Kolisek Frank R, McGrath Mike S, Jessup Nenette M, Monesmith Eric A, Mont Michael A
OrthoIndy, Indianapolis, IN, USA.
Clin Orthop Relat Res. 2009 Jun;467(6):1438-42. doi: 10.1007/s11999-009-0730-0. Epub 2009 Feb 18.
New protocols have been designed for outpatient total knee arthroplasty procedures, but concerns exist about the potential for increased complication rates. We compared the results of two selected matched cohorts of 64 patients who underwent total knee arthroplasty during the same time period. One cohort of patients, who had no severe medical conditions, lived within one hour of the office, and had help at home, followed an accelerated pathway in which they were discharged within 23 hours of surgery, and the other cohort followed a standard inpatient protocol, with a mean hospital stay of 2.3 days (range, 2-4 days). There were no perioperative complications in either cohort, and none of the patients who followed the outpatient protocol returned to the hospital for any reason. At a mean followup of 24 months (range, 12-41 months), the mean Knee Society knee scores of the outpatient and inpatient cohorts were 96 points (range, 67-100 points) and 95 points (range, 78-100 points), respectively. The mean Knee Society function scores were 89 points (range, 50-100 points) and 90 points (range, 60-100 points), respectively. We believe outpatient total knee arthroplasty may be a safe procedure in certain selected patients, with similar outcomes to a traditional protocol.
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
已设计出用于门诊全膝关节置换手术的新方案，但人们担心并发症发生率可能会增加。我们比较了同期接受全膝关节置换手术的两个选定匹配队列，每组64例患者的结果。一组患者没有严重的内科疾病，居住在距诊所一小时路程内，且家中有人照料，他们遵循加速康复路径，术后23小时内出院；另一组遵循标准住院方案，平均住院时间为2.3天（范围2 - 4天）。两组均无围手术期并发症，且遵循门诊方案的患者无一因任何原因返回医院。在平均24个月（范围12 - 41个月）的随访中，门诊组和住院组患者的膝关节协会膝关节平均评分分别为96分（范围67 - 100分）和95分（范围78 - 100分）。膝关节协会功能平均评分分别为89分（范围50 - 100分）和90分（范围60 - 100分）。我们认为，对于某些选定的患者，门诊全膝关节置换术可能是一种安全的手术，其结果与传统方案相似。
II级，预后研究。有关证据水平的完整描述，请参阅作者指南。
