Accelerated rehabilitation after total knee replacement

Isaac, David; Falode, Tunde; Liu, Phong; I’Anson, Helen; Dillow, Katherine; Gill, Paul

doi:10.1016/j.knee.2004.11.007

Cited by 79 publications

(66 citation statements)

References 12 publications

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“…Intensity of postoperative pain, consumption of rescue analgesics, and length of hospital stay were significantly reduced in the group that received ropivacaine. Open studies have shown similar results (Rasmussen et al 2004, Isaac et al 2005.…”

mentioning

confidence: 62%

Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

et al. 2007

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BackgroundPostoperative pain after total knee arthroplasty (TKA) can be difficult to manage and may delay recovery. Recent studies have suggested that periarticular infiltration with local anesthetics may improve outcome.Methods 80 patients undergoing TKA under spinal anesthesia were randomized to receive continuous femoral nerve block (group F) or peri-and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections of these substances through an intraarticular catheter.Results More patients in group I than in group F could walk > 3 m on the first postoperative day (29/39 vs. 7/37, p < 0.001). Group I also had significantly lower pain scores during activity and lower consumption of opioids on the first postoperative day. No differences between groups were seen regarding side effects or length of stay.Interpretation Peri-and intraarticular application of analgesics by infiltration and bolus injections can improve early analgesia and mobilization for patients undergoing TKA. Further studies of optimal drugs, dosage, and duration of this treatment are warranted.

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mentioning

confidence: 62%

Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

et al. 2007

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“…With the increasing popularity of integrated care pathways for patients undergoing TKRs, joint replacement after care is becoming increasingly standardised. It is currently a widely held standard that patients receive physiotherapy on the first post-operative day but some studies have already shown that aggressive physiotherapy and mobilisation on the day of surgery has reduced LOS following a TKR [13,14]. There is also evidence to suggest that there is no change in the rate of complications following a TKR if mobilisation is initiated on the first post-operative day [15], thus highlighting the benefit of early and aggressive post-operative mobilisation.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

Raut

Mertes

Muniz‐Terrera

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to examine factors associated with a prolonged length of stay (LOS) in patients over 75 undergoing a total knee replacement (TKR). Methods Patients over 75 undergoing a TKR at our institution from January 2008 to February 2009 were identified (n0112). Patient and operative factors previously shown to affect length of stay were identified. Patient notes were reviewed for details on each of these and data analysed for their effect on length of stay. Discrete data were analysed for their effect on postoperative length of stay using either the Mann-Whitney U test or the Kruskall-Wallis test and continuous data analysed with the Spearman's rank correlation coefficient. Results The following factors were associated with length of stay at the 95 % confidence level: patient age, pre-operative mobility and the use of walking aids, BMI, whether the patient was able to mobilise within 24 or 48 hours of the surgery, the day on which the patient first walked ten metres and achieved 90°active knee flexion, pre and post-operative haemoglobin and the need for a blood transfusion. Conclusions Pre-operative use of walking aids, perioperative haemoglobin concentration, failure to mobilise early following the operation and post-operative complications (including the need for a blood transfusion) seem to be the significant factors associated with a prolonged stay in hospital in the over 75 year olds.

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“…An option that has gained popularity is local infiltration with local anesthetics through the placement of an intraarticular catheter that allows for continuous local anesthetic infusion within the joint [4,7,14,17,19,22]. Recent studies have examined continuous intraarticular infusion of local anesthetic in orthopaedic surgery, concluding postoperative pain, the need for opioids as rescue medication, and mean length of hospital stay are reduced [4,8,10,14,19,21].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies of this technique have obtained promising results, showing a series of advantages for this technique compared with regional techniques or the use of intravenous opioids [4,7,14,19,22]. Local anesthetic use can produce analgesic effects through several mechanisms: afferent nociceptor blockade to prevent the transmission of painful nerve impulses, inhibition of inflammatory mediator release, and reduction of free radical and edema formation [11,12].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Analgesia in TKA: Ropivacaine Continuous Intraarticular Infusion

Gómez-Cardero

Rodríguez-Merchán

2010

Clinical Orthopaedics &Amp; Related Research

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Background Postoperative pain control is a challenge in patients undergoing TKA due to side effects and technical limitations of current analgesic approaches. Local anesthetic infiltration through continuous infusion pumps has been shown to reduce postoperative pain in previous studies. Questions/purposes We assessed the effectiveness of intraarticular ropivacaine infusions in reducing pain and postoperative opioid use after TKA and determined whether such infusions accelerate functional recovery of the patient and reduce length of hospital stay. Methods In a randomized, prospective, double-blind study, two groups were assigned: Group A (n = 25) underwent continuous intraarticular infusion with 300 mL ropivacaine 0.2% at a speed of 5 mL/hour through an elastomeric infusion pump and Group B (n = 25) had an elastomeric pump insertion with 300 mL saline solution at an infusion speed of 5 mL/hour. All patients had the same prosthesis model implanted. Parameters analyzed over the first 3 days, at discharge, and 1 month later included postoperative pain, joint function, opioid use, and length of hospital stay.

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Accelerated rehabilitation after total knee replacement

Cited by 79 publications

References 12 publications

Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

Postoperative Analgesia in TKA: Ropivacaine Continuous Intraarticular Infusion

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