An evidence-based review of enhanced recovery after surgery in total knee replacement surgery

2018 ◽  
Vol 29 (9) ◽  
pp. 281-290 ◽  
Author(s):  
Arijit Ghosh ◽  
Urjit Chatterji
Keyword(s):  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Evidence Base ◽  
Evidence Based ◽  
Replacement Surgery ◽  
Cochrane Database ◽  
Total Knee ◽  
Study Methodology ◽  
Insight Into

Rationale: Enhanced recovery after surgery is gaining popularity among orthopaedic surgeons across the globe and hence a strong evidence base had to be reviewed to make an evidence-based sustainable protocol. Methods The following databases, PubMed, OVID, Cochrane database and EMBASE were searched. The search was limited to 15 components of enhanced recovery after surgery programme which is divided into preoperative, intraoperative and postoperative phases. Inclusion criteria were restricted to articles published in English within the last 15 years and articles comprising of unicompartmental arthroplasty, revision knee arthroplasty, bilateral simultaneous knee arthroplasty and only hip arthroplasty excluded. The full texts were analysed and controversies and limitations of various studies were summarised. Discussion Each component of the programme was thoroughly reviewed and strength and weaknesses of the evidence base summarised. The strength of the evidence was assessed by critically appraising the study methodology and justifying the appropriateness of the inclusion in enhanced recovery after surgery protocol. Conclusion Enhanced recovery after surgery has already been used successfully in various surgical specialities. Enhanced recovery after surgery programmes in knee arthroplasty are yet to be established as a universal practice to be adopted globally. This evidence-based review provides an insight into the best evidence linked to each component and their rationale for inclusion in the proposed enhanced recovery after surgery protocol.

scholarly journals Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Emmanuel Noel ◽  
Luca Miglionico ◽  
Mickael Leclercq ◽  
Harold Jennart ◽  
Jean-François Fils ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Multimodal Analgesia ◽  
Sublingual Tablet ◽  
Randomized Controlled ◽  
Total Knee ◽  
Median Pain

Abstract Purpose Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. Methods This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. Results Median pain score at 24 h at rest was 3 [2–4] for Oxy group vs 2 [1.75–3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3–6] vs 3 [2–5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). Conclusions In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. Trial registration Clinical Trials: NCT04448457; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3

scholarly journals Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Jingyi Li ◽  
Haibei Zhu ◽  
Ren Liao
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Clinical Practice ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Controlled Trial ◽  
Total Hip ◽  
Randomized Controlled ◽  
Total Knee

Abstract Background: With the substantially growing trend of the aging populations in China and the rest of the world, the number of total hip and total knee arthroplasty (THA and TKA) cases are increasing dramatically. It’s important to develop practical strategies to improve the quality of healthcare and better outcome for patients undergoing THA and TKA. Enhanced recovery after surgery (ERAS) pathways have been reported to promote earlier recovery and be beneficial for patients. We propose the hypothesis that ERAS pathway could provide better recovery for patients undergoing primary THA or TKA. Methods/Design: This trial is a prospective, open-labelled, randomized controlled trial that will evaluate the length of stay (LOS) in hospital, and other end points of interest for the patients undergoing ERAS pathway as compared to current non-ERAS clinical practice. A total of 640 patients undergoing primary THA or TKA will be randomly allocated to either ERAS pathway (ERAS group) or conventional care according to individual participating center (non-ERAS group). The primary outcome is the total LOS in hospital, the secondary outcomes include Postoperative LOS, all-cause mortality by 30 days after operation, in-hospital complications, early mobilization, postoperative pain control, total in-hospital cost, and readmission rate by 30 days after discharge from the hospital. Discussion: This trial is designed to evaluate the superiority of the ERAS pathway to conventional non-ERAS clinical practice in reducing the LOS without increasing the incidence of complications or medical cost. The results will provide new insight into the clinical applications of ERAS pathway for total hip and total knee arthroplasty. Trial registration: The National Institutes of Health Clinical Trials Registry, NCT03517098. Registered 04, May, 2018. https://register.clinicaltrials.gov/prs/app/action/ SelectProtocol?sid=S0007YV7&selectaction=Edit&uid=U0001B4E&ts=2&cx=97eyz9

Self-Management following Total Knee Arthroplasty: A concept to emphasize

2021 ◽  
Vol 15 (11) ◽  
pp. 2835-2835
Author(s):  
Samreen Sadiq ◽  
Rabiya Noor ◽  
Ashfaq Ahmed ◽  
Rizwan Akram ◽  
Izzat Hassan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
World Health ◽  
Self Management ◽  
Health Service Provider ◽  
Replacement Surgery ◽  
Successful Recovery ◽  
Total Knee

Knee Osteoarthritis (OA) is considered as one of the leading cause of disability around the world1. Total knee Arthroplasty is known to be the best treatment option available for reduction in pain and symptoms in case of failure of conservative management2. Recently enhanced recovery pathways have been followed after knee replacement surgery which includes a combination of early mobility, education of patient and care giver, nutritional and fluid support. These enhanced pathways lead to shorter hospital stay3. Due to the shortened hospital stay, the aspect of self-management by patient becomes fundamental. Post-operative self-management of patients following knee replacement is a crucial factor for successful recovery. Self-management as defined by World Health Organization is the ability of patients, care givers and community to effectively manage with the disease, either with the support of health service provider or independently. In knee replacement, self-management includes pain management, physical therapy exercises, daily self-activities and precautionary measures4.

scholarly journals Factors associated with the length of stay in total knee arthroplasty patients with the enhanced recovery after surgery model

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Guoqing Li ◽  
Jian Weng ◽  
Chang Xu ◽  
Deli Wang ◽  
Ao Xiong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Single Factor ◽  
Hidden Blood Loss ◽  
Physical Status Classification ◽  
Total Knee

Abstract Objectives The purpose of this study is to identify the factors that influence the length of stay (LOS) in total knee arthroplasty (TKA) patients with an enhanced recovery after surgery (ERAS) program. Methods Information from 167 patients (31 males and 136 females, range from 43 years to 88 years old) who underwent the unilateral elective primary TKA from January 2017 to January 2019 were reviewed retrospectively. Factors were analyzed by single-factor variance and multi-factor linear regression. Results By single-factor variance analysis, American Society of Anesthesiologists (ASA) physical status classification system, pre-operation albumin, pre-operation erythrocyte sedimentation rate (ESR), primary and merge diseases, hidden blood loss, and length of operation were correlated with LOS (P < 0.05). Multi-factor linear regression results suggested that gender, ASA class, pre-operation Alb, and pre-operation ESR were associated with LOS (P < 0.05). Moreover, ASA class 3 (B value 4.84), pre-operation Alb < 30 g/L (B value 18.33), and pre-operation ESR > 15 mmol/h (B value 2.21) could increase the LOS, while males (B value − 3.56) had a shortened LOS. Conclusions Overall, our research found that female, ASA class 3, pre-operation Alb < 30 g/L, and pre-operation ESR > 15 mmol/h could extend LOS in TKA patients with ERAS.

scholarly journals Application of enhanced recovery after surgery in total knee arthroplasty in patients with haemophilia A: A pilot study

Nursing Open ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 80-86
Author(s):  
Yan Wu ◽  
Haipeng Xue ◽  
Wenqiang Zhang ◽  
Yuhong Wu ◽  
Yanwei Yang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pilot Study ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Haemophilia A ◽  
Total Knee
Sign in / Sign up

Export Citation Format

Share Document