Early mobilisation following fragility hip fracture surgery: current trends and association with dicharge outcomes in a local tertiary hospital

Introduction: Postoperative day 1 (POD1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD1 mobilisation at our institution; and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. Methods: In this preliminary observational study, data pertaining to demographics, pre-morbid function, health status, injury and surgical factors, POD1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD1 ambulation formed the “Early Ambulation (EA)” Group while the remaining patients formed the “Delayed Ambulation (DA)” group. Data were analysed for any significant difference between the groups. Results: 115 patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD1 was 80.0% (92 patients) which was comparable with data available from international hip fracture audit databases. 55 patients (47.8%) formed the EA group and 60 patients (52.5%) formed the DA group. EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20; 95% Confidence Interval 1.50-56.45; p = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to DA group (p > 0.05). Conclusion: This is the first local study to offer benchmark of the POD1 mobilisation status for this population. Patients who attained POD1 ambulation had better early functional recovery.

Application of MET Technique after Upper Limb Dysfunction after Breast Cancer Surgery

Object: Explore the application and actual effect of MET (Muscle Energy) technology after breast cancer surgery with upper limb dysfunction. Methods: Taking 40 female breast cancer patients who underwent surgical treatment in our hospital from September 2017 to June 2019 as the research objects, all of them successfully completed modified radical mastectomy for breast cancer. According to different nursing methods, the patients were randomly divided into two groups. The experiment There were 20 cases in each group and the control group. The control group was given routine functional recovery exercise intervention after the operation, and the experimental group added MET technology to the base of the control group. One month after the operation, the functional recovery of the affected limbs of the two groups of patients was effectively assessed. The upper limb dysfunction of the two groups was compared by statistical methods, and the shoulder joint range of motion (ROM) was used for performance. Results: Through early functional recovery training and MET technology, 19 cases of ROM in the experimental group showed compliance (95%), compared with only 14 cases (70%) in the control group. The difference in upper limb dysfunction between the two groups is very obvious with statistical significance (P<0.05). Conclusions: Early functional recovery training combined with muscle energy technology can promote the recovery of upper limb dysfunction after breast cancer surgery faster and better, which is conducive to the recovery of patients as soon as possible and improve the quality of life.

Robotic Assistance in Unicompartmental Knee Arthroplasty Results in Superior Early Functional Recovery and Is More Likely to Meet Patient Expectations

Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR.), VR/SF-12, Visual Analog Scale (VAS) pain scores, and perioperative opioid consumption. Patients in the robotic cohort had superior early functional outcomes, with greater LEFS (conventional = 23; robotic = 31) at 1 week post-op p = 0.015 and KOOS-JR (conventional = 74; robotic = 81) at up to 6 months post-op p = 0.037 ; these two values remained statistically significant after mixed-model regression analysis p = 0.010 ; p = 0.023 , respectively. At 1 year post-op, expectations were more likely to be met in those who received robotic assistance p = 0.06 . No differences were reported with respect to postoperative opioid usage p = 0.320 , reoperations p = 1.00 , and complications p = 0.628 . Robotic-assisted UKA resulted in more rapid recovery and less early postoperative pain and were more likely to meet expectations than conventional UKA, although functional differences equilibrated by 1 year postoperatively. Further follow-up is necessary to determine if implant durability is impacted by robotics.