The introduction of day-case total knee arthroplasty in a national healthcare system: A review of the literature and development of a hospital pathway

Thompson, Joshua W.; Wignadasan, Warran; Ibrahim, Mazin; Plastow, Ricci; Beasley, Lucy; Haddad, Fares S.

doi:10.1016/j.surge.2021.01.017

Cited by 12 publications

(16 citation statements)

References 34 publications

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“…Thus, the difference was small and statistically insignificant ( p = 0.679). Several studies found that earlier mobilisation with increased frequency of physiotherapy on POD0 as part of an ARP can be implemented safely without an increase in adverse events (Krause et al 2018 ; Riemer et al 2017 ; Thompson et al 2021 ; Yakkanti et al 2019 ). The reasons for readmission in our study were because of a family member of a patient with a total hip replacement being concerned about excessive swelling around the thigh area.…”

Section: Discussionmentioning

confidence: 99%

Same-day discharge after early mobilisation and increased frequency of physiotherapy following hip and knee arthroplasty

Prinsloo

Keller

2022

South African Journal of Physiotherapy

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Background: Advanced rehabilitation pathway (ARP) after hip and knee arthroplasties is popular globally and is gaining ground in South Africa (SA). A multidisciplinary team in Rustenburg, SA, has implemented an ARP with the first same-day discharge (SDD) from hospital. The lack of evidence of physiotherapy protocols within an ARP determined our study.Objectives: Determine and compare hospital length of stay (LOS) (hours), patient satisfaction (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), patient safety (30-day re-admission) and cost between the two cohorts.Method: A quantitative prospective patient (treatment) group receiving early mobilisation with increased frequency of physiotherapy on post-operative day zero (POD0) was compared to a conservatively managed retrospective historical (control) group following post-operative elective hip and knee arthroplasties.Results: Results for the prospective group which were significantly improved relative to the retrospective group included decreased LOS (median 7.650, p 0.001), less pain at 6 weeks (mean 16.20, standard deviation [SD] = 2.673, p 0.001), less stiffness (mean 5.82, SD = 1.214, p = 0.007), higher function (mean 54.87, SD = 8.544, p 0.001), lower hospital cost (mean R43 340, p 0.001) and physiotherapy cost (mean R1069, p 0.001), and total costs compared to the retrospective group (mean R117 062, p 0.001).Conclusion: Safe and cost-effective SDD is possible in an ARP with earlier mobilisation and increased frequency of physiotherapy on POD0.Clinical implications: Achieving safe SDD after hip and knee arthroplasty surgeries saved costs and improved patient satisfaction, with a decrease in LOS being beneficial for medical funders and stakeholders including government aiming to implement National Health Insurance (NHI) in the future.

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Section: Discussionmentioning

confidence: 99%

Same-day discharge after early mobilisation and increased frequency of physiotherapy following hip and knee arthroplasty

Prinsloo

Keller

2022

South African Journal of Physiotherapy

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“…The physiotherapy protocol will start with pre-operative education, pre-habilitation (rehabilitation performed by the physiotherapist before the surgery) and include an evaluation session (measurement of hip and knee range of movement Thompson et al 2021). Preventive hip arthroplasty measures implemented for the first 3 months post-operatively include no hip internal rotation, no hip adduction (crossing the legs) and no hip flexion more than 90°.…”

Section: Pre-intervention Protocol and Assessment For Hip And Knee Arthroplastymentioning

confidence: 99%

“…The physiotherapy post-operatively starts by making the patient sit more upright (while respecting hip flexion precaution of 90° after total hip replacements) to assist with hypotension. Bed exercises consisting of foot pumps, static quadriceps muscle strengthening exercises, free active hip abduction ROM/functional exercises and heel slides exercises to encourage joint ROM are performed (Jenkins et al 2019;Thompson et al 2021).…”

Section: Protocol After Returning From the Recovery Roommentioning

confidence: 99%

“…Before discharge, the patient is expected to demonstrate good independent bed mobility (be able to get in and out of bed by themselves), mobilise 50 m or more with an appropriate assistive device, navigate by climbing five stairs safely with crutches or one step in case of a walking frame (Berger et al 2009;Thompson et al 2021). Range of motion should be close to 90° knee flexion and 90° hip flexion for knee and hip arthroplasty.…”

Section: Post-intervention Assessment and Protocol Before Dischargementioning

confidence: 99%

“…Range of motion should be close to 90° knee flexion and 90° hip flexion for knee and hip arthroplasty. When the patient is medically stable, pain is under control (patient indicating that they feel they will manage at home using pain tablets with a visual analogue scale rating of equal or less than 5 out of a maximum of 10 pain), and the physiotherapy criteria are met, the patient is discharged home (Thompson et al 2021). A home exercise programme that was already provided pre-operatively is continued.…”

Section: Post-intervention Assessment and Protocol Before Dischargementioning

confidence: 99%

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Physiotherapy in an advanced rehabilitation pathway for patients after hip and knee arthroplasty: A proposal

Prinsloo

Keller

2021

S. Afr. j. physiother.

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Background: Accelerated rehabilitation pathway (ARP) decrease patients’ hospital length of stay (LOS). A lack of evidence exists on physiotherapy management and outcome as part of ARP in South Africa (SA). Our study will aim to determine whether early mobilisation and increased frequency of physiotherapy treatments for participants after hip or knee arthroplasty surgery on post-operative day 0 (POD 0) affect outcome.Methods/design: A quantitative prospective cohort study incorporating ARP on (n = 60) non-randomised elective hip and knee arthroplasty participants will be compared with a more conservatively managed historical control group (n = 60). The physiotherapy protocol includes early mobilisation and exercises 1–3 h post-operatively on POD 0 and a second mobilisation and exercise session, 1–2 h later. Outcomes measures are as follows: hours for LOS, the WOMAC measured pre-operatively, 6 weeks and 3 months post-operatively, 30-day readmission for safety and cost comparison between the prospective and historical cohorts. Descriptive statistics will be undertaken. A paired t-test will be used to analyse each of the outcome measures across the time periods if data are normally distributed. Length of stay, WOMAC score and cost data will be compared between the groups, using a Mann–Whitney U test. The occurrence of adverse events will be compared between the groups using Pearson’s chi-square tests. The confidence interval will be set at 95% and p = 0.05 will be considered statistically significant.Discussion: Globally, ARP’s are successfully implemented to manage patients presenting with hip and knee osteoarthritis (OA). Research investigating physiotherapy protocols in an ARP is lacking in the literature.Conclusion: Achieving the same-day discharge after hip and knee arthroplasty surgeries may help elective surgery backlogs and waiting lists in a more cost-effective manner.Clinical implications: The same day discharge after arthroplasty may be a cost-effective management option in the future.Protocol identification: Pan African Clinical Trial Registry, PACTR202103637993156.

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Rapid Recovery in Arthroplasty: The Importance of Patient Expectation

Qurashi,

McEwen,

Budhiparama

2024

Fast Track Surgery in Hip and Knee Arthroplasty

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The introduction of day-case total knee arthroplasty in a national healthcare system: A review of the literature and development of a hospital pathway

Cited by 12 publications

References 34 publications

Same-day discharge after early mobilisation and increased frequency of physiotherapy following hip and knee arthroplasty

Same-day discharge after early mobilisation and increased frequency of physiotherapy following hip and knee arthroplasty

Physiotherapy in an advanced rehabilitation pathway for patients after hip and knee arthroplasty: A proposal

Rapid Recovery in Arthroplasty: The Importance of Patient Expectation

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