Compression Bandaging Improves Mobility following Total Knee Replacement in An Enhanced Recovery Setting

AbstractTotal knee replacement (TKR) is one of the most common orthopaedic procedures performed, and enhanced recovery after surgery (ERAS) has been developed and incorporated into inpatient surgical pathways to improve patient outcomes. Under ERAS recommendations, multimodal prophylaxis has been used to help manage postoperative nausea and vomiting (PONV) following TKR. Dexamethasone is one of the commonly used for this and the anti-inflammatory properties could depress vagal activity, reducing postural hypotension (PH). The hypothesis of this study is that postoperative dexamethasone use is associated with lower rates of early postoperative PH following TKR surgery. In our institution, patients who undergo elective primary TKR are admitted on the day of surgery and follow a standardized ERAS protocol. Data on patients who underwent elective primary TKR under a single adult reconstruction team from September 2017 to March 2020 were reviewed and analyzed. A review of demographic characteristics, surgical data, postoperative medications, and postoperative notes was performed. Binary logistic regression was used to assess the effect of the use of dexamethasone on PH, with an adjusted odds ratio (OR) calculated after accounting for potential confounders. Of the 149 patients were included in the study, 78 had dexamethasone postoperatively, and 71 did not. Patients who had received dexamethasone were statistically less likely to suffer from PH (OR = 0.31, p = 0.03) and less likely to develop PONV (OR = 0.21, p = 0.006). Patients who had received dexamethasone were more likely able to participate in early physiotherapy (OR = 2.42, p = 0.14), and this result was statistically insignificant. The use of postoperative intravenous dexamethasone is significantly associated with lower rates of postoperative PH after TKR. However, more studies are required to assess the optimal dosing amount and frequency, as well as to assess other factors which can enhance early postoperative patient mobilization as part of our goals for ERAS. This therapeutic study reflects level of evidence III.

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A Randomized, Controlled Trial Comparing Compression Bandaging and Cold Therapy In Postoperative Total Knee Replacement Surgery

Orthopaedic Nursing ◽

10.1097/00006416-200203000-00009 ◽

2002 ◽

Vol 21 (2) ◽

pp. 61-62 ◽

Cited By ~ 38

Author(s):

John Smith ◽

John Stevens ◽

Maree Taylor ◽

Jill Tibbey

Keyword(s):

Randomized Controlled Trial ◽

Total Knee Replacement ◽

Knee Replacement ◽

Controlled Trial ◽

Knee Replacement Surgery ◽

Replacement Surgery ◽

Randomized Controlled ◽

Cold Therapy ◽

Compression Bandaging ◽

Total Knee

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Enhanced recovery programmes can reduce length of stay after total knee replacement without sacrificing functional outcome at one year

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2015.0016 ◽

2015 ◽

Vol 97 (8) ◽

pp. 563-567 ◽

Cited By ~ 13

Author(s):

JF Maempel ◽

PJ Walmsley

Keyword(s):

Length Of Stay ◽

Total Knee Replacement ◽

Range Of Motion ◽

Functional Outcome ◽

Knee Replacement ◽

Enhanced Recovery ◽

District General Hospital ◽

Significant Difference ◽

Total Knee ◽

One Year

Introduction Enhanced recovery programmes (ERPs) are being widely adopted in total knee replacement (TKR) procedures but studies confirming that they have no adverse effects on functional outcomes are lacking. The aim of this study was to compare length of stay, postoperative functional outcome and range of motion at one year postoperatively between patients undergoing TKR with an ERP and those with traditional rehabilitation. Methods A total of 165 consecutive patients undergoing primary unilateral TKR were included in the study. Overall, 84 patients undergoing TKR with an ERP were compared with a series of 81 patients undergoing primary unilateral TKR with traditional rehabilitation, immediately before the introduction of the ERP. Results The median postoperative length of stay was 3 days in the ERP cohort and 4 in the traditionally rehabilitated cohort (p<0.001). There were no significant differences in the preintervention characteristics of the groups and there was no significant difference in operative time, transfusion or rates of manipulation under anaesthesia. There was no difference in magnitude of improvement in American Knee Society score (p=0.12) or range of motion (p=0.81) between the groups. Conclusions ERP can reduce length of stay after TKR while offering improvements in knee function equivalent to those experienced by patients undergoing TKR with traditional rehabilitation. Furthermore, ERP can be implemented successfully in the setting of a district general hospital.

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Total Hip Replacement and Total Knee Replacement outcomes in the elderly - An opportunity for further improvement of ERAS pathways.

10.14293/s2199-1006.1.sor-.ppq8hwz.v1 ◽

2020 ◽

Author(s):

Louise Burgess ◽

Thomas Wainwright

Keyword(s):

Length Of Stay ◽

Total Knee Replacement ◽

Elderly Patients ◽

Total Hip Replacement ◽

Knee Replacement ◽

Hip Replacement ◽

Enhanced Recovery ◽

The Elderly ◽

Very Elderly ◽

Total Knee

Introduction Postoperative outcomes of total hip replacement (THR) and total knee replacement (TKR) have been improved by Enhanced Recovery after Surgery (ERAS) guidelines. The elderly population is increasing and successful fast-track rehabilitation can be achieved amongst this cohort. However, the cohorts studied in previous literature are generally younger, healthy patients, who would be expected to recover well from a multidisciplinary pathway. Literature to assess the role of enhanced recovery in the very elderly is limited. The aim of this study is to assess the current outcomes for elderly patients post THR and TKR and explore the opportunity for further application of ERAS pathways. Methods This retrospective study was completed by collecting UK acute NHS hospital data through Hospital Episode Statistics (HES), accessed via the Dr. Foster Healthcare Intelligence Portal. Length of stay, readmission rates, complication of care and mortality were recorded for all THR and TKR cases. Results Length of stay, readmission and complication of care rates increased linearly with age for both THR and TKR patients. For over 85s, average length of stay was 5.0 and 4.5 days (THR and TKR respectively), 30 day re-admission was 9.4% and 9.9%, complication of care was 13.3% and 11.9% and mortality rate was 0.5% and 0.4%. Conclusions The very elderly have the most to gain from an ERAS programme but still have the longest stay in hospital and the greatest post-operative complications. Further work is required to determine how to reduce the risk of complications and increase functional recovery in elderly patients.

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