group ( P < 0.05 ). After arthroscopic treatment and joint replacement treatment, the recovery time and postoperative exhaust time of borborygmus in the observation group were significantly lower than those in the control group (both P < 0.05 ). After the treatment, the number of patients with different degrees of abdominal distension in the arthroscopic and joint replacement treatment group and the control group was significantly improved ( P < 0.05 ), and the observation group was significantly better than the control group ( P < 0.05 ). Conclusion. The curative effect of Shou Hui Tong Bian capsule on patients undergoing arthroscopic joint surgery and joint replacement during perioperative period is obviously superior to that of conventional treatment. It can effectively improve the total effective rate, shorten the first exhaust time, and increase the number of patients without abdominal distension after treatment. It was safe and effective, and worthy of clinical promotion.

Section: Introductionmentioning

confidence: 99%

Effect of Observation of Shou Hui Tong Bian Capsule (Polygonum Multiflorum and Aloe-Based Herbal Capsule for Cathartic Effect) in Rapid Rehabilitation of Joint Surgery

Xie

Evidence-Based Complementary and Alternative Medicine

et al. 2021

British Journal of Anaesthesia

“…A strength of this study is the specialised arthroplasty units having similar fast-track set-ups for many years, 7 whilst limitations include the use of self-reported pain and the pain diary after 48 h. External validity was supported by the internationally accepted evidence-based fast-track set-up, 28 opioid-sparing multimodal analgesia regimen with neuraxial block, and infiltration analgesia. However, this is also a limitation when interpreting effects in other set-ups and regimes, including the use of PNB, although HD might rationally be expected to decrease postoperative pain and opioid consumption even more in regimes without multimodal analgesia.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 , 3 In spite of extensive research, pain is still a significant problem, both in the early and late recovery after TKA, 4 , 5 , 6 which, combined with fatigue and muscle weakness, inhibits early mobilisation and recovery. 7 Current multimodal opioid-sparing techniques, including the use of paracetamol, NSAIDs, or cyclooxygenase-2 inhibitors; local infiltration analgesia (LIA); and peripheral nerve blocks (PNBs), still leave many patients with moderate-to-severe postoperative pain. 8 In addition, specific patient groups are at increased risk of excessive postoperative pain, such as pain catastrophisers and patients on preoperative opioid treatment.…”

mentioning

confidence: 99%

High-dose steroids in high pain responders undergoing total knee arthroplasty: a randomised double-blind trial

Nielsen

Kehlet

Gromov

et al. 2022

Self Cite

Background Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain despite multimodal opioid-sparing analgesia. Pain catastrophising or preoperative opioid therapy is associated with increased postoperative pain. Preoperative glucocorticoid improves pain after TKA, but dose-finding studies and benefit in high pain responders are lacking. Methods A randomised double-blind controlled trial with preoperative high-dose intravenous dexamethasone 1 mg kg −1 or intermediate-dose dexamethasone 0.3 mg kg −1 in 88 patients undergoing TKA with preoperative pain catastrophising score >20 or regular opioid use was designed. The primary outcome was the proportion of patients experiencing moderate-to-severe pain (VAS >30) during a 5 m walk 24 h postoperatively. Secondary outcomes included pain at rest during nights and at passive leg raise, C-reactive protein, opioid use, quality of sleep, Quality of Recovery-15 and Opioid-Related Symptom Distress Scale, readmission, and complications. Results Moderate-to-severe pain when walking 24 h postoperatively was reduced (high dose vs intermediate dose, 49% vs 79%; P <0.01), along with pain at leg raise at 24 and 48 h (14% vs 29%, P =0.02 and 12% vs 31%, P =0.03, respectively). C-reactive protein was reduced in the high-dose group at both 24 and 48 h (both P <0.01). Quality of Recovery-15 was also improved ( P <0.01). Conclusions When compared with preoperative dexamethasone 0.3 mg kg −1 i.v., dexamethasone 1 mg kg −1 reduced moderate-to-severe pain 24 h after TKA and improved recovery in high pain responders without apparent side-effects. Clinical trial registration NCT03763734 .

“…Identifying patients at high risk of complications can lead to adequate qualification for the procedure and initiation of more rigorous prophylaxis. On the other hand, low-risk patients could be subjected to fast-track surgery, reducing the length of stay and care-related costs [ 58 ]. The current methods used to assess health status among patients qualified for THA are very diverse among the authors, making it difficult to compare individual results in a pooled analysis.…”

Section: Discussionmentioning

confidence: 99%

“… Discriminative ability of elixhauser's comorbidity measure is superior to other comorbidity scores for inpatient adverse outcomes after total hip arthroplasty [ 19 ] Ondeck, NT 2018 Retrospective 68680 mFI CCI ECM Myocardial infarction, pneumonia, sepsis Bleeding, pulmonary embolism, death Mechanical complications, infection Extended LOS Discharge to facility ECM outperformed CCI and mFI in the prediction of all measured adverse outcomes 13. Predicting adverse outcomes after total hip arthroplasty: a comparison of demographics, the american society of anesthesiologists class, the modified Charlson Comorbidity Index, and the Modified Frailty Index [ 58 ] Ondeck, NT 2018 Retrospective 67792 ASA mFI-11 mCCI (modified) Severe adverse event Minor adverse event LOS Discharge to a higher-level care center ASA significantly outperformed mCCI and mFI in all investigated outcomes 14. Is gain in health-related quality of life after a total hip arthroplasty dependent on the comorbidity burden?…”

Section: Introductionmentioning

confidence: 99%

The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty

Pulik

Podgajny

Kaczyński

et al. 2021

JOIO

Introduction It is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient's comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used. Methods The article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient's comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient's physical functioning was performed by two independent researchers. Results The initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies. Conclusion The comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.