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Enhanced recovery after arthroplasty

H Kehlet
No abstract text is available yet for this article.
April 1, 2017: British Journal of Anaesthesia
Abdullah Sulieman Terkawi, Dimitris Mavridis, Daniel I Sessler, Megan S Nunemaker, Khaled S Doais, Rayan Sulieman Terkawi, Yazzed Sulieman Terkawi, Maria Petropoulou, Edward C Nemergut
BACKGROUND: Optimal analgesia for total knee arthroplasty remains challenging. Many modalities have been used, including peripheral nerve block, periarticular infiltration, and epidural analgesia. However, the relative efficacy of various modalities remains unknown. The authors aimed to quantify and rank order the efficacy of available analgesic modalities for various clinically important outcomes. METHODS: The authors searched multiple databases, each from inception until July 15, 2016...
May 2017: Anesthesiology
J G Galbraith, C Fenelon, J Gibbons, G A Kelly, D Bennett
BACKGROUND: In the current economic climate of staff shortages and bed closures, orthopaedic surgeons must look for system efficiencies. Enhanced Recovery Programmes (ERP) have the potential not only to reduce length of stay (LOS) and concurrent costs but also to improve patient outcomes. The aim of this paper is to evaluate the effect of ERP for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) on length of stay (LOS) in the Irish Setting. METHODS: A single-surgeon retrospective case-control study was conducted comparing those who underwent primary lower limb arthroplasty before and after the introduction of an ERP...
February 7, 2017: Irish Journal of Medical Science
G van der Sluis, R A Goldbohm, J E Elings, M W Nijhuis-van der Sanden, R P Akkermans, R Bimmel, T J Hoogeboom, N L van Meeteren
AIMS: To investigate whether pre-operative functional mobility is a determinant of delayed inpatient recovery of activities (IRoA) after total knee arthroplasty (TKA) in three periods that coincided with changes in the clinical pathway. PATIENTS AND METHODS: All patients (n = 682, 73% women, mean age 70 years, standard deviation 9) scheduled for TKA between 2009 and 2015 were pre-operatively screened for functional mobility by the Timed-up-and-Go test (TUG) and De Morton mobility index (DEMMI)...
2017: Bone & Joint Journal
E M Soffin, J T YaDeau
Enhanced recovery after surgery (ERAS) protocols produce significant clinical and economic benefits in a range of surgical subspecialties. There is a long tradition of applying clinical pathways to the perioperative care of joint arthroplasty patients. Enhanced recovery after surgery represents the next step in the evolution of standardized care. To date, reports of full ERAS pathways for hip or knee arthroplasty are lacking. In this narrative review, we present the evidence base that can be usefully applied to constructing ERAS pathways for hip or knee arthroplasty...
December 2016: British Journal of Anaesthesia
D A McDonald, A H Deakin, B M Ellis, Y Robb, T E Howe, A W G Kinninmonth, N B Scott
AIMS: This non-blinded randomised controlled trial compared the effect of patient-controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established enhanced recovery programme on the attainment of discharge criteria and recovery one year after total knee arthroplasty (TKA). The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by the fourth post-operative day but would not affect outcomes at one year. PATIENTS AND METHODS: A total of 242 patients were randomised; 20 were excluded due to failure of spinal anaesthesia leaving 109 patients in the PCEA group and 113 in the LIA group...
September 2016: Bone & Joint Journal
Christian Skovgaard Nielsen, Kirill Gromov, Øivind Jans, Anders Troelsen, Henrik Husted
BACKGROUND: Postoperative anemia is frequent after revision of total knee arthroplasty (TKA) with reported transfusion rates up to 83%. Despite increased efforts of reducing blood loss and enhancing fast recovery within the fast-track setup, a considerable transfusion rate is still evident. The aim of this study was therefore to evaluate the effect of a bipolar sealer on blood loss and transfusion in revision TKA. METHODS: In this single-center prospective cohort study with retrospective controls, 51 patients were enrolled in a fast-track setup for revision TKA without the use of a tourniquet...
