Cook Jon R, Warren Meghan, Ganley Kathleen J, Prefontaine Paul, Wylie Jack W
Department of Rehabilitation Sciences, Verde Valley Medical Center, 269 S. Candy Lane, Cottonwood, AZ, USA.
BMC Musculoskelet Disord. 2008 Nov 19;9:154. doi: 10.1186/1471-2474-9-154.
Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program - the Joint Replacement Program (JRP) - and report post-surgical outcomes.
74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period.
All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90 degrees (91.7 +/- 5.4 degrees ), but did not achieve the knee extension ROM goal of 0 degrees (2.4 +/- 2.6 degrees ). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period.
The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe protocol for providing care after a TKA.
全膝关节置换术（TKA）在美国是一种常见的外科手术。拥有一个全面的住院TKA项目很重要，该项目能在使不良事件最小化的同时最大化治疗效果。本研究的目的是描述一个TKA项目——关节置换项目（JRP）——并报告术后结果。
74名初次TKA候选人被纳入JRP。JRP旨在通过包括患者、患者家属和多学科医疗专业团队的团队方法，将并发症最小化并优化以患者为中心的结果。JRP包括术前课程、医疗护理标准路径、全面的围手术期疼痛管理、积极的物理治疗（PT）和主动的出院计划。测量指标包括功能测试、膝关节活动范围（ROM），以及在6个月随访期内对患者人口统计学、住院时间、出院处置和并发症的病历摘要。
所有患者均达到出院的医学标准。患者达到了膝关节屈曲ROM目标90度（91.7±5.4度），但未达到膝关节伸展ROM目标0度（2.4±2.6度）。53%的患者住院时间为两天，分别有39%和7%的患者在三天和四天后出院。除三名患者外，所有患者均出院回家且功能独立。其中68%的患者接受门诊物理治疗，相比之下，32%的患者在出院后立即接受家庭物理治疗。两名患者（<3%）在住院期间出现医疗并发症，9名患者（12%）在6个月随访期内出现并发症。
TKA的综合JRP与令人满意的临床结果、短住院时间、高比例患者出院回家并接受门诊PT以及最小并发症相关。这个JRP可能代表了一种高效、有效且安全的TKA术后护理方案。
