Outpatient Total Knee Arthroplasty

Krause, Andrew R.; Sayeed, Zain; El-Othmani, Mouhanad M.; Pallekonda, Vinay; Mihalko, William M.; Saleh, Khaled J.

doi:10.1016/j.ocl.2017.08.003

Cited by 10 publications

(8 citation statements)

References 44 publications

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“…Outcome analysis must be an ongoing process to ensure success throughout each phase 6 . Hospitals must know how to engage staff members in cultural change because full support becomes critical throughout the process 7 . Hospitals must not forget about the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Hospitals have become more value-driven throughout the care delivery process. Energy currently focuses on using resources to the maximum effect, minimizing waste, and providing high-quality care 7 . Hospitals realize that enhanced recovery pathways are associated with cost savings because of decreased length of stay, increased discharge home rate, reduced procedure-related morbidity, and reduced readmission rates 6,8 .…”

Section: Review Of Literaturementioning

confidence: 99%

“…Prevention of nausea and vomiting is best performed by avoiding general anesthesia and minimizing intraoperative/postoperative narcotic use. Prophylactic medications such as corticosteroids, serotonin antagonists (Zofran), and dopamine antagonists (Reglan) are routinely used 7,13 .…”

Section: Postoperative Phasementioning

confidence: 99%

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Hospital-Based Rapid Recovery Protocol in Knee Arthroplasty

Spadaccini

2022

JBJS Journal of Orthopaedics for Physician Assistants

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This review aims to determine the elements a hospital-based knee arthroplasty program should consider when developing a rapid recovery protocol. It will examine the perioperative pathway and how a program can break down each phase for success. Secondary objectives of this review include how and why the culture surrounding knee arthroplasty has changed and why it is in a hospital's best interest to adopt a rapid recovery pathway in light of this new landscape. An extensive search was performed through databases which included Still OneSearch, EBSCOhost, and PubMed. Sources aligned with the review's objectives. Inclusion criteria involved primary sources, secondary sources, and peer-reviewed articles less than 5 years old. On finding primary and secondary sources, reference sections provided additional materials to ensure high-quality research.Outpatient knee arthroplasty has gained interest in the past 10 years, and rapid recovery protocols have helped promote this likely development. The rapidly changing landscape surrounding knee arthroplasty was triggered by insurance companies and pushed even further because of the COVID-19 pandemic. Developing a rapid recovery protocol in the hospital setting involves a change in overall culture, interprofessional participation, and patient and family cooperation. Although not an easy task, adopting a rapid recovery protocol for knee arthroplasty has been shown to improve overall patient outcomes by decreasing length of stay, decreasing complications, and increasing discharge home rates. Along with improved outcomes, we have improvements in patient satisfaction and overall cost savings.

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Section: Discussionmentioning

confidence: 99%

Section: Review Of Literaturementioning

confidence: 99%

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Hospital-Based Rapid Recovery Protocol in Knee Arthroplasty

Spadaccini

2022

JBJS Journal of Orthopaedics for Physician Assistants

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“…At our institution, we now obtain noninvasive arterial studies and vascular consultations for patients with postop palsies that have undergone correction of varus malalignment. With an increasing number of TKAs performed on an outpatient basis, there is concern over limited serial neurovascular monitoring [16]. Orthopedic surgeons should carefully select candidates for outpatient TKAs.…”

Section: Discussionmentioning

confidence: 99%

Delayed Arterial Occlusion Presenting as Foot Drop Following Primary Total Knee Arthroplasty in a Varus Knee: A Case Report and Review of the Literature

Prince¹,

Matthews²,

Phillips³

2021

Case Rep Orthop Res

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We present a 69-year-old male with osteoarthritis of a varus mechanically aligned left knee that developed delayed arterial thrombosis after primary total knee arthroplasty (TKA) requiring stenting and subsequent trans-metatarsal amputation. This case is unique since initial presentation involved neurologic instead of ischemic changes. We also performed a literature review of arterial injuries in primary TKA. This case highlights the importance of maintaining a high clinical suspicion for vascular insult in patients undergoing correction of varus malalignment with initial complaints of neurologic dysfunction.

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“…In 2005, there were 523,000 total knee arthroplasty (TKA) procedures performed in the United States, with these numbers increasingly yearly [4][5][6][7]. This large patient population affords orthopedic surgeons an opportunity to help reduce the opioid burden through advancements in post-operative pain control with less reliance on narcotic medications.…”

Section: Introductionmentioning

confidence: 99%

A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

Roberts

Foster

Shi

et al. 2019

Cureus

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Introduction: Opioid pain medications are commonly prescribed following orthopedic procedures, with overprescribing of these pain medications implicated as a driver of the current opioid epidemic. In an effort to reduce reliance on opioid pain medications, surgeons are relying on periarticular injections or peripheral nerve blocks. The purpose of this study was to compare numerical rating scale (NRS) pain scores and oral morphine equivalents (OMEs) in patients who underwent primary total knee arthroplasty (TKA) with a periarticular injection alone to those who underwent a collaborative approach with a periarticular injection in the posterior tissue and an adductor canal catheter for anterior knee analgesia. Methods: In this study, 236 patients underwent a primary TKA between December 2017 and April 2018. Forty patients received an adductor canal catheter and 196 underwent a periarticular injection alone. Results: We found no difference in patient demographics between the cohorts (p>0.05). The patients that underwent the collaborative approach with a periarticular injection and adductor canal catheter had lower NRS pain scores on post-operative day 0, 1, and 2 (all P≤0.033). These patients demonstrated a reduction of 43% in opioid consumption during the hospitalization (P<0.001). These patients also demonstrated improved range of motion (ROM) (96 vs. 92 degrees) on the day of discharge (P=0.013). Conclusion: This study provides strong evidence that in patients undergoing TKA, the collaborative approach with the adductor canal catheter and periarticular injection is associated with lower post-operative pain scores, fewer total OMEs per hospital day, and a greater ROM arc prior to discharge compared to patients receiving a periarticular injection alone.

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Outpatient Total Knee Arthroplasty

Cited by 10 publications

References 44 publications

Hospital-Based Rapid Recovery Protocol in Knee Arthroplasty

Hospital-Based Rapid Recovery Protocol in Knee Arthroplasty

Delayed Arterial Occlusion Presenting as Foot Drop Following Primary Total Knee Arthroplasty in a Varus Knee: A Case Report and Review of the Literature

A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

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