Pathway-controlled fast-track rehabilitation after total knee arthroplasty: a randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay
Tóm tắt
To investigate fast-track rehabilitation concept in terms of a measurable effect on the early recovery after total knee arthroplasty (TKA). This was an open, randomized, prospective clinical study, comparing the fast-track rehabilitation—a pathway-controlled early recovery program (Joint Care®)—with standard postoperative rehabilitation care, after TKA. Overall, 147 patients had TKA (N = 74 fast-track rehabilitation,
N = 73 standard
rehabilitation). The fast-track rehabilitation patients received a group therapy, early mobilization (same day as surgery) and 1:1 physiotherapy (2 h/day). Patient monitoring occurred over 3 months (1 pre- and 4 post-operative visits). The standard rehabilitation group received individual postoperative care according to the existing protocol, with 1:1 physiotherapy (1 h/day). The cumulative American Knee Society Score (AKSS) was the primary evaluation variable, used to detect changes in joint function and perception of pain. The secondary evaluation variables were WOMAC index score, analgesic drug consumption, length of stay (LOS), and safety. After TKA, patients in the fast-track rehabilitation group showed enhanced recovery compared with the standard
rehabilitation group, as based on the differences between the groups for the cumulative AKSS (p = 0.0003), WOMAC index score (<0.0001), reduced intake of concomitant analgesic drugs, reduced LOS (6.75 vs. 13.20 days, p < 0001), and lower number of adverse events. For TKA, implementation of pathway-controlled fast-track rehabilitation is achievable and beneficial as based on the AKSS and WOMAC score, reduced intake of analgesic drugs, and reduced LOS.
Tài liệu tham khảo
Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The Swedish Knee Arthroplasty Register 1975–1997: an update with special emphasis on 41,223 knees operated on in 1988–1997. Acta Orthop Scand 72:503–513
Kane RL, Saleh KJ, Wilt TJ, Bershadsky B (2005) The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am 87:1719–1724
Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton LJ, III, Kurland RL, Berry DJ (2010) A population-based study of trends in the use of total hip and total knee arthroplasty, 1969–2008. Mayo Clin Proc 85:898–904
Robertsson O, Bizjajeva S, Fenstad AM, Furnes O, Lidgren L, Mehnert F, Odgaard A, Pedersen AB, Havelin LI (2010) Knee arthroplasty in Denmark, Norway and Sweden. Acta Orthop 81:82–89
Schneider M, Kawahara I, Ballantyne G, McAuley C, Macgregor K, Garvie R, McKenzie A, Macdonald D, Breusch SJ (2009) Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty. Arch Orthop Trauma Surg 129:1585–1591
Yasunaga H, Tsuchiya K, Matsuyama Y, Ohe K (2009) Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: nationwide web-based survey. J Orthop. Sci 14:10–16
Barmer (2010) Schriftenreihe zur Gesundheitsanalyse. Barmer GEK Report Krankenhaus Schwäbisch Gmünd 3:145
BQS-Bundesauswertung (2008) Knie-Totalendoprothesen-Erstimplantation. BQS, Institut für Qualität and Patientensicherheit. http://www.bqs-outcome.de/2008/ergebnisse/leistungsbereiche/knie_tep_erst/buaw/basis/0017_Basis.html. Accessed 19 December 2011
Anon (2008) Scottish Arthroplasty Project Annual Report. Scottish Arthroplasty Project Annual Report, Appendix 8:14–17
Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2010) What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130:263–268
Husted H, Jensen CM, Solgaard S, Kehlet H (2012) Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Arch Orthop Trauma Surg 132:101–104
Berger RA, Kusuma SK, Sanders SA, Thill ES, Sporer SM (2009) The feasibility and perioperative complications of outpatient knee arthroplasty. Clin Orthop Relat Res 467:1443–1449
Lingard EA, Sledge CB, Learmonth ID (2006) Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia. J Bone Joint Surg Am 88:1201–1207
Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79:168–173
InEK (2011): (Institut für das Entgeltsystem im Krankenhaus) Institute for the Hospital Remuneration System. http://www.g-drg.de/cms/index.php/inek_site_de/G-DRG-System_2010/Fallpauschalen-Katalog/Fallpauschalen-Katalog_2010. Fallpauschalen-Katalog, 144B. http://www.g-drg.de/cms/inek_site_de/layout/set/standard/G-DRG-System_2011/Fallpauschalen-Katalog/Fallpauschalen-Katalog_2011. Accessed 19 December 2011
Dawson J, Carr A (2001) Outcomes evaluation in orthopaedics. J Bone Joint Surg Br 83:313–315
