Dataset Information

The first 6 weeks of recovery after total knee arthroplasty with fast track.

ABSTRACT:

Background and purpose

During the last decade, many hospitals have implemented fast-track protocols for total knee arthroplasty (TKA). These protocols reduce the length of hospital stay, but there is no literature on the first period after hospital discharge. We determined how patients experienced the first 6 weeks after hospital discharge after fast-track TKA surgery.

Patients and methods

34 consecutive patients who had TKA surgery with fast track received a diary for 6 weeks, which contained various international validated questionnaires. In addition, general questions regarding pain, the wound, physiotherapy, and thrombosis prophylaxis injections were posed.

Results

4 of the 34 patients were excluded during the study. Of the remaining 30 patients, 28 were positive regarding the short length of hospital stay. Pain gradually decreased and quality of life and function gradually improved during the 6 weeks. Mean hours of weekly physiotherapy were 0.6 for the first week and 0.9 during the sixth week, with high variance of treatment modalities due to the lack of standardized treatment protocols. Additional clinical consultations were needed in 9 patients during the 6-week period.

Interpretation

28 of 30 patients were satisfied with the short length of hospital stay. The intensity of physiotherapy was surprisingly low. The quality of life 6 weeks after discharge was similar to that before the surgery.

SUBMITTER: Van Egmond JC

PROVIDER: S-EPMC4750771 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

The first 6 weeks of recovery after total knee arthroplasty with fast track.

Van Egmond Jeroen C JC Verburg Hennie H Mathijssen Nina M C NM

Acta orthopaedica 20151009 6

<h4>Background and purpose</h4>During the last decade, many hospitals have implemented fast-track protocols for total knee arthroplasty (TKA). These protocols reduce the length of hospital stay, but there is no literature on the first period after hospital discharge. We determined how patients experienced the first 6 weeks after hospital discharge after fast-track TKA surgery.<h4>Patients and methods</h4>34 consecutive patients who had TKA surgery with fast track received a diary for 6 weeks, wh ...[more]

PMID: 26452995

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Project description:BackgroundLoading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA.ObjectiveTo investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA.DesignCross-sectional study.SettingConsecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013.ParticipantsSeventeen patients, no more than 3 weeks after their TKA.Main outcome measuresIn a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0-10).ResultsTwo patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001). Resting knee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88).ConclusionBoth loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived.Trial registrationClinicalTrials.gov NCT01729520.

Project description:Total hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after these procedures, but early mobilization and short hospitalization length of stay (LOS) could potentially increase the risk of falls after discharge. We investigated injuries, circumstances, and the timing of fall-related hospital admissions 90 days after fasttrack THA and TKA.This was a prospective, descriptive multicenter study on fall-related hospital admissions, in 5145 elective fast-track THA and TKA patients, with complete 90-day follow up through the Danish National Patient registry and medical charts.Of 83 (1.6%) fall-related hospital admissions, 43 (51.8%) were treated in the Emergency Room and 40 (48.2%) were admitted to a regular ward. The median LOS after surgery was 3 days (interquartile range [IQR]: 2-3) in fallers versus (vs) 2 days (IQR: 2-3) (P=0.022) in patients without falls. Injuries were classified as "none" or minor in 39.8%, moderate in 9.6%, and major in 50.6%. Most falls (54.8%) occurred within 1 month of discharge. Falls due to physical activity (12.0%) and extrinsic factors (14.5%) occurred later than did surgery-related falls (73.5%), contributing to 40% of all falls >30 days after discharge. In multivariate analysis, age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.0-1.08) (P=0.001), living alone (OR: 2.09; 95% CI: 1.20-3.62) (P=0.009), and psychiatric disease (OR: 2.80; 95% CI: 1.42-5.50) (P=0.001) were associated with surgery-related falls, whereas the use of a walking aid (OR: 1.20; 95% CI: 0.67-2.16) (P=0.544) and LOS ?4 days (OR:1.19; 95% CI: 0.52-1.28) (P=0.680) was not.Hospital admissions due to falls are most frequent within the first month after fast-track THA and TKA. The overall incidence of surgery-related falls amongst these patients is low, declines after the first month, and is related to patient characteristics rather than short LOS. The effect of interventions aimed at surgery-related falls should focus on the first 30 days after surgery and differentiate between the causes of falling.

Dataset Information

The first 6 weeks of recovery after total knee arthroplasty with fast track.

Background and purpose

Patients and methods

Results

Interpretation

Publications

The first 6 weeks of recovery after total knee arthroplasty with fast track.

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