Modifiable factors influencing length of stay after total knee arthroplasty

Missmann, Martin; Grenier, Jean-Pascal; Raas, Christoph

doi:10.1007/s00590-022-03306-y

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…Previous studies have also explored the impact of preoperative complications on postoperative outcomes and have obtained conclusions similar to those of our study [32]. For example, Missmann, M. et al conducted a retrospective study involving 194 patients undergoing primary knee arthroplasty and found that preoperative complications such as a history of diabetes, hypertension, or cancer did not affect the length of patients' postoperative hospital stays [33]. One possible explanation for this result is that, although there were differences between the two groups, the absolute numbers of patients with a history of stroke, previous surgeries, and heart disease were all relatively small in this study.…”

Section: Discussionsupporting

confidence: 80%

Early ambulation after total knee arthroplasty: a retrospective single-center study

zhou,

yao,

shen

et al. 2024

Preprint

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Purpose: Early ambulation is an important step in accelerating post-joint replacement surgery recovery. However, there is limited research on the populations who are unable to complete early walking in the early postoperative period. The purpose of this study was to determine the factors influencing early postoperative ambulation in total knee arthroplasty (TKA) patients. Methods: primary TKA patients were included in this retrospective study. All patients were divided into two groups. Patients who began walking within 24 hours were categorized as the early ambulation (EA) group, while patients who began walking after 24 hours were classified as the late ambulation (LA) group. Recorded demographic data included age, gender, body mass index (BMI), clinical diagnosis, and comorbidities. Hematological parameters potentially affecting patients' preoperative physical condition were also documented. Additionally, intraoperative metrics such as surgical time, surgical side, tourniquet time, intraoperative blood loss, and the placement of drains were recorded. Results: A total of 453 patients (79.0% female, 21.0% male) were included in this study. The average age of all patients was 68.5±7.9 years, ranging from 36 to 87 years, with an average BMI of 27.2±9.9 kg/m2. The mean postoperative ambulation time was 1.6 days, with a range of 0 to 4 days. In univariate group comparisons, an increase in postoperative time to ambulation was significantly associated with a history of heart disease (P＜0.001), stroke history (P=0.003), and prior surgeries (P=0.003). Patients who delayed ambulation also exhibited significantly higher coagulation-related parameters including PT (P＜0.001), APTT (P=0.002), TT (P=0.039) before surgery compared to those who mobilized early. Furthermore, prolonged surgical time (P= 0.030), increased intraoperative blood loss (P＜0.001), and the placement of intraoperative drains (P＜0.001) also significantly extended the time to postoperative ambulation. However, after multivariate logistic regression analysis, only PT (OR 1.86, 95%CI 1.32–2.61, P < 0.001), TT (OR 1.30, 95% CI 1.09-1.55, P=0.004) intraoperative blood loss (OR 1.01, 95% CI 1.00-1.01, P=0.008) and the placement of intraoperative drains (OR 11.39, 95% CI 6.59-19.69, P < 0.001) were identified as predictive factors for late ambulation in patients after TKA. Conclusions: In this study, preoperative coagulation function, intraoperative blood loss and the placement of intraoperative drains were factors contributing to delay ambulation time. Therefore, it is believed that properly improving preoperative coagulation function, effective intraoperative hemostasis, and reducing the placement of drains have a positive impact on early postoperative ambulation in patients undergoing TKA.

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Section: Discussionsupporting

confidence: 80%

Early ambulation after total knee arthroplasty: a retrospective single-center study

zhou,

yao,

shen

et al. 2024

Preprint

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“…Modifiable factors associated with successful early discharge include non-smoking status, independent preoperative ambulation, and presence of a postoperative caregiver [ 9 ]. On the other hand, higher prevalence of medical comorbidities, lower hemoglobin levels, requirement of blood transfusion(s), planned discharge to a rehabilitation facility, and truancy of preoperative patient education were associated with longer length of hospital stay [ 10 ]. For non-modifiable factors, male sex and married status were associated with shorter time to successful discharge whereas African-American ethnicity was associated with longer length of stay [ 9 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

A balance focused biometric does not predict rehabilitation needs and outcomes following total knee arthroplasty

Lee,

Arora,

Finlay

et al. 2024

BMC Musculoskelet Disord

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Background Both length of hospital stay and discharge to a skilled nursing facility are key drivers of total knee arthroplasty (TKA)-associated spending. Identifying patients who require increased postoperative care may improve expectation setting, discharge planning, and cost reduction. Balance deficits affect patients undergoing TKA and are critical to recovery. We aimed to assess whether a device that measures preoperative balance predicts patients’ rehabilitation needs and outcomes after TKA. Methods 40 patients indicated for primary TKA were prospectively enrolled and followed for 12 months. Demographics, KOOS-JR, and PROMIS data were collected at baseline, 3-months, and 12-months. Single-leg balance and sway velocity were assessed preoperatively with a force plate (Sparta Science, Menlo Park, CA). The primary outcome was patients’ discharge facility (home versus skilled nursing facility). Secondary outcomes included length of hospital stay, KOOS-JR scores, and PROMIS scores. Results The mean preoperative sway velocity for the operative leg was 5.7 ± 2.7 cm/s, which did not differ from that of the non-operative leg (5.7 ± 2.6 cm/s, p = 1.00). Five patients (13%) were discharged to a skilled nursing facility and the mean length of hospital stay was 2.8 ± 1.5 days. Sway velocity was not associated with discharge to a skilled nursing facility (odds ratio, OR = 0.82, 95% CI = 0.27–2.11, p = 0.690) or longer length of hospital stay (b = -0.03, SE = 0.10, p = 0.738). An increased sway velocity was associated with change in PROMIS items from baseline to 3 months for global07 (“How would you rate your pain on average?” b = 1.17, SE = 0.46, p = 0.015) and pain21 (“What is your level of pain right now?” b = 0.39, SE = 0.17, p = 0.025) at 3-months. Conclusion Preoperative balance deficits were associated with postoperative improvements in pain and function after TKA, but a balance focused biometric that measured single-leg sway preoperatively did not predict discharge to a skilled nursing facility or length of hospital stay after TKA making their routine measurement cost-ineffective.

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“…The risks of complications and costs associated with convalescence are significant. There is an established need for optimizing recovery and reducing risks associated with knee arthroplasty ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation prior to total knee arthroplasty does not improve post-surgical pain or recovery: a double-blinded, multi-center, randomized clinical trial

Lyman¹,

Olscamp²,

Lovell³

et al. 2023

Ann Joint

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Background Radiofrequency ablation (RFA) targeting the genicular nerves is an effective treatment for knee pain due to osteoarthritis. The aim of this study was to determine the effects of two RFA interventions delivered preoperatively on early postoperative pain management and subjective outcomes after total knee arthroplasty (TKA). Methods One hundred forty-three participants were enrolled in this double blinded, sham-controlled prospective randomized trial. Participants assigned at random to traditional RFA (t-RFA) (n=50), cooled RFA (c-RFA) (n=49), or sham (n=44) procedures prior to TKA. Outcomes were recorded at postoperative day 3, week 1, week 2, week 12, month 6, and month 12 following TKA. Primary outcomes included hospital length of stay (LOS), opioid consumption (reported as MEQ, or daily morphine equivalents), time to narcotic cessation (reported in days), and pain scores (reported as NRS, or Numeric Rating Scale). Secondary outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measures. All side effects and complications were reported. Participants were followed for a year to detect any unexpected side effects. Results Compared with sham controls, t-RFA and c-RFA did not affect inpatient LOS, pain scores, or opioid consumption. There were no reductions in time to opioid cessation, pain scores, or WOMAC scores at any time point post-TKA. Conclusions RFA of the genicular nerves prior to TKA did not affect opioid use or time to cessation, pain, or WOMAC scores, following TKA. Current techniques of t-RFA and c-RFA of these specific geniculate nerves preoperatively are not indicated as routine interventions to improve short-term surgical recovery after TKA. Trial Registration The trial was registered on ClinicalTrials.gov (NCT02925442).

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Modifiable factors influencing length of stay after total knee arthroplasty

Cited by 5 publications

References 23 publications

Early ambulation after total knee arthroplasty: a retrospective single-center study

Early ambulation after total knee arthroplasty: a retrospective single-center study

A balance focused biometric does not predict rehabilitation needs and outcomes following total knee arthroplasty

Radiofrequency ablation prior to total knee arthroplasty does not improve post-surgical pain or recovery: a double-blinded, multi-center, randomized clinical trial

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