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Fast-track arthroplasty

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https://www.readbyqxmd.com/read/28744857/the-effect-of-pre-operative-methylprednisolone-on-early-endothelial-damage-after-total-knee-arthroplasty-a-randomised-double-blind-placebo-controlled-trial
#1
V Lindberg-Larsen, S R Ostrowski, M Lindberg-Larsen, M L Rovsing, P I Johansson, H Kehlet
We wished to evaluate whether inhibition of the systemic inflammatory response by a single pre-operative dose of methylprednisolone reduced markers of early endothelial damage after fast-track total knee arthroplasty. We randomly allocated 70 patients undergoing elective unilateral total knee arthroplasty (1:1) to receive either pre-operative intravenous methylprednisolone 125 mg (methylprednisolone group) or isotonic saline (control group). All procedures were performed under spinal anaesthesia without a tourniquet, using a standardised multimodal analgesic regime...
July 26, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28682892/in-patients-undergoing-fast-track-total-knee-arthroplasty-addition-of-buprenorphine-to-a-femoral-nerve-block-has-no-clinical-advantage-a-prospective-double-blinded-randomized-placebo-controlled-trial
#2
RANDOMIZED CONTROLLED TRIAL
Rienk van Beek, Harry J Zonneveldt, Tjeerd van der Ploeg, Jeroen Steens, Phillip Lirk, Marcus W Hollmann
BACKGROUND: Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol. METHODS: The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28681427/delirium-after-fast-track-hip-and-knee-arthroplasty-a-cohort-study-of-6331-elderly-patients
#3
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/28657575/perioperative-pain-management-in-fast-track-knee-arthroplasty
#4
Chiara Caparrini, Irene Miniati, Marco Ponti, Andrea Baldini
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June 7, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/28657396/preoperative-methylprednisolone-does-not-reduce-loss-of-knee-extension-strength-after-total-knee-arthroplastya-randomized-double-blind-placebo-controlled-trial-of-61-patients
#5
Viktoria Lindberg-Larsen, Thomas Q Bandholm, Camilla K Zilmer, Jens Bagger, Mette Hornsleth, Henrik Kehlet
Background and purpose - Patients undergoing total knee arthroplasty (TKA) face challenges related to postoperative reduction in knee-extension strength. We evaluated whether inhibition of the inflammatory response by a single preoperative dose of methylprednisolone (MP) reduces the pronounced loss of knee-extension strength at discharge after fast-track TKA. Patients and methods - 70 patients undergoing elective unilateral TKA were randomized (1:1) to preoperative intravenous (IV) MP 125 mg (group MP) or isotonic saline IV (group C)...
June 28, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28633186/erratum-early-removal-of-drainage-tube-after-fast-track-primary-total-knee-arthroplasty
#6
Shaoyun Zhang, Bin Xu, Qiang Huang, Huan Yao, Jinwei Xie, Fuxing Pei
No abstract text is available yet for this article.
July 2017: Journal of Knee Surgery
https://www.readbyqxmd.com/read/28630756/fast-track-in-hip-arthroplasty
#7
Torben Bæk Hansen
'Fast-track' surgery was introduced more than 20 years ago and may be defined as a co-ordinated peri-operative approach aimed at reducing surgical stress and facilitating post-operative recovery.The fast-track programmes have now been introduced into total hip arthroplasty (THA) surgery with reduction in post-operative length of stay, shorter convalescence and rapid functional recovery without increased morbidity and mortality. This has been achieved by focusing on a multidisciplinary collaboration and establishing 'fast-track' units, with a well-defined organisational set-up tailored to deliver an accelerated peri-operative course of fast-track surgical THA procedures...
May 2017: EFORT open reviews
https://www.readbyqxmd.com/read/28630755/advances-in-hip-arthroplasty-surgery-what-is-justified
#8
Luigi Zagra
Total hip arthroplasty (THA) surgery has shown dramatic changes in terms of increased number of procedures and of technical development in recent years. It has been described as "the operation of the 20(th) century" for the excellent results, the high satisfaction of the patients and the improvement of the quality of life.A lot of variations have been introduced over the last few decades in THA especially in terms of indications (both in younger and older patients), techniques and devices (approaches, tissue preservation, biomaterials and industrial finishing), per-operative management (blood loss and pain control) and post-operative protocols (the so called "fast track" surgery)...
May 2017: EFORT open reviews
https://www.readbyqxmd.com/read/28628534/daily-physical-activity-in-total-hip-arthroplasty-patients-undergoing-different-surgical-approaches-a-cohort-study
#9
Monika Engdal, Olav A Foss, Kristin Taraldsen, Vigdis S Husby, Siri B Winther
OBJECTIVE: Muscle weakness due to trauma from the surgical approach is anticipated to affect the ability of the patient to undertake daily physical activity early after total hip arthroplasty (THA). The objective of this study was to compare daily physical activity on days 1 to 4 after discharge, in patients following THA performed by 1 of 3 surgical approaches. DESIGN: A cohort study included 60 hip osteoarthritis patients, scheduled for THA, allocated to direct lateral approach, posterior approach, or anterior approach...
July 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28554709/ultrasound-guided-genicular-nerve-block-for-pain-control-after-total-knee-replacement-preliminary-case-series-and-technical-note
#10
V González Sotelo, F Maculé, J Minguell, R Bergé, C Franco, X Sala-Blanch
INTRODUCTION: Total knee arthroplasty (TKA) is an operation with moderate to severe postoperative pain. The Fast-Track models employ local infiltration techniques with anaesthetics at high volumes (100-150ml). We proposed a genicular nerve block with low volume of local anaesthetic. The aim of our study is to evaluate the periarticular distribution of these blocks in a fresh cadaver model and to describe the technique in a preliminary group of patients submitted to TKA. MATERIALS AND METHODS: In the anatomical phase, 4 genicular nerves (superior medial, superior lateral, inferior medial and inferior lateral) were blocked with 4ml of local anaesthetic with iodinated contrast and methylene blue in each (16ml in total)...
May 26, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28537346/does-length-of-stay-influence-how-patients-rate-their-hospitalization-after-total-hip-arthroplasty
#11
Ronald E Delanois, Chukwuweike Gwam, Jaydev B Mistry, Anton Khlopas, Morad Chughtai, Prem Ramkumar, Nicolas Piuzzi, Ryan Berger, Peter M Bonutti, Arthur L Malkani, Michael A Mont
BACKGROUND: The reimbursement for medical services by Medicare and Medicaid (CMS) has recently changed from fee-for-service to quality-based payments. This is being implemented through the use of patient administered surveys, most commonly Press Ganey. With a recent strive for fast-track total hip arthroplasty (THA), it is important to ascertain whether length-of-stay (LOS) in post-THA patients influences the Press Ganey scores and overall hospital ratings. Therefore, we looked at: 1) Which Press Ganey survey factors affect overall hospital rating in patients who have a short (=2) or longer (>2) length of stay; and 2) whether hospital satisfaction is different between patients who have varied lengths of stay...
May 24, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28511195/safety-aspects-of-postanesthesia-care-unit-discharge-without-motor-function-assessment-after-spinal-anesthesia-a-randomized-multicenter-semiblinded-noninferiority-controlled-trial
#12
Eske Kvanner Aasvang, Christoffer Calov Jørgensen, Mogens Berg Laursen, Jacob Madsen, Søren Solgaard, Mogens Krøigaard, Per Kjærsgaard-Andersen, Hans Mandøe, Torben Bæk Hansen, Jørgen Ulrich Nielsen, Niels Krarup, Annette Elisabeth Skøtt, Henrik Kehlet
BACKGROUND: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. METHODS: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken...
June 2017: Anesthesiology
https://www.readbyqxmd.com/read/28477230/a-matched-case-control-comparison-of-hospital-costs-and-outcomes-for-knee-replacement-patients-admitted-postoperatively-to-acute-care-versus-rehabilitation
#13
Brian K Tse, Tessa L Walters, Steven K Howard, T Edward Kim, Stavros G Memtsoudis, Eric C Sun, Alex Kou, Lorrie Graham, Robert King, Edward R Mariano
For select total knee arthroplasty (TKA) patients, we have established an alternative pathway to bypass the acute care surgical ward and directly admit patients from the post-anesthesia care unit to on-campus rehabilitation. We retrospectively examined whether this 'fast track' pathway decreased costs and improved patient outcomes. After reviewing records of consecutive primary unilateral TKA patients over a 15-month period, each patient admitted to rehabilitation was matched with a control admitted to the acute care ward...
May 5, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28331362/anesthesia-for-the-patient-undergoing-total-knee-replacement-current-status-and-future-prospects
#14
REVIEW
Zachary A Turnbull, Dahniel Sastow, Gregory P Giambrone, Tiffany Tedore
Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28290738/increased-risk-of-intraoperative-and-early-postoperative-periprosthetic-femoral-fracture-with-uncemented-stems
#15
Martin Lindberg-Larsen, Christoffer C Jørgensen, Søren Solgaard, Anne G Kjersgaard, Henrik Kehlet
Background and purpose - The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Registry studies have indicated an increased risk of revision of uncemented implants due to early periprosthetic femoral fracture. In this paper, we describe the incidence and predisposing factors for intraoperative and early postoperative (≤ 90 days) periprosthetic femoral fractures after cemented and uncemented THA. Patients and methods - This was a prospective observational study in 8 Danish high-volume centers from February 2010 to November 2013...
August 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28229182/outpatient-unicompartmental-knee-arthroplasty-who-is-afraid-of-outpatient-surgery
#16
Alexander Hoorntje, Koen L M Koenraadt, Margreet G Boevé, Rutger C I van Geenen
PURPOSE: In recent years, duration of hospitalisation after knee arthroplasty has decreased and fast track and outpatient surgery protocols have been developed. Studies have shown that outpatient surgery is feasible, safe, and cost effective. However, the psychological well-being of patients undergoing outpatient surgery has never been described before. The purpose of this study was to investigate how patients experience outpatient surgery for unicompartmental knee arthroplasty (UKA), examining levels of anxiety and depression, satisfaction, and pain...
March 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28211285/can-local-infiltration-analgesia-increase-satisfaction-in-postoperative-short-term-pain-control-in-total-knee-arthroplasty
#17
David Barastegui, I Robert, E Palau, S Haddad, M Reverte-Vinaixa, L Lorente, M Cots
BACKGROUND: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient's early functional outcomes. OBJECTIVES: Compare length of stay (LOS) short-term pain control, and patients' satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. PATIENTS AND METHODS: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups...
January 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28150297/time-course-and-reasons-for-90-day-mortality-in-fast-track-hip-and-knee-arthroplasty
#18
C C Jørgensen, H Kehlet
BACKGROUND: Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. METHODS: Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates...
April 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28145024/psychopharmacologic-treatment-and-blood-transfusion-in-fast-track-total-hip-and-knee-arthroplasty
#19
MULTICENTER STUDY
Silas Hinsch Gylvin, Christoffer Calov Jørgensen, Anders Fink-Jensen, Pär I Johansson, Henrik Kehlet
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance. STUDY DESIGN AND METHODS: Prospective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment...
April 2017: Transfusion
https://www.readbyqxmd.com/read/28126275/time-driven-activity-based-cost-of-fast-track-total-hip-and-knee-arthroplasty
#20
Signe E Andreasen, Henriette B Holm, Mira Jørgensen, Kirill Gromov, Per Kjærsgaard-Andersen, Henrik Husted
BACKGROUND: Fast-track total hip and knee arthroplasty (THA and TKA) has been shown to reduce the perioperative convalescence resulting in less postoperative morbidity, earlier fulfillment of functional milestones, and shorter hospital stay. As organizational optimization is also part of the fast-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare this between 2 departments with different logistical set-ups...
December 29, 2016: Journal of Arthroplasty
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