January 2017: Journal of Arthroplasty
M G M Schotanus, Y F L Bemelmans, B Grimm, I C Heyligers, N P Kort
PURPOSE AND HYPOTHESIS: The purpose of this study was to 'objectively' measure improvement of physical activity with the use of an activity monitor between patients who followed an enhanced recovery- or outpatient surgery pathway after total knee arthroplasty (TKA). It was hypothesized that both pathways will have comparable physical activity after TKA at 6-week follow-up. METHODS: This prospective observational comparative case study was designed to investigate activity parameters (e...
August 4, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Toby O Smith, Paul Jepson, Andrew Beswick, Gina Sands, Avril Drummond, Edward T Davis, Catherine M Sackley
BACKGROUND: Total hip arthroplasty (THA) is one of the most common orthopaedic operations performed worldwide. Painful osteoarthritis of the hip is the primary indication for THA. Following THA, people have conventionally been provided with equipment, such as raised toilet seats and chairs, and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees, or adduction or rotation past the midline. These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation...
July 4, 2016: Cochrane Database of Systematic Reviews
Zhirui Li, Daohong Liu, Jiyuan Dong, Long Gong, Yong Wang, Peifu Tang, Yan Zhang
Several studies have indicated that pain peaks at 24 to 48 hours after total knee arthroplasty (TKA) surgery. TKA has been associated with disruption in normal sleep patterns, swelling knee, and significant blood loss. However, a satisfactory regime to resolve these mentioned problems has yet to be found.In this study, a total of 420 patients were randomly allocated into two groups and treated with continuous irrigation of either 4000 mL cold saline with 0.5% epinephrine or normal temperature solution. Clinical outcomes including pain scores at rest during postoperative three days, drainage output, analgesic consumption, decreased hemoglobin, sleep quality, and satisfaction rate were analyzed...
June 2016: Medicine (Baltimore)
I A Malek, G Royce, S U Bhatti, J P Whittaker, S P Phillips, I R B Wilson, J R Wootton, I Starks
AIMS: We assessed the difference in hospital based and early clinical outcomes between the direct anterior approach and the posterior approach in patients who undergo total hip arthroplasty (THA). PATIENTS AND METHODS: The outcome was assessed in 448 (203 males, 245 females) consecutive patients undergoing unilateral primary THA after the implementation of an 'Enhanced Recovery' pathway. In all, 265 patients (mean age: 71 years (49 to 89); 117 males and 148 females) had surgery using the direct anterior approach (DAA) and 183 patients (mean age: 70 years (26 to 100); 86 males and 97 females) using a posterior approach...
June 2016: Bone & Joint Journal
Frederik T Pitter, Christoffer C Jørgensen, Martin Lindberg-Larsen, Henrik Kehlet
BACKGROUND: Elderly patients are at risk of increased length of hospital stay (LOS), postoperative complications, readmission, and discharge to destinations other than home after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Recent studies have found that enhanced recovery protocols or fast-track surgery can be safe for elderly patients undergoing these procedures and may result in reduced LOS. However, detailed studies on preoperative comorbidity and differentiation between medical and surgical postoperative morbidity in elderly patients are scarce...
June 2016: Anesthesia and Analgesia
Luciana Rebecca Russo, Maria Grazia Benedetti, Elisabetta Mariani, Tommaso Roberti di Sarsina, Stefano Zaffagnini
PURPOSE: The purpose of this randomized double-blind study was to investigate the effectiveness of the Videoinsight(®) psychological enhancing method in promoting early recovery during rehabilitation following total knee arthroplasty. METHODS: One-hundred and ten patients treated with cemented total knee arthroplasty were randomly assigned to Group A or Group B, and both groups underwent the same rehabilitation programme. Group A (55 patients) received one art video selected according to Videoinsight(®) concept...
