Study: Enhanced recovery protocols alleviate concerns for outpatient bilateral TKA
Click Here to Manage Email Alerts
Key takeaways:
- An enhanced recovery protocol for outpatient bilateral TKA yielded promising results vs. conventional recovery.
- Enhanced recovery protocols may alleviate surgeon and patient concerns for outpatient surgery.
According to results published in The Journal of Arthroplasty, patients who received an enhanced recovery protocol had safe same-day discharge and improved functional outcomes after outpatient simultaneous bilateral total knee arthroplasty.
Researchers performed a retrospective study of data from 100 patients who underwent outpatient simultaneous bilateral TKA with an enhanced recovery protocol and 100 propensity-matched patients who underwent inpatient simultaneous bilateral TKA with a conventional recovery protocol.
According to the study, outcome measures were collected for 1 year and included complications readmissions, VAS pain scores, range of motion (ROM) and Knee Society Score (KSS).
Researchers found patients in the outpatient enhanced recovery cohort had a complication rate of 4% and a 90-day readmission rate of 2%, whereas patients in the inpatient conventional recovery cohort had a complication rate of 7% and a 90-day readmission rate of 3%.
They found VAS pain scores were “significantly lower” in the outpatient enhanced recovery cohort for 2 weeks after surgery (P < .001). They also found ROM and KSS were “significantly better” in the enhanced recovery cohort at 2 weeks after surgery (P < .001); however, these outcomes as well as VAS were comparable between the groups after 1 month postoperatively.
“The promising results of our study and similar future studies can alleviate surgeon and patient concerns about outpatient simultaneous bilateral TKA,” the researchers wrote in the study.
Perspective
Back to Top
Bilateral simultaneous total knee replacement is an excellent procedure for patients with disabling pain and severe arthritis in both knees. It has been demonstrated that the patient must be in an optimal physical and medical condition, and without significant comorbidities to undergo this procedure. Regional anesthesia is recommended, and duration of surgery should be in the 2-hour to 2.5-hour or less range. Pain management and experienced rehabilitation is mandatory for an excellent result.
The authors demonstrate excellent results in same-day discharge for bilateral TKA in a carefully selected cohort of patients. One issue with comparing inpatient and outpatient groups in this paper is that these were not randomized and were separated by several years. Much improvement has occurred during that interim in surgical technique, anesthesia management and pain protocols that can bias the data and results in both the short- and long-term. Bilateral simultaneous knee replacement is a considerably greater surgical procedure than unilateral, and serious potential perioperative complications can occur. While a small cohort might safely be discharged the same day, most patients likely benefit from an overnight stay, as it is safer to address complications in the hospital than at home.
Collapse
Read more about
Click Here to Manage Email Alerts