Comparison of two accelerated clinical pathways - after total knee replacement how fast can we really go?

Abstract

Early postoperative functional process indicators tended to be higher within the optimized pathway group, but the main effects flattened over the course of the first eight postoperative days.

The Use of Exparel (Liposomal Bupivacaine) to Manage Postoperative Pain in Unilateral Total Knee Arthroplasty Patients

“…The early ambulation in the study group appeared to correlate with decreased LOS as well. This is consistent with other studies [15,16]. The liposomal bupivacaine group stayed 0.29 fewer days in the hospital.…”

Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review

“…Renkawitz showed a flattening of benefits at day 8 post operation in a pathway of further optimisation of an existing accelerated clinical pathway protocol after total knee replacement (which included ultra-early/ doubled physiotherapy and use of motor-driven continuous passive motion machine units). 6 Lenssen showed that two daily sessions received by an experimental group and one by a comparison group following total knee arthroplasty resulted in no between-group difference in the primary outcome measure of range of motion. 29 Perhaps early mobilization within the first 24 post operative hours and one therapy session per day, as was typical in the trials included in this systematic review, could be considered as a benchmark.…”

Status of Healthcare

“…Undesired events caused by early mobilization, such as hemodynamic instability or the increased risk of falling, did not occur significantly more frequently when compared to control groups without early mobilization (Guerra et al 2015). Other studies were able to demonstrate lower risks of DTV, PE, chest infections and urinary retention during early mobilization (Renkawitz et al 2010). …”