Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
Eur J Orthop Surg Traumatol. 2022 May;32(4):711-717. doi: 10.1007/s00590-021-03031-y. Epub 2021 Jun 7.
With an increasing number of total knee arthroplasty (TKA), protocols for better standard of patient care and shorter duration of hospital stay are necessary. Enhanced recovery (ER) protocols are becoming popular to meet these objectives. The current study aims to evaluate the clinical outcome of fast-track TKA using ER protocol in terms of length of hospital stay, perioperative complications and functional outcomes.
Patients undergoing single-stage bilateral primary TKA were prospectively included in the study. All patients went through a pre-defined ER protocol of TKA. Length of hospital stay, readmission rates, pain scores and functional scores of patients operated under ER protocol were compared with another matched historical control-group. Factors delaying the discharge of the patients by 48 h after the surgery were noted.
We compared 275 patients undergoing single-stage bilateral primary TKA through ER protocol (Group 1) with 190 patients who had undergone bilateral primary TKA before the ER protocol was initiated (Group 2). The length of hospital stay (3.9 ± 2.1 days in group 1 and 7.5 ± 3.2 days in group 2, p 0.0001) and post-operative pain scores at 12 h (5.2 ± 2.9 in group 1 and 5.7 ± 2.1 in group 2, p 0.03) and 24 h (4.1 ± 1.6 in group 1 and 4.6 ± 1.4 in group 2, p 0.0005) were found to be significantly better with ER protocol. There was no difference in Oxford knee scores, infection rates, readmissions or mortality between the two groups.
ER protocol in single-stage bilateral primary TKA resulted in decreased length of hospital stay without increasing complications and compromising the clinical outcome. It requires an integrated approach and adherence to clinical pathways.
Level II, Prospective comparative study.
随着全膝关节置换术（TKA）数量的增加，有必要制定更好的患者护理标准和缩短住院时间的方案。强化康复（ER）方案越来越受欢迎，以实现这些目标。本研究旨在评估使用 ER 方案的快速通道 TKA 在住院时间、围手术期并发症和功能结果方面的临床效果。
前瞻性纳入接受单阶段双侧初次 TKA 的患者。所有患者均遵循 TKA 预定义的 ER 方案。比较 ER 方案下手术患者的住院时间、再入院率、疼痛评分和功能评分，并与另一组匹配的历史对照组进行比较。记录手术后 48 小时内延迟患者出院的因素。
我们比较了 275 例接受 ER 方案单阶段双侧初次 TKA 的患者（第 1 组）和 190 例在 ER 方案实施前接受双侧初次 TKA 的患者（第 2 组）。第 1 组的住院时间（3.9±2.1 天）和第 2 组（7.5±3.2 天）比较，p＜0.0001）和术后 12 小时（第 1 组 5.2±2.9，第 2 组 5.7±2.1，p=0.03）和 24 小时（第 1 组 4.1±1.6，第 2 组 4.6±1.4，p＜0.0005）疼痛评分明显更好。两组在牛津膝关节评分、感染率、再入院率或死亡率方面无差异。
单阶段双侧初次 TKA 中 ER 方案可缩短住院时间，且不增加并发症，不影响临床结果。这需要综合方法和遵守临床路径。
II 级，前瞻性比较研究。