Kehlet H, Soballe K (2010) Fast-track hip and knee replacement—what are the issues? Acta Orthop 81:271–272
Mabrey JD, Toohey JS, Armstrong DA, Lavery L, Wammack LA (1997) Clinical pathway management of total knee arthroplasty. Clin Orthop Relat Res 345:125–133
Palmer RM (2009) Perioperative care of the elderly patient: an update. Cleve Clin J Med 76:S16–S21
Panella M, Marchisio S, Di SF (2003) Reducing clinical variations with clinical pathways: do pathways work? Int J Qual Health Care 15:509–521
Petersen MK, Andersen NT, Soballe K (2008) Self-reported functional outcome after primary total hip replacement treated with two different perioperative regimes: a follow-up study involving 61 patients. Acta Orthop 79:160–167
Rapp SM (2010) Fast-track joint arthroplasty protocols increasing patient safety and satisfaction. Orthopedics Today Europe. http://www.orthosupersite.com/view.aspx?rid=77419. Accessed 19 December 2011
Brunenberg DE, van Steyn MJ, Sluimer JC, Bekebrede LL, Bulstra SK, Joore MA (2005) Joint recovery programme versus usual care: an economic evaluation of a clinical pathway for joint replacement surgery. Med Care 43:1018–1026
Kim S, Losina E, Solomon DH, Wright J, Katz JN (2003) Effectiveness of clinical pathways for total knee and total hip arthroplasty: literature review. J Arthroplasty 18:69–74
Macario A, Horne M, Goodman S, Vitez T, Dexter F, Heinen R, Brown B (1998) The effect of a perioperative clinical pathway for knee replacement surgery on hospital costs. Anesth Analg 86:978–984
Pearson SD, Kleefield SF, Soukop JR, Cook EF, Lee TH (2001) Critical pathways intervention to reduce length of hospital stay. Am J Med 110:175–180
Barbieri A, Vanhaecht K, Van HP, Sermeus W, Faggiano F, Marchisio S, Panella M (2009) Effects of clinical pathways in the joint replacement: a meta-analysis. BMC Med 7:32
Husted H, Solgaard S, Hansen TB, Soballe K, Kehlet H (2010) Care principles at four fast-track arthroplasty departments in Denmark. Dan Med Bull 57:A4166
Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928
Kehlet H, Wilmore DW (2005) Fast-track surgery. Br J Surg 92:3–4
Larsen K, Hansen TB, Thomsen PB, Christiansen T, Soballe K (2009) Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. J Bone Joint Surg Am 91:761–772
Healy WL, Ayers ME, Iorio R, Patch DA, Appleby D, Pfeifer BA (1998) Impact of a clinical pathway and implant standardization on total hip arthroplasty: a clinical and economic study of short-term patient outcome. J Arthroplasty 13:266–276
Anon (1996) Declaration of Helsinki (1964). BMJ, 313. http://www.cirp.org/library/ethics/helsinki/. Accessed 19 December 2011
Insall JN, Hood RW, Flawn LB, Sullivan DJ (1983) The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg Am 65:619–628
Angst F, Aeschlimann A, Steiner W, Stucki G (2001) Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis 60:834–840
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840
Anon (2007) Oxford league table of analgesics in acute pain. Bandolier, http://www.medicine.ox.ac.uk/bandolier/booth/painpag/acutrev/analgesics/leagtab.html. Accessed 19 December 2011
European Medicines Agency (1998) ICH Topic E9. Statistical principles for clinical trials. ICH Harmonised Tripartite Guideline, CPMP/ICH/363/96. http://www.emea.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500002928.pdf. Accessed 19 December 2011
Cook JR, Warren M, Ganley KJ, Prefontaine P, Wylie JW (2008) A comprehensive joint replacement program for total knee arthroplasty: a descriptive study. BMC Musculoskelet Disord 9:154. doi:10.1186/1471-2474-9-154
Walter FL, Bass N, Bock G, Markel DC (2007) Success of clinical pathways for total joint arthroplasty in a community hospital. Clin Orthop Relat Res 457:133–137
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
Angst F, Ewert T, Lehmann S, Aeschlimann A, Stucki G (2005) The factor subdimensions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) help to specify hip and knee osteoarthritis. a prospective evaluation and validation study. J Rheumatol 32:1324–1330
Larsen K, Hansen TB, Soballe K, Kehlet H (2012) Patient-reported outcome after fast-track knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1919-4
Larsen K, Hansen TB, Soballe K, Kehlet, H (2010) Patient-reported outcome after fast-track hip arthroplasty: a prospective cohort study. Health Qual Life Outcomes 8:144
Husted H, Otte KS, Kristensen BB, Kehlet H (2011) Fast-track revision knee arthroplasty. A feasibility study. Acta Orthop 82:438–440
Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H (2011) Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 82:679–684