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Enhanced recovery after arthroplasty

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https://www.readbyqxmd.com/read/28870300/enhancing-recovery-after-total-knee-arthroplasty
#1
REVIEW
Richard W Rutherford, Jason M Jennings, Douglas A Dennis
There have been multiple successful efforts to improve and shorten the recovery period after elective total joint arthroplasty. The development of rapid recovery protocols through a multidisciplinary approach has occurred in recent years to improve patient satisfaction as well as outcomes. Bundled care payment programs and the practice of outpatient total joint arthroplasty have provided additional pressure and incentives for surgeons to provide high-quality care with low cost and complications. In this review, the evidence for modern practices are reviewed regarding patient selection and education, anesthetic techniques, perioperative pain management, intraoperative factors, blood management, and postoperative rehabilitation...
October 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28802778/cryotherapy-treatment-after-unicompartmental-and-total-knee-arthroplasty-a-review
#2
REVIEW
Morad Chughtai, Nipun Sodhi, Michael Jawad, Jared M Newman, Anton Khlopas, Anil Bhave, Michael A Mont
BACKGROUND: Cryotherapy is widely utilized to enhance recovery after knee surgeries. However, the outcome parameters often vary between studies. Therefore, the purpose of this review is to compare (1) no cryotherapy vs cryotherapy; (2) cold pack cryotherapy vs continuous flow device cryotherapy; (3) various protocols of application of these cryotherapy methods; and (4) cost-benefit analysis in patients who had unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). METHODS: A search for "knee" and "cryotherapy" using PubMed, EBSCO Host, and SCOPUS was performed, yielding 187 initial reports...
July 21, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28751437/enhanced-recovery-after-surgery-for-hip-and-knee-arthroplasty-a-systematic-review-and-meta-analysis
#3
Shibai Zhu, Wenwei Qian, Chao Jiang, Canhua Ye, Xi Chen
OBJECTIVES: To collect data of randomised controlled trials (RCTs) and clinical controlled trials (CCTs) for evaluating the effects of enhanced recovery after surgery on postoperative recovery of patients who received total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: Relevant, published studies were identified using the following key words: arthroplasty, joint replacement, enhanced recovery after surgery, fast track surgery, multi-mode analgesia, diet management, or steroid hormones...
July 27, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/28708200/periacetabular-bone-densitometry-after-total-hip-arthroplasty-with-highly-porous-titanium-cups-a-2-year-follow-up-prospective-study
#4
Leo Massari, Alessandro Bistolfi, Pier Paolo Grillo, Alda Borré, Gaetano Gigliofiorito, Carlotta Pari, Andrea Francescotto, Piermario Tosco, Davide Deledda, Laura Ravera, Araldo Causero
INTRODUCTION: Trabecular Titanium is an advanced cellular solid structure, composed of regular multiplanar hexagonal interconnected cells that mimic the morphology of the trabecular bone. This biomaterial demonstrated improved mechanical properties and enhanced osteoinduction and osteoconduction in several in vitro and in vivo studies. The aim of this study was to assess Trabecular Titanium osseointegration by measuring periacetabular changes in bone mineral density (BMD) with dual-emission X-ray absorptiometry (DEXA)...
July 1, 2017: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/28705543/oral-multimodal-analgesia-for-total-joint-arthroplasty
#5
Gregory J Golladay, Karl R Balch, David F Dalury, Jibanananda Satpathy, William A Jiranek
BACKGROUND: Oral multimodal analgesia for hip and knee arthroplasty is increasingly used as part of enhanced recovery protocols designed to minimize early postoperative pain and to facilitate early discharge, while minimizing undesirable side effects related to single-agent opioid administration. METHODS: This article is a review of previously published data evaluating the use of various oral medications in the management of postoperative pain after lower extremity arthroplasty and was presented as part of a symposium at the November 2016 AAHKS Annual Meeting...
September 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28681427/delirium-after-fast-track-hip-and-knee-arthroplasty-a-cohort-study-of-6331-elderly-patients
#6
P B Petersen, C C Jørgensen, H Kehlet
BACKGROUND: Postoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS > 4 days...
August 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28623409/evaluation-of-bone-viability-in-patients-after-girdlestone-arthroplasty-comparison-of-bone-spect-ct-and-mri
#7
G Diederichs, P Hoppe, F Collettini, G Wassilew, B Hamm, W Brenner, M R Makowski
PURPOSE: To test the diagnostic performance of bone SPECT/CT and MRI for the evaluation of bone viability in patients after girdlestone-arthroplasty with histopathology used as gold standard. MATERIALS AND METHODS: In this cross-sectional study, patients after girdlestone-arthroplasty were imaged with single-photon-emission-computed-tomography/computed-tomography (SPECT/CT) bone-scans using 99mTc-DPD. Additionally, 1.5 T MRI was performed with turbo-inversion-recovery-magnitude (TIRM), contrast-enhanced T1-fat sat (FS) and T1-mapping...
September 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28494480/implementation-and-effects-of-enhanced-recovery-after-surgery-for-hip-and-knee-replacements-and-fractured-neck-of-femur-in-new-zealand-orthopaedic-services
#8
Suzanne Proudfoot, Brandon Bennett, Simon Duff, Julie Palmer
AIM: The National Orthopaedic Enhanced Recovery After Surgery (ERAS) Collaborative was launched in November 2013 to implement ERAS protocols for hip and knee total joint arthroplasty (TJA) and fractured neck of femur (NOF) in participating district health boards (DHBs) by December 2014. This paper reports on the results. METHOD: ERAS protocols were developed for hip and knee TJA and fractured NOF. Breakthrough Series collaborative methodology was used to implement the ERAS protocols in 18 DHBs...
May 12, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28474088/two-doses-of-low-dose-perioperative-dexamethasone-improve-the-clinical-outcome-after-total-knee-arthroplasty-a-randomized-controlled-study
#9
Bin Xu, Jun Ma, Qiang Huang, Ze-Yu Huang, Shao-Yun Zhang, Fu-Xing Pei
To study the clinical effect and safety of two doses of low-dose perioperative dexamethasone on pain and recovery after total knee arthroplasty. Methods A total of 108 patients were included in this randomized, double-blinded, placebo-controlled study. They received two doses of 10 mg IV dexamethasone (group Dexa) or IV isotonic saline (group Placebo). The CRP, IL-6 and pain levels, postoperative nausea and vomiting (PONV) incidence, nausea severity, postoperative fatigue, range of motion, length of stay, analgesic rescue and antiemetic rescue consumption, and complications were compared...
May 4, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28403415/enhanced-recovery-after-surgery-for-hip-and-knee-arthroplasty-where-is-the-evidence
#10
H Kehlet
No abstract text is available yet for this article.
April 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28288050/pain-management-modalities-after-total-knee-arthroplasty-a-network-meta-analysis-of-170-randomized-controlled-trials
#11
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
https://www.readbyqxmd.com/read/28176194/enhanced-recovery-in-lower-limb-arthroplasty-in-the-irish-setting
#12
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
https://www.readbyqxmd.com/read/28148663/pre-operative-functional-mobility-as-an-independent-determinant-of-inpatient-functional-recovery-after-total-knee-arthroplasty-during-three-periods-that-coincided-with-changes-in-clinical-pathways
#13
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
https://www.readbyqxmd.com/read/27940457/enhanced-recovery-after-surgery-for-primary-hip-and-knee-arthroplasty-a-review-of-the-evidence
#14
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
https://www.readbyqxmd.com/read/27587519/the-technique-of-delivery-of-peri-operative-analgesia-does-not-affect-the-rehabilitation-or-outcomes-following-total-knee-arthroplasty
#15
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/27554781/no-effect-of-a-bipolar-sealer-on-total-blood-loss-or-blood-transfusion-in-nonseptic-revision-knee-arthroplasty-a-prospective-study-with-matched-retrospective-controls
#16
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
https://www.readbyqxmd.com/read/27492381/physical-activity-after-outpatient-surgery-and-enhanced-recovery-for-total-knee-arthroplasty
#17
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
https://www.readbyqxmd.com/read/27374001/assistive-devices-hip-precautions-environmental-modifications-and-training-to-prevent-dislocation-and-improve-function-after-hip-arthroplasty
#18
REVIEW
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
https://www.readbyqxmd.com/read/27310945/effects-of-cold-irrigation-on-early-results-after-total-knee-arthroplasty-a-randomized-double-blind-controlled-study
#19
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)
https://www.readbyqxmd.com/read/27235516/a-comparison-between-the-direct-anterior-and-posterior-approaches-for-total-hip-arthroplasty-the-role-of-an-enhanced-recovery-pathway
#20
COMPARATIVE STUDY
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
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