Enhanced recovery protocol after single-stage bilateral primary total knee arthroplasty decreases duration of hospital stay without increasing complication rates

Azam, Quamar; Goyal, Tarun; Paul, Souvik; Yadav, Arvind Kumar; Govil, Nishith

doi:10.1007/s00590-021-03031-y

Cited by 3 publications

(9 citation statements)

References 37 publications

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“…Proper postoperative care of patients undergoing BTKA can reduce length of stay and morbidity, including rates of DVT and pulmonary embolism 16,70 . In particular, postoperative thromboprophylaxis with aspirin has been shown to be more effective than warfarin in the prevention of DVT and pulmonary embolism after simultaneous BTKA 70 .…”

Section: Current Guidelinesmentioning

confidence: 99%

“…In particular, postoperative thromboprophylaxis with aspirin has been shown to be more effective than warfarin in the prevention of DVT and pulmonary embolism after simultaneous BTKA 70 . In addition, enhanced recovery protocols, including interventions such as preoperative patient optimization, opioid sparing multimodal anesthesia, and early mobilization, have been shown to decrease length of hospital stay without increasing complication rate in single-stage bilateral primary TKA 16,71 .…”

Section: Current Guidelinesmentioning

confidence: 99%

“…Knowledge of the current evidence for bilateral knee arthritis is crucial for informed clinical decision making. Proponents of simultaneous BTKA note that performing both TKAs under a single anesthetic setting offers the advantages of a shorter total hospital stay 11,13,14 , a single rehabilitation period 15-17 , and increased cost effectiveness without substantial compromises in postoperative complications or functional outcomes 11,18 . Others argue that simultaneous BTKA is associated with greater morbidity and mortality 14,19,20 .…”

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confidence: 99%

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Bilateral Total Knee Arthroplasty

et al. 2023

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Bilateral total knee arthroplasty (BTKA) is an effective surgical treatment for bilateral knee arthritis and can be performed as a simultaneous surgery under a single anesthetic setting or as staged surgeries on separate days.Appropriate patient selection is important for simultaneous BTKA with several factors coming into consideration such as age, comorbidities, work status, and home support, among others.While simultaneous BTKA is safe when performed on appropriately selected patients, current evidence suggests that the risk of complications after simultaneous BTKA remains higher than for staged BTKA.When staged surgery is preferred, current evidence indicates that complication risks are minimized if the 2 knees are staged at least 3 months apart.Simultaneous BTKA is the economically advantageous treatment option relative to staged BTKA, primarily because of shorter total operative time and total hospital stay.

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Section: Current Guidelinesmentioning

confidence: 99%

Section: Current Guidelinesmentioning

confidence: 99%

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confidence: 99%

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Bilateral Total Knee Arthroplasty

et al. 2023

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“…The study and participant characteristics of the 49 included studies as well as a description of the shortstay and usual care groups are shown in Table 1. They were published from 2005 to 2023 and originated from sixteen countries: thirteen from the United Kingdom (UK) [25][26][27][28][29][30][31][32][33][34][35][36][37], seven from the United States (US) [38][39][40][41][42][43][44], four from China [45][46][47][48], three studies each from France [49][50][51], Italy [52][53][54] and the Netherlands [55][56][57], two studies each from Canada [58,59], Denmark [60,61], New Zealand [62,63], and Sweden [64,65], and one study each from Australia [66], Brazil [67], Germany [68], India [69], Ireland …”

Section: Trial Design Setting and Characteristicsmentioning

confidence: 99%

“…More than half (n = 25, 51%) included participants undergoing either hip or KR [25, 28, 31, 34-36, 38, 39, 42, 44, 45, 49, 51, 53, 54, 59, 60, 62-66, 70, 72, 73], 13 (27%) included participants undergoing TKR only [26,27,30,32,43,46,47,50,52,[56][57][58]69], 11 (22%) included participants undergoing THR only [11,29,37,40,41,48,55,61,67,68,71], one included participants undergoing unicompartmental KR [33], one included participants undergoing bilateral total KR [69] and one included participants undergoing either unilateral or same-day bilateral THR [67].…”

Section: Trial Design Setting and Characteristicsmentioning

confidence: 99%

A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection

Berkovic,

Vallance,

Harris

et al. 2023

BMC Med

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Background Short-stay joint replacement programmes are used in many countries but there has been little scrutiny of safety outcomes in the literature. We aimed to systematically review evidence on the safety of short-stay programmes versus usual care for total hip (THR) and knee replacement (KR), and optimal patient selection. Methods A systematic review and meta-analysis. Randomised controlled trials (RCTs) and quasi-experimental studies including a comparator group reporting on 14 safety outcomes (hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, neurovascular injury, other complications, periprosthetic fractures, postoperative falls, venous thromboembolism, wound complications, dislocation, stiffness) within 90 days postoperatively in adults ≥ 18 years undergoing primary THR or KR were included. Secondary outcomes were associations between patient demographics or clinical characteristics and patient outcomes. Four databases were searched between January 2000 and May 2023. Risk of bias and certainty of the evidence were assessed. Results Forty-nine studies were included. Based upon low certainty RCT evidence, short-stay programmes may not reduce readmission (OR 0.95, 95% CI 0.12–7.43); blood transfusion requirements (OR 1.75, 95% CI 0.27–11.36); neurovascular injury (OR 0.31, 95% CI 0.01–7.92); other complications (OR 0.63, 95% CI 0.26–1.53); or stiffness (OR 1.04, 95% CI 0.53–2.05). For registry studies, there was no difference in readmission, infection, neurovascular injury, other complications, venous thromboembolism, or wound complications but there were reductions in mortality and dislocations. For interrupted time series studies, there was no difference in readmissions, reoperations, blood loss volume, emergency department visits, infection, mortality, or neurovascular injury; reduced odds of blood transfusion and other complications, but increased odds of periprosthetic fracture. For other observational studies, there was an increased risk of readmission, no difference in blood loss volume, infection, other complications, or wound complications, reduced odds of requiring blood transfusion, reduced mortality, and reduced venous thromboembolism. One study examined an outcome relevant to optimal patient selection; it reported comparable blood loss for short-stay male and female participants (p = 0.814). Conclusions There is low certainty evidence that short-stay programmes for THR and KR may have non-inferior 90-day safety outcomes. There is little evidence on factors informing optimal patient selection; this remains an important knowledge gap.

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Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis

Zhang,

Chen,

et al. 2023

Postgraduate Medical Journal

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Purpose Enhanced recovery after surgery (ERAS) was characterized as patient-centered, evidence-based, multidisciplinary team-developed routes for a surgical speciality and institution to improve postoperative recovery and attenuate the surgical stress response. However, evidence of their effectiveness in osteoarthroplasty remains sparse. This study aimed to develop an ERAS standard and evaluate the significance of ERAS interventions for postoperative outcomes after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods We searched Medline, Embase, Cochrane databases, and Clinicaltrials.gov for randomized controlled trials, cohort studies, and case–control studies until 24 February 2023. All relevant data were collected from studies meeting the inclusion criteria. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was the length of stay (LOS), postoperative complications, and readmission rate. The secondary outcomes included transfusion rate, mortality rate, visual analog score (VAS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Short Form 36 (SF-36) bodily pain (SF-36 BP), SF-36 physical function (SF-36 PF), oxford knee score, and range of motion (ROM). Results A total of 47 studies involving 76 971 patients (ERAS group: 29 702, control group: 47 269) met the inclusion criteria and were included in the meta-analysis. The result showed that ERAS could significantly shorten the LOS (WMD = −2.65, P < .001), reduce transfusion rate (OR = 0.40, P < .001), and lower 30-day postoperative mortality (OR = 0.46, P = .01) without increasing postoperative complications or readmission rate. Apart from that, ERAS may decrease patients’ VAS (WMD = −0.88, P = .01) while improving their ROM (WMD = 6.65, P = .004), SF-36 BP (WMD = 4.49, P < .001), and SF-36 PF (WMD = 3.64, P < .001) scores. However, there was no significant difference in WOMAC, oxford knee score between the ERAS and control groups. Furthermore, we determined that the following seven components of the ERAS program are highly advised: avoid bowel preparation, PONV prophylaxis, standardized anesthesia, use of local anesthetics for infiltration analgesia and nerve blocks, tranexamic acid, prevent hypothermia, and early mobilization. Conclusion Our meta-analysis suggested that the ERAS could significantly shorten the LOS, reduce transfusion rate, and lower 30-day postoperative mortality without increasing postoperative complications or readmission rate after THA and TKA. Meanwhile, ERAS could decrease the VAS of patients while improving their ROM, SF-36 BP, and SF-36 PF scores. Finally, we expect future studies to utilize the seven ERAS elements proposed in our meta-analysis to prevent increased readmission rate for patients with THA or TKA.

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Enhanced recovery protocol after single-stage bilateral primary total knee arthroplasty decreases duration of hospital stay without increasing complication rates

Cited by 3 publications

References 37 publications

Bilateral Total Knee Arthroplasty

Bilateral Total Knee Arthroplasty

A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection

Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis

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