Combining enhanced recovery and short-stay protocols for hip and knee joint replacements: the ideal solution

Vendittoli, Pascal-André; Pelleï, Karina; Williams, Carla; Laflamme, Claude

doi:10.1503/cjs.019519

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Concerning perioperative care, introducing principles of enhanced recovery after surgery (ERAS) and implementing arthroplasty-specific recovery pathways have had a dramatic, positive impact on patient outcomes ( 42 , 43 ). A successful ERAS program requires multidisciplinary collaboration among anesthesiologists, surgeons, physiotherapists, nurses, and hospital administrators.…”

Section: Optimized and Personalized Perioperative Carementioning

confidence: 99%

Why personalized surgery is the future of hip and knee arthroplasty: a statement from the Personalized Arthroplasty Society

Vendittoli,

Riviere,

Hirschmann

et al. 2023

EFORT Open Reviews

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Although hip and knee joint replacements provide excellent clinical results, many patients still do not report the sensation and function of a natural joint. The perception that the joint is artificial may result from the anatomical modifications imposed by the surgical technique and the implant design. Moreover, the joint replacement material may not function similarly to human tissues. To restore native joint kinematics, function, and perception, three key elements play a role: (i) joint morphology (articular surface geometry, bony anatomy, etc.), (ii) lower limb anatomy (alignment, joint orientation), and (iii) soft tissue laxity/tension. To provide a ‘forgotten joint’ to most patients, it is becoming clear that personalizing joint replacement is the key solution. Performing a personalized joint replacement starts with patient selection and preoperative optimization, followed by using a surgical technique and implant design aimed at restoring the patient’s native anatomy, creating optimal implant-to-bone stress transfer, restoring the joint’s native articular range of motion without imposed limitations, macro- and micro-stability of the soft tissues, and a bearing whose wear resistance provides lifetime survivorship with unrestricted activities. In addition, the whole perioperative experience should follow enhanced recovery after surgery principles, favoring a rapid and complication-free recovery. As a new concept, some confusion may arise when applying these personalized surgery principles. Therefore, the Personalized Arthroplasty Society was created to help structure and accelerate the adoption of this paradigm change. This statement from the Society on personalized arthroplasty will serve as a reference that will evolve with time.

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Section: Optimized and Personalized Perioperative Carementioning

confidence: 99%

Why personalized surgery is the future of hip and knee arthroplasty: a statement from the Personalized Arthroplasty Society

Vendittoli,

Riviere,

Hirschmann

et al. 2023

EFORT Open Reviews

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“…By adopting this multimodal technique, the regulation of cortisol and adrenocorticotrophic hormone levels is better maintained. Range-of-motion and weight-bearing restrictions should be avoided to facilitate early mobilization [ 6 , 36 , 37 , 38 ].…”

Section: Early Mobilizationmentioning

confidence: 99%

“…In 2014, a team led by Dr Pascal-André Vendittoli introduced a perioperative short-stay protocol for THA procedures at Maisonneuve-Rosemont Hospital, following the ERAS principles to minimize adverse events. Implementing the ERAS short-stay protocols ( Figure 1 , flow diagram) required the involvement of a multidisciplinary team (inclusive of patients), who committed to a standardized, evidence-based protocol for the perioperative management of the patient [ 6 ].…”

Section: Eras and Outpatient Pathway Integration For Thamentioning

confidence: 99%

“…On the other hand, some short-stay protocols have shifted from aiming to reduce complications and improve recovery to using length-of-stay as the primary measure of success. Combining the principles of ERAS as part of an innovative integrated ERAS-outpatient protocol, hospitals have the opportunity to reduce the challenges of bed capacity and reduce healthcare costs whilst optimizing the patient experience, clinical safety, and clinical effectiveness [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol

Sivaloganathan

Blakeney

Vendittoli

2022

JCM

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Pressure to reduce healthcare costs, limited hospital availability along with improvements in surgical technique and perioperative care motivated many centers to focus on outpatient pathway implementation. However, in many short-stay protocols, the focus has shifted away from aiming to reduce complications and improved rehabilitation, to using length of stay as the main factor of success. To improve patient outcomes and maintain safety, the best way to implement a successful outpatient program would be to combine it with the principles of enhanced recovery after surgery (ERAS), and to improve patient recovery to a level where the patient is able to leave the hospital sooner. This article delivers a case for modernizing total hip arthroplasty perioperative pathways by implementing ERAS-outpatient protocols.

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“…Current rates of joint replacement surgery and forecast future demand necessitate efficient models of care that can safely shorten hospital admissions and maximise surgical throughput. Short-stay joint replacement programs (also known as ‘fast-track’, ‘rapid recovery’ or ‘enhanced recovery after surgery’ programs) are designed to reduce acute hospital length of stay through specific anaesthetic, analgesia, early mobilisation, and hospital discharge protocols [ 1 ]. Short-stay joint replacement programs have been introduced in numerous countries including the United States [ 2 ], United Kingdom [ 3 ], and Sweden [ 4 ], but do not feature prominently in the Australian health system.…”

Section: Introductionmentioning

confidence: 99%

Stakeholder perspectives on short-stay joint replacement programs: results from a national cross-sectional study

Ackerman,

Berkovic,

Soh

et al. 2023

BMC Health Serv Res

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Background The capacity to meet anticipated growth in joint replacement demand requires safe, efficient models of care. While short-stay joint replacement programs are being used internationally, they have not been widely implemented in many countries. Importantly, the critical challenges that need to be addressed ahead of large-scale program implementation remain unclear. This study aimed to investigate stakeholder perspectives on short-stay joint replacement programs, including perceived barriers and enablers to implementation and sustainability, and understand current practices in Australia. Methods Four key stakeholder groups were invited to participate in this national study: (1) health professionals who provide joint replacement care; (2) hospital administrators involved in joint replacement provision; (3) patients with recent joint replacement; and (4) carers of people with recent joint replacement. Data on perceived feasibility (0 (not at all feasible) − 10 (highly feasible), appeal (0 (not at all appealing) − 10 (highly appealing), current practices, and barriers and enablers were collected using visual analogue scales, multiple response option and open-ended questions, via an online platform. Descriptive analysis and free-text content analysis was undertaken. Results Data were available from 1,445 participants including 360 health professionals, 20 hospital administrators, 1,034 patients, and 31 carers. Short-stay program implementation was considered moderately feasible by health professionals (median 6, interquartile range (IQR) 3–8) and hospital administrators (median 5, IQR 5–6). Short-stay programs were moderately appealing to patients (median 7, IQR 2–9) but of little appeal to carers (median 3, IQR 1–7). Prominent implementation barriers included perceived limited appropriateness of short-stay programs, inadequate home supports, and issues around reimbursement models or program funding. Not having daily physiotherapy access and concerns about pain and mobility at home were common barriers for patients. Concern about patients’ ability to manage daily activities was the most common barrier for carers. Access to post-discharge services, better funding models, improved staffing, and consistent protocols and national care standards were prominent enablers. Conclusions This national study has uniquely captured multiple stakeholder perspectives on short-stay joint replacement programs. The findings can guide future quality improvement and implementation initiatives and the development of resources to best support patients, carers, clinicians, and hospitals.

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Combining enhanced recovery and short-stay protocols for hip and knee joint replacements: the ideal solution

Cited by 6 publications

References 5 publications

Why personalized surgery is the future of hip and knee arthroplasty: a statement from the Personalized Arthroplasty Society

Why personalized surgery is the future of hip and knee arthroplasty: a statement from the Personalized Arthroplasty Society

Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol

Stakeholder perspectives on short-stay joint replacement programs: results from a national cross-sectional study

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