Results of a fast-track knee arthroplasty according to the experience of a multidisciplinary team

Abstract

Introduction: Fast-Track is a multidisciplinary system that has changed the perception of total knee arthroplasty surgery. It's based on the education of the patient, an increased autonomy, adequate pain control and early mobilization. In the bibliography, there are no articles that refer to the evolution of the protocol once established, and most of them are comparatives with the previously existing conventional system. For this reason, the objective of our work is to study the evolution of the clinical results obtained through a Fast-Track system according to the experience acquired by the multidisciplinary team in this protocol. Material and methods: It's a prospective observational study. We have analyzed the results obtained in our center from its implementation in 2013 (n = 65) to the end of the study in 2016 (n = 60). We evaluated the pain at 24 and 48 h after surgery, the time until the first ambulation, the range of flexion and extension at discharge, and length of hospital stay. Results: The results obtained at the beginning of the implantation of the Fast-Track protocol in our center and the present ones do not present statistically significant differences. Mean pain at 24 h was 1,65/10 in 2013 and 1,5/ 10 in 2016, and at 48 h 1,61/10 and 1,58/10 respectively. Most of the patients in both years scored a pain below 4/10 at 24 h and 48 h. Mean time of the first ambulation was 260 min in 2013 and 254 min in 2016 (most of the patients started walking in ≤5 h). Mean flexion at discharge was 90,3°in 2013 and 87,92°in 2016 (most of the patients presented a flexion between 80 and 100°). Mean extension at discharge was 6,95°in 2013 and 8,1°in 2016 (most of the patients presented an extension between 0 and 10°). Mean length of stay was 2,46 days in 2013 and 2,43 days in 2016 (most of the patients had a stay of fewer than 4 days). Conclusions: When applying the Fast-Track protocol by a multidisciplinary team in primary knee prosthetic surgery, the clinical results obtained are independent of the experience of this team in the protocol. So, from our experience, we can affirm that the protocol has enough solidity since its beginning and it maintains similar results despite the years of execution.

Gonyautoxins 2/3 Local Periarticular Injection for Pain Management after Total Knee Arthroplasty: A Double-Blind, Randomized Study

“…21,22 Early mobilization allows for better rehabilitation with a lower risk of falls-an essential goal in fast-track protocols. 23,24 Preliminary studies show higher morphine consumption than that found in our study with periarticular infiltration. Fan et al reported a total consumption of 37.8 mg using LIA.…”

“…A logistic regression using 50-resampling missing imputation was estimated for intended-to-treat analysis of total morphine consumption, 24…”

Clinical Results Before and After Implementation of a Fast - Track Protocol For 507 Patients Who Underwent Total Knee Arthroplasty Surgery: A Retrospective, Observational Study

“…The fast-track program continued to use existing clinical guidelines for state-of-the-art working protocols and continuous improvement [12]. Once a patient was considered eligible for TKA, they were invited to participate in an educational workshop with a relative.…”

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

“…They are characterized by changes to the surgical procedure and the post-discharge function [ 5 , 6 ] and by the participation of different specialists at all stages [ 3 , 7 ]. Their goal is to reduce the physiological and psychological stress of surgery, achieve earlier mobilization and faster recovery, and reduce length of stay (LOS) and hospital costs [ 8 ].…”