title: An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom--follow up at one year.
abstract: The concepts of Enhanced Recovery Programmes (ERP) are to reduce peri-operative morbidity whilst accelerating patient's rehabilitation resulting in a shortened hospital stay following primary joint arthroplasty. These programmes should include all patients undergoing surgery and should not be selective. We report a consecutive series of 1081 primary total knee arthroplasties undergoing an enhanced recovery programme with a one year follow up period. A comparative cohort of 735 patients from immediately prior to the enhanced recovery programme implementation was also reviewed. The median day of discharge home was reduced from post-operative day six to day four (p<0.001) for the ERP group. Post-operative urinary catheterisation (35% vs. 6.9%) and blood transfusion (3.