Introduction: Fast-Track is a multidisciplinary system that has changed the perception of total knee arthroplasty surgery. It's based on the education of the patient, an increased autonomy, adequate pain control and early mobilization. In the bibliography, there are no articles that refer to the evolution of the protocol once established, and most of them are comparatives with the previously existing conventional system. For this reason, the objective of our work is to study the evolution of the clinical results obtained through a Fast-Track system according to the experience acquired by the multidisciplinary team in this protocol. Material and methods: It's a prospective observational study. We have analyzed the results obtained in our center from its implementation in 2013 (n = 65) to the end of the study in 2016 (n = 60). We evaluated the pain at 24 and 48 h after surgery, the time until the first ambulation, the range of flexion and extension at discharge, and length of hospital stay. Results: The results obtained at the beginning of the implantation of the Fast-Track protocol in our center and the present ones do not present statistically significant differences. Mean pain at 24 h was 1,65/10 in 2013 and 1,5/ 10 in 2016, and at 48 h 1,61/10 and 1,58/10 respectively. Most of the patients in both years scored a pain below 4/10 at 24 h and 48 h. Mean time of the first ambulation was 260 min in 2013 and 254 min in 2016 (most of the patients started walking in ≤5 h). Mean flexion at discharge was 90,3°in 2013 and 87,92°in 2016 (most of the patients presented a flexion between 80 and 100°). Mean extension at discharge was 6,95°in 2013 and 8,1°in 2016 (most of the patients presented an extension between 0 and 10°). Mean length of stay was 2,46 days in 2013 and 2,43 days in 2016 (most of the patients had a stay of fewer than 4 days). Conclusions: When applying the Fast-Track protocol by a multidisciplinary team in primary knee prosthetic surgery, the clinical results obtained are independent of the experience of this team in the protocol. So, from our experience, we can affirm that the protocol has enough solidity since its beginning and it maintains similar results despite the years of execution.

Background: Total Knee Arthroplasty (TKA) is an intervention that can significantly improve the quality of life of patients with advanced knee osteoarthritis. Early start of rehabilitation and its continuation at home once the patient is discharged are key factors for the success of the process.This study aims to assess the effectiveness of a home-based telerehabilitation solution (ReHub) on improving functional capacity and clinical outcomes for patients who underwent TKA. Methods/design:The study is a randomized, open-label with blinded outcome assessor, parallel assignment clinical trial with a sample size of 52 patients that is conducted according to the SPIRIT recommendations. After the TKA intervention, the patients are randomly allocated to the control group or the experimental group with a 1:1 ratio. Both groups follow a Fast Track recovery protocol which includes discharge after 2-3 days from surgery, a daily plan of 5 exercises for autonomous rehabilitation and domiciliary visits by a physiotherapist starting approximately 2 weeks after surgery. The experimental group uses the sensor-based telerehabilitation system ReHub to perform the exercises. The primary outcome measure is the range of motion of the knee. Secondary outcomes include physical performance, quality of life, pain intensity, muscle strength, treatment adherence and satisfaction with the ReHub system. The outcomes assessment is performed at hospital discharge (baseline), at stitch removal (2 weeks after baseline) and 2 weeks after stitch removal (4 weeks after baseline).The study conforms to the guidelines of the Declaration of Helsinki and was approved by the hospital's ethics committee.Discussion: The study will address an important gap in the evidence base by reporting the effectiveness of an affordable and low-cost home-based telerehabilitation solution in patients who underwent TKA. Ethics and dissemination:The study was approved by the hospital's ethics committee ("Comité Ético de Investigación Clínica del HCB", reg. HCB/2019/0571). The trial was registred at ClinicalTrials.gov (NCT04155957). The results of this study will be published in peer-reviewed journals as well as national and international conferences.

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