Introduction of an innovative day surgery pathway for unicompartmental knee replacement: no need for early knee flexion

Jenkins, C.; Jackson, William F.; Bottomley, Nicholas; Price, Andrew; Murray, David; Barker, Karen

doi:10.1016/j.physio.2018.11.305

Cited by 18 publications

(27 citation statements)

References 15 publications

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“…This resulted in a higher mean ASA score in patients compared with the above-mentioned studies, and a very large range in both patient age and BMI. This large range in patient demographics in an unselected cohort was also reported by Jenkins et al (2019). Furthermore, all patients in our study were discharged to their own homes with no additional care.…”

Section: Discussionsupporting

confidence: 73%

“…We found that 22% of unselected patients were discharged on DOS. A study by Jenkins et al (2019) reported 39% (n = 669) of consecutive unselected unilateral UKA patients to be discharged on DOS. The aim of that study was to investigate the effect of delaying knee flexion on different outcome measures such as LOS.…”

Section: Discussionmentioning

confidence: 99%

“…Also, efforts were made to have UKA patients scheduled for surgery as #1 if possible. Jenkins et al (2019) reported reduced muscle strength to be the most common reason for continued hospitalization as well as dizziness and nausea. A study by Bradley et al (2017) reported a day of surgery discharge percentage of 85% (n=72).…”

Section: Discussionmentioning

confidence: 99%

“…We found a substantially lower number of UKA patients discharged on DOS compared with the studies mentioned above. In the case of Jenkins et al (2019) the main reason for this difference might be that we have introduced no changes to our postoperative protocol in relation to this study, thus not increasing the focus on LOS as measurement of performance within the department. Also, no changes were made regarding available resources such as a physiotherapist working late or UKA patients being scheduled for early surgery slots.…”

Section: Discussionmentioning

confidence: 99%

“…UKA is effective and safe when performed in a fast-track setting and outpatient UKA in selected patients has been shown to be feasible and safe (Munk et al 2012, Cross and Berger 2014, Bovonratwet et al 2017, Kort et al 2017. However, the number of patients actually being discharged on DOS that were scheduled for outpatient surgery differs between studies and ranges from 37% to 100% (Gondusky et al 2014, Bradley et al 2017, Jenkins et al 2019, Rytter et al 2019.…”

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confidence: 99%

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Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

et al. 2020

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Background and purpose — Previous studies have investigated risk factors related to prolonged length of stay following total knee arthroplasty (TKA), but little is known about specific factors resulting in continued hospitalization within the 1st postoperative days after unicompartmental knee arthroplasty (UKA). We investigated what specific factors prevent patients from being discharged on the day of surgery (DOS) and the first postoperative day (POD-1) following primary UKA in a fast-track setting. Patients and methods — We prospectively collected data on 100 consecutive and unselected medial UKA patients operated from December 2017 to May 2019. All patients were operated in a standardized fast-track setup with functional discharge criteria continuously evaluated from DOS and until discharge. Results — Median length of stay for the entire cohort was 1 day. 22% and 78% of all patients were discharged on DOS and POD-1, respectively. Lack of mobilization and pain separately delayed discharge in respectively 78% and 24% of patients on DOS. The main reasons for lack of mobilization were motor blockade (37%) and logistical factors (26%). For patients placed 1st or 2nd on the operating list, we estimate that the same-day discharge rate would increase to 55% and 40% respectively, assuming that pain and mobilization were successfully managed. Interpretation — One-fifth of unselected UKA patients operated in a standardized fast-track setup were discharged on DOS. Pain and lack of mobilization were the major reasons for continued hospitalization within the initial postoperative 24–48 hours. Strategies aimed at decreasing length of stay after UKA should strive to improve analgesia and postoperative mobilization.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

et al. 2020

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Prehabilitation for Patients Undergoing Orthopedic Surgery

et al. 2023

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ImportancePrehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results.ObjectiveTo evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery.Data SourcesBibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022.Study SelectionRandomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included.Data Extraction and SynthesisTwo independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.Main Outcomes and MeasuresPain, function, muscle strength, and health-related quality of life (HRQOL).ResultsForty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], −0.70 [95% CI, −1.08 to −0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, –8.20 [95% CI, −8.85 to −7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, −0.51 [95% CI, −0.85 to −0.17]) and at 6 months in those undergoing lumbar surgery (SMD, −2.35 [95% CI, −3.92 to −0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence.Conclusions and RelevanceIn this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.

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