Results of a fast-track knee arthroplasty according to the experience of a multidisciplinary team
Introduction
The implementation of the Fast-Track protocols in our environment has meant a drastic change in the perception of total knee replacement surgery (TKRS). These multidisciplinary systems have allowed the optimization of the recovery by significantly reducing the postoperative pain, time to first ambulation, and complications. Secondarily, all this has made it possible to shorten hospital stay, as well as reduce economic costs.1 In addition, it does not decrease the satisfaction2 of our patients nor increases the risk of readmission or death.3 (see Table 1, Table 2, Fig. 1, Fig. 2)
Multiple Fast-Track systems have been described, all sharing a series of common basic premises, such as preoperative education, an adequate pain control, and early mobilization.
There is not enough literature that studies the relationship between the experience of the multidisciplinary team in these protocols and clinical results. For this reason, the objective of our work is to study the evolution of the clinical results obtained through a Fast-Track system according to the experience acquired by the multidisciplinary team in this protocol. We have analyzed the results obtained in our center from its implementation in 2013 to the present day (2016).
Section snippets
Patients and design of the study
Since the establishment of the Fast-Track program, a database of all patients undergoing TKRS in our center under this protocol was created. Given that this was a prospective observational study with a retrospective analysis, all data was revised in order to obtain two samples: 65 patients operated in 2013 (same year of the implementation of the program), and 60 patients operated in 2016. A cluster sampling was carried out, being the clusters the different months of the year. Following this
Pain
In 2013, 95,2% of the patients scored a VAS 24 h below 4, and, in 2016, they were 96,7% (p = 1). The mean was 1,65 in 2013, and 1,5 in 2016 (p = 0,52).
In 2013, 95.1% of the patients scored a VAS 48 h below 4, and in 2016 they were 98,3% (p = 0.619). The mean was 1.61 in 2013, and 1.58 in 2016 (p = 0.89). No statistically significant differences were found.
Time to the first ambulation
The mean time was 260 min in 2013, and 254 min in 2016 (p = 0,78). The median was 225 min in 2013, and 255 min in 2016 (p = 0.155).
In 2013,
Discussion
In most studies published in reference to Fast-Track, some aspects of this program have been individually valued, such as cost-benefit,4 bleeding,5 days of admission,6 or complications. The purpose of our work is to study the evolution of the clinical results obtained through a Fast-Track system according to the experience acquired by the multidisciplinary team in this protocol. In the bibliography, there are no articles that refer to the evolution of the protocol once established, and most of
Limitations
The main limitation of this study is the lack of indicators that allows us to analyze the evolution of our patients in the long term. This is because the second sample has been recently operated (2016), and the follow-up will be studied in the coming years.
On the other hand, this is a prospective observational study.
Conclusion
The results obtained at the beginning of the implantation of the Fast-Track protocol in our center and the present ones do not present significant differences in pain after 24 h and 48 h, the time of the first ambulation, flexion-extension at discharge, nor the length of hospital stay.
The results obtained in our center are similar to the results shown by other studies.
When applying the Fast-Track protocol by a multidisciplinary team in primary knee prosthetic surgery, the clinical results
Funding source
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of interest
All authors declare no conflict of interest.
Ethical statement
All authors declare that the ethical norms have been followed during this study.
Declarations of interest
None.
Acknowledgement
We thank Dr. Campos, B. professor of the Unit of Biostatistics of the University of Barcelona for her help in statistical analysis.
References (15)
- et al.
Fast-track knee arthroplasty – status and future challenges
Knee
(2013) Fast-Track hip and knee arthroplasty
Lancet
(2013 May11)- et al.
Range of motion predictability after total knee arthroplasty with medial pivot prosthesis
Rev Bras Ortop
(2017 Mar 9) - et al.
Patient-reported outcome after fast-track knee arthroplasty
Knee Surg Sports Traumatol Arthrosc
(2012) - et al.
Risk of readmission, reoperation, and mortality within 90 days of total hip and knee arthroplasty in fast-track departments in Denmark from 2005 to 2011
Acta Orthop
(2014) Técnica de recuperación acelerada (fast-track) aplicada a cirugía protésica primaria de rodilla y cadera. Análisis de costos y complicaciones
Rev Española Cirugía Ortopédica Traumatol
(2016)- et al.
Lundbeck foundation centre for fast-track hip and knee replacement collaborative group. Postoperative anemia and early functional outcomes after fast-track hip arthroplasty: a prospective cohort study
Transfusion
(2016 Apr)
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