Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study

Abstract

Background Several strategies have been devised to reduce the length of stay after orthopedic surgery. Telerehabilitation has proved effective in functional outcomes after orthopedic procedures and is appreciated by patients. There is limited information on fast-track surgery and telerehabilitation protocols for unicompartmental knee arthroplasty (UKA). The purpose of this pilot study was to report and compare functional outcomes and satisfaction levels during first 12 months of recovery in patients who underwent UKA according to a fast-track and telerehabilitation protocol (G1) or standard surgery and rehabilitation program (G2). Methods Data were retrospectively collected and reviewed for all elective UKAs from January 2018 to November 2019. A total of seven patients undergoing UKA according to the fast-track and telerehabilitation protocol were propensity score matched (1:3 ratio) to 21 patients undergoing standard surgery and rehabilitation. Patients were matched for age, sex, body mass index (BMI), and laterality. The Western Ontario and McMaster University (WOMAC) osteoarthritis index and range of motion (ROM) were collected pre- and postoperatively in both groups for 12 months. In addition, patient’ satisfaction was collected at 40 days. Results The G1 group demonstrated significantly better outcomes in WOMAC index scores at 2, 15, and 40 days (p < 0.001, p < 0.001, p < 0.020, respectively) and a significantly greater knee ROM after surgery and at 2, 15, 40, and 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively). No patients in either group had postoperative complications. One patient was not completely satisfied in the G2, while no one in G1 reported not being completely satisfied (p = 1.000). Conclusions This fast-track and telerehabilitation protocol after UKA can potentially be applied to patients as it is safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 score was better regarding WOMAC and ROM when compared with the propensity score-matched G2 program. A larger study is warranted to explore the role of fast-track and telerehabilitation in clinical and functional outcomes of UKA.

No difference in Oxford Knee Score between medial and lateral unicompartmental knee arthroplasty after two years of follow‐up: a clinical trial

“…Enoxaparin sodium 4000 units subcutaneously daily for 45 days was used as thromboembolic prophylaxis. The postoperative protocol was conducted following a previous report [12]. Briefly, both the patient groups followed the same study protocol involving passive mobilisation from day one after the surgery.…”

Assessment of Fast-Track Pathway in Hip and Knee Replacement Surgery by Propensity Score Matching on Patient-Reported Outcomes

“…Even though this latter study is outside of the Fast Track setting, and none of the above-mentioned studies use PSM to compare the procedures on the PROMs, the studies confirm the increasing adoption of bias-correcting techniques, such as PSM, to eliminate confounders in the comparison of cohorts of patients in orthopedic settings. As we mentioned in the introduction, only the recent study by De Berardinis et al [ 15 ], applied PSM to analyze the impact of the Fast Track on PROMs: in particular, the authors found that patients undergoing UKA, according to a fast-track and telerehabilitation protocol, had significantly better WOMAC index scores at 2, 15, and 40 days than those undergoing standard surgery and rehabilitation, using the PSM methods. When compared with this previous study, our results are more general in terms of the considered procedures (in that they apply to both hip- and knee-related procedures, rather than only knee-related ones), and also we consider the SF-12 scores, rather than WOMAC, which, as mentioned before, is one of the most common tools used to measure HRQoL.…”

“…Conversely, Care-as-Usual rehabilitation programs result in a longer delay between surgery and rehabilitation activities aimed at functional recovery, leading to delayed discharge, as well as complications associated with a longer hospital stay. Although [ 14 ] observed that supervised progressive resistance training was not superior when compared to unsupervised home-based exercise, in the rehabilitation of patients who have had unicompartmental knee arthroplasty (UKA), a recent study by [ 15 ] found that patients undergoing UKA, according to a Fast Track and telerehabilitation protocol, had significantly better WOMAC index scores at 2, 15, and 40 days than those undergoing standard surgery and rehabilitation.…”

Metal-backed or all-poly tibial components: which are better for medial unicompartmental knee arthroplasty? A propensity-score-matching retrospective study at the 5-year follow-up

“…Data analysis was performed using Microsoft Excel (2019) in conjunction with the XLSTAT resource pack (XLSTAT Premium, Addinsoft, New York, NY, USA). A propensity-score-matching (PSM) analysis was employed to minimize variations in known covariates between the cohorts [ 49 ], since several retrospective arthroplasty studies have used this type of analysis to minimize selection bias [ 8 , 27 , 50 – 57 ]. The two patient groups were matched one-to-one by an optimal matching algorithm [ 58 ].…”