May 9, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Eleonora Baldissarro, Roberto Aquilani, Federica Boschi, Paola Baiardi, Paolo Iadarola, Marco Fumagalli, Evasio Pasini, Manuela Verri, Maurizia Dossena, Arianna Gambino, Sharon Cammisuli, Simona Viglio
It is not known whether postsurgery systemic inflammation and plasma amino acid abnormalities are still present during rehabilitation of individuals after elective hip arthroplasty (EHA). Sixty subjects (36 females; age 66.58 ± 8.37 years) were randomized to receive 14-day oral EAAs (8 g/day) or a placebo (maltodextrin). At admission to and discharge from the rehabilitation center, serum C-reactive protein (CRP) and venous plasma amino acid concentrations were determined. Post-EHA hip function was evaluated by Harris hip score (HHS) test...
2016: BioMed Research International
Marinus D J Stowers, Jacob T Munro, Andrew G Hill
No abstract text is available yet for this article.
May 2016: ANZ Journal of Surgery
A Di Francesco, S Flamini, R Pizzoferrato, P Fusco, A Paglia
BACKGROUND: Total knee arthroplasty (TKA) can result in major postoperative pain which can impact the recovery and rehabilitation of patients and for this reason the use of a pain-control infusion pumps (PCIP) enhances analgesia for TKA. PURPOSE: To investigate whether a PCIP of levobupivacaine would reduce pain in patients following TKA. METHODS: This was a prospective, randomized, controlled study conducted in 55 patients. Criteria for participation were unilateral TKA for osteoarthritis and no allergies to levobupivacaine...
September 2016: Journal of Orthopaedics
Udai S Sibia, James H MacDonald, Paul J King
BACKGROUND: Shorter length of stay (LOS) for total hip arthroplasty (THA) is becoming standard, yet variables identifying candidates for a 1-day discharge in an enhanced recovery after surgery program are not well defined. With growing emphasis on cost-efficiency and bundled care for THA, this study looked to identify variables that correlated with LOS. METHODS: A retrospective chart review was performed for 273 primary THAs, from April 2014 to January 2015. Clinical measures differentiating a 1-day LOS cohort from that of a LOS longer than 1 day were identified...
October 2016: Journal of Arthroplasty
Jason E Hsu, Roger E Bumgarner, Frederick A Matsen
➤ Propionibacterium is a slow-growing gram-positive rod that is part of the normal skin microbiome but can be found on culture of specimens from a large number of patients having revision shoulder arthroplasty performed for pain, stiffness, and component loosening. ➤ Propionibacterium infections do not present with obvious signs of infection, such as swelling, erythema, drainage, or tenderness, but rather are of the so-called stealth type, presenting with unexplained pain, stiffness, or component loosening months to years after the index arthroplasty...
April 6, 2016: Journal of Bone and Joint Surgery. American Volume
Miguel Aprelino Alito, José Eduardo de Aguilar-Nascimento
BACKGROUND: Multimodal protocols of perioperative care may enhance postoperative recovery. However, limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty. We aimed to investigate the effect of a multimodal protocol (ACERTO protocol) plus preoperative immune nutrition on the length of stay (LOS) and the postoperative acute phase response of patients undergoing total hip arthroplasty. METHODS: Thirty-two patients (mean age, 58 years; range, 26-85 years; 16 males) were randomized to receive either the ACERTO protocol (n = 15, ACERTO Group), which consisted of 6 h preoperative fasting for solids, an oral drink (200 mL of 12...
April 2, 2016: Nutrition Journal
J F Maempel, N D Clement, J A Ballantyne, E Dunstan
AIMS: The primary aim of this study was to investigate the effect of an enhanced recovery program (ERP) on the short-term functional outcome after total hip arthroplasty (THA). Secondary outcomes included its effect on rates of dislocation and mortality. PATIENTS AND METHODS: Data were gathered on 1161 patients undergoing primary THA which included 611 patients treated with traditional rehabilitation and 550 treated with an ERP. RESULTS: The ERP was shown to be a significant independent factor which shortened length of stay (LOS) by a mean of 1...
April 2016: Bone & Joint Journal
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