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Nasu T, Yamanoi J, Kitagawa T. The Investigation of Preoperative Factors Associated With Postoperative Outcomes Following Total Knee Arthroplasty for Osteoarthritis: A Scoping Review. Cureus 2024; 16:e64989. [PMID: 39161506 PMCID: PMC11333026 DOI: 10.7759/cureus.64989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
This study aimed to investigate preoperative factors associated with non-home discharges from acute care hospitals in patients undergoing total knee arthroplasty (TKA) due to osteoarthritis. It was a scoping review focused on patients who received their first unilateral TKA for osteoarthritis. The research targeted observational studies that examined the destinations of patients post-surgery based on preoperative factors, with a literature search conducted in April 2023. Out of 3,255 identified papers, 28 met the eligibility criteria. A total of 26 preoperative factors were identified as potentially related to discharge destinations, including age, gender, comorbidities, and obesity. By selecting an appropriate discharge destination based on preoperative factors, there may be potential for more efficient use of medical resources. Future studies should consider preoperative factors in the context of national healthcare systems and lengths of hospital stay.
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Affiliation(s)
- Takafumi Nasu
- Department of Rehabilitation Medicine, Juko Osu Hospital, Nagoya, JPN
| | - Junya Yamanoi
- Department of Rehabilitation Medicine, Juko Osu Hospital, Nagoya, JPN
| | - Takashi Kitagawa
- Department of Physical Therapy, Shinshu University, Matsumoto, JPN
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Padki A, Vemula V, Purnomo G, Lim JBT, Liow LMH, Yeo SJ, Chen JY. Adductor Canal Block Does not Confer Better Immediate Postoperative Pain Relief after Total Knee Arthroplasty. J Knee Surg 2023; 36:843-848. [PMID: 35436805 DOI: 10.1055/s-0042-1743495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The adductor canal block (ACB) is a useful adjunct to control postoperative pain in total knee arthroplasty (TKA). The aim of our study was to compare postoperative day 1 (POD1) pain scores, ambulation distance, range of motion, active straight leg raise (SLR), and length of stay (LOS) in TKA patients receiving no ACB (NACB), ACB by surgeon (ACBS), or ACB by anesthetist (ACBA). After obtaining institutional ethics approval, a retrospective review of 135 patients who underwent TKA between September 2020 and March 2021 was performed. All patients underwent TKA by the same surgeon and received the same standardized postoperative rehabilitation. Operating theater time was shortest in the NACB group with 129.3 ± 23.1 minutes compared with 152.4 ± 31.6 minutes in ACBA and 139.2 ± 29.4 minutes in ABCS (p = 0.001). For the POD1 pain score after therapy, the NACB group scored 4.9 ± 3.1 compared with 3.5 ± 2.2 and 3.9 ± 1.8 scored by the ACBA and ACBS groups, respectively (p = 0.302). The mean POD1 ambulation distance was 21.1 ± 15.2 m in the NACB group compared with 15.4 ± 1.3 and 17.8 ± 13.2 m in the ACBA and ACBS groups (all p > 0.05), respectively. There were no significant differences in the median LOS between three groups or ability to perform active SLR (all p > 0.05). Our study found no significant differences when comparing ACBS and ACBA by POD1 pain score, ambulation distance, range of motion, and LOS. We recommend against the use of ACB and instead recommend surgeons to perform an adequate periarticular cocktail injection.
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Affiliation(s)
- Akshay Padki
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Vishnu Vemula
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Glen Purnomo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
- St. Vincentius a Paulo Catholic Hospital, Surabaya, Indonesia
| | - Jason Beng Teck Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Konnyu KJ, Thoma LM, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Balk EM, Pinto D. Rehabilitation for Total Knee Arthroplasty: A Systematic Review. Am J Phys Med Rehabil 2023; 102:19-33. [PMID: 35302953 PMCID: PMC9464796 DOI: 10.1097/phm.0000000000002008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT We sought to determine the comparative benefit and harm of rehabilitation interventions for patients who have undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. The team assessed strength of evidence. Evidence from 53 studies randomized controlled trials suggests that various rehabilitation programs after total knee arthroplasty may lead to comparable improvements in pain, range of motion, and activities of daily living. Rehabilitation in the acute phase may lead to increased strength but result in similar strength when delivered in the postacute phase. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period after total knee arthroplasty; risk of harms among various postacute rehabilitation programs seems comparable. All findings were of low strength of evidence. Evaluation of rehabilitation after total knee arthroplasty needs a systematic overhaul to sufficiently guide future practice or research including the use of standardized intervention components and core outcomes.
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Affiliation(s)
- Kristin J. Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Roy K. Aaron
- Department of Orthopaedic Surgery, Warren Albert Medical School of Brown University, Providence, Rhode Island; Orthopedic Program in Clinical/Translational Research, Warren Albert Medical School of Brown University, Providence, Rhode Island; Miriam Hospital Total Joint Replacement Center, Providence, Rhode Island
| | - Orestis A. Panagiotou
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Monika Reddy Bhuma
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Gaelen P. Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ethan M. Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Dan Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
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Rak D, Nedopil AJ, Sayre EC, Masri BA, Rudert M. Postoperative Inpatient Rehabilitation Does Not Increase Knee Function after Primary Total Knee Arthroplasty. J Pers Med 2022; 12:1934. [PMID: 36422110 PMCID: PMC9697033 DOI: 10.3390/jpm12111934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 01/14/2024] Open
Abstract
Inpatient rehabilitation (IR) is a common postoperative protocol after total knee replacement (TKA). Because IR is expensive and should therefore be justified, this study determined the difference in knee function one year after TKA in patients treated with IR or outpatient rehabilitation, fast-track rehabilitation (FTR) in particular, which also entails a reduced hospital length of stay. A total of 205 patients were included in this multi-center prospective cohort study. Of the patients, 104 had primary TKA at a German university hospital and received IR, while 101 had primary TKA at a Canadian university hospital and received FTR. Patients receiving IR or FTR were matched by pre-operative demographics and knee function. Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and EuroQol visual analogue scale (EQ-VAS) determined knee function one year after surgery. Patients receiving IR had a 2.8-point lower improvement in OKS (p = 0.001), a 6.7-point lower improvement in WOMAC (p = 0.063), and a 12.3-point higher improvement in EQ-VAS (p = 0.281) than patients receiving FTR. IR does not provide long-term benefits to patient recovery after primary uncomplicated TKA under the current rehabilitation regime.
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Affiliation(s)
- Dominik Rak
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074 Würzburg, Germany
| | - Alexander J. Nedopil
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074 Würzburg, Germany
| | - Eric C. Sayre
- Arthritis Research Canada, Vancouver, BC V5Y 3P2, Canada
| | - Bassam A. Masri
- Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Maximilian Rudert
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074 Würzburg, Germany
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A Model for Delivery of Orthopaedic Perioperative Education via Telehealth. Orthop Nurs 2022; 41:229-236. [PMID: 35772063 DOI: 10.1097/nor.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With orthopaedic surgery, there is a risk of poor outcomes such as pain, decreased mobility, and decreased function, particularly if patients do not receive adequate preoperative and postoperative orthopaedic education. Healthcare education delivered via telehealth can be individualized to the patient's specific situation and health literacy level and is accessible, convenient, and timely for patients and providers. The purpose of this article is to combine two models of best practice, the EDUCATE model of patient education and Bashshur's Taxonomy of Telehealth, to describe a framework for improving delivery of preoperative and postoperative orthopaedic education. This innovative model presents a patient-centered approach to orthopaedic education that can increase patient comprehension and retention and address health literacy, through consideration of three dimensions essential for effective telehealth programs: functionality, application, and technology. Applications of the model are presented.
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Ding BTK, Ng J, Tan KG. Enhanced Recovery after Surgery for Knee Arthroplasty in the Era of COVID-19. J Knee Surg 2022; 35:424-433. [PMID: 32838454 DOI: 10.1055/s-0040-1715125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Enhanced recovery after surgery (ERAS) represents a paradigm shift in perioperative care, aimed at achieving early recovery for surgical patients, reducing length of hospital stay, and complications. The purpose of this study was to provide an insight of the impact of the COVID-19 on ERAS protocols for knee arthroplasty patients in a tertiary hospital and potential strategy changes for postpandemic practice. We retrospectively reviewed all cases that underwent surgery utilizing ERAS protocols in the quarter prior to the pandemic (fourth quarter of 2019) and during the first quarter of 2020 when the pandemic started. A review of the literature on ERAS protocols for knee arthroplasty during the COVID-19 pandemic was also performed and discussed. A total of 199 knee arthroplasties were performed in fourth quarter of 2019 as compared with 76 in the first quarter of 2020 during the COVID-19 outbreak. Patients who underwent surgery in the first quarter of 2020 had shorter inpatient stays (3.8 vs. 4.5 days), larger percentage of discharges by postoperative day 5 (86.8 vs. 74.9%), and a larger proportion of patients discharged to their own homes (68 vs. 54%). The overall complication rate (1.3 vs. 3%) and readmission within 30 days (2.6 vs. 2%) was similar between both groups. ERAS protocols appear to reduce hospital lengths of stay for patients undergoing knee arthroplasty without increasing the risk of short-term complications and readmissions. The beneficial effects of ERAS appear to be amplified by and are synchronous with the requirements of operating in the era of a pandemic.
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Affiliation(s)
| | - Jensen Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kelvin Guoping Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Laskow T, Zhu J, Buta B, Oni J, Sieber F, Bandeen-Roche K, Walston J, Franklin PD, Varadhan R. Risk Factors for Non-Resilient Outcomes in Older Adults after Total Knee Replacement in the FORCE-TJR Cohort. J Gerontol A Biol Sci Med Sci 2021; 77:1915-1922. [PMID: 34480562 DOI: 10.1093/gerona/glab257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) is a common procedure in older adults. Physical resilience may be a useful construct to explain variable outcomes. We sought to define a simple measure of physical resilience and identify risk factors for non-resilient patient outcomes. METHODS Secondary analysis of FORCE-TJR cohort study, a prospective registry of total joint replacement. Analysis included 7,239 adults ages 60 or older who underwent TKR between 2011- 2015. Measures included sociodemographic and health factors. Outcomes were categorized as physically resilient versus non-resilient based on the change from baseline to 1-year follow up for three patient-reported outcomes: the physical component summary (PCS), bodily pain (BP), and vitality (VT) from the Short Form-36 (SF-36) subcomponent scores, at pre-op and 1-year post-procedure. Associations were expressed as relative risk of physically non-resilient outcomes using generalized linear regression models, with Poisson distribution and log link. RESULTS Age, BMI, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically non-resilient outcomes across PCS, BP, and VT: age, per 5-years for PCS (RR=1.18[1.12-1.23]), BP (RR=1.06[1.01-1.11), and VT (RR=1.09[1.06-1.12]); BMI, per 5 Kg/m 2, for PCS (RR=1.13[1.07-1.19]), BP (RR=1.06[1.00-1.11]), and VT (RR=1.08[1.04-1.11]); and CCI for PCS CCI=1 (RR=1.38[1.20-1.59]), CCI=2-5 (RR=1.59[1.35-1.88]), CCI>=6 (RR=1.55[1.31-1.83]. Household-income >$45,000 associated with lower risk for PCS (RR=0.81[0.70-0.93]), BP (RR=0.80[0.69-0.91],), and VT (RR=0.86[0.78-0.93]). CONCLUSIONS We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
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Affiliation(s)
- Thomas Laskow
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiafeng Zhu
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian Buta
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julius Oni
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Frederick Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Karen Bandeen-Roche
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patricia D Franklin
- Institute for Public Health and Medicine at Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
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Effects of Early Postoperative Physical Therapy Evaluation After Total Hip and Knee Arthroplasty on Discharge Disposition. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2021. [DOI: 10.1097/jat.0000000000000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Onggo JR, Onggo JD, De Steiger R, Hau R. The Efficacy and Safety of Inpatient Rehabilitation Compared With Home Discharge After Hip or Knee Arthroplasty: A Meta-Analysis and Systematic Review. J Arthroplasty 2019; 34:1823-1830. [PMID: 31053467 DOI: 10.1016/j.arth.2019.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip and knee arthroplasties (THKAs) are successful procedures in managing end-stage arthritis when nonoperative treatments fail. The immediate postoperative period is an important time for the body to recuperate and rehabilitate. Studies have shown that early intensive rehabilitation can enhance recovery. Rehabilitation can be provided as inpatient rehabilitation (IR) or discharge with home rehabilitation. These options have been studied, but literature on the efficacy and safety of IR compared to home discharge is scarce, and evidence is not well established. This meta-analysis aims to compare the efficacy and safety of IR to home discharge with rehabilitation after THKA. METHODS A multidatabase search was performed according to PRISMA guidelines. Data from studies assessing the efficacy and safety of IR and home as discharge destinations after THKA were extracted and analyzed. RESULTS Fifteen studies were included, consisting of 37,411 IR patients and 172,219 home discharge patients. These studies had heterogeneous reporting methods, with some conflicting results. There was no clinically significant difference in clinical outcomes between the groups. Readmission was nearly 5 times (odds ratio = 4.87, 95% confidence interval = 3.24-7.33, P < .001) and periprosthetic complications nearly 3 times (odds ratio = 2.82, 95% confidence interval: 1.54-5.24, P < .001) higher in IR patients than those discharged home after THKA. CONCLUSION Although IR is associated with higher risks of complications and readmissions, this may be because of patient selection bias in the clinical setting. Following THKA, it is safe to discharge patients to home with rehabilitation whenever possible. EVIDENCE LEVEL Level II, Meta-analysis of heterogeneous studies.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Richard De Steiger
- Department of Surgery Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Department of Orthopaedic Surgery, Northern Hospital, Melbourne, Victoria, Australia
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