Rapid recovery protocol may restore range of motion faster vs standard protocol for TKA
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Use of a rapid recovery protocol after total knee arthroplasty may lead to faster restoration of range of motion and shorter length of stay compared with the use of a standard recovery protocol, according to published results.
Vinod Dasa, MD, and colleagues reviewed the medical charts of 323 patients who underwent primary TKA with either a standard recovery protocol (n=129) or a rapid recovery protocol (n=194). Researchers assessed knee range of motion preoperatively and at 2, 6, 12, 26 and 52 weeks postoperatively and compared differences in mean length of stay between the two groups. Researchers also evaluated the effects of recovery protocol, time and the interaction of recovery protocol by time on flexion and flexion contracture using repeated measures analysis of covariance.
Results showed patients who received rapid recovery protocol had a mean length of stay of 0.8 days vs. 2.5 days for the standard recovery protocol group. Researchers found an association between the rapid recovery protocol and greater flexion at 2, 6 and 12 weeks postoperatively. Patients in the rapid recovery group also had a higher probability of attaining flexion of 120° or greater at 6 and 12 weeks postoperatively, according to results. Researchers noted less severe flexion contracture and a lower probability of flexion contracture of 10° or greater at 2, 6 and 12 weeks postoperatively in the rapid recovery protocol group.
“Based on these results, orthopedic practices should consider a [rapid recovery protocol] RRP with non-opioid options to help enhance the recovery experience for patients undergoing total knee replacements,” Dasa told Healio Orthopedics. “The outcomes provide optimism for the future of orthopedics and the innovative approaches being implemented reduce health care costs while allowing our patients to get back to their day-to-day activities sooner with limited opioid exposure. I hope these results will encourage surgeons, not only in orthopedics but other specialties as well, to find opportunities to substantively improve outcomes while simultaneously reducing opioid use.”
Perspective
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This study discusses the effects of a rapid recovery program on magnitude and rate of improvement in postoperative range of motion after TKA. This article is unique in that most comparison studies of recovery protocols focus on safety, including complications and readmissions. Postoperative range of motion and the rate and ease of which patients obtain motion are correlated with patient satisfaction. This paper shows that by implementing a comprehensive rapid recovery protocol that patients can not only be safely discharged home sooner, but are more likely to obtain higher levels of motion at a faster pace.
The authors’ rapid recovery protocol instituted a multimodal pain management program including cryoneurolysis and adductor canal blocks of sensory nerves instead of their historical femoral nerve catheters. This type of change promotes immediate ambulation, day of surgery physical therapy and same-day discharge. The authors’ historical protocol included an average hospital stay of 2.5 days and delayed therapy within the first week of surgery. This new protocol proved effective at helping patients obtain higher levels of motion at all time points in the first 12 weeks.
Despite being a retrospective, single surgeon, unblinded study with potential for bias, this paper was well powered and showed statistically and clinically significant improvements in range of motion with a rapid recovery protocol. This paper adds to the current evidence supporting multimodal pain management and rapid recovery protocols for TKA.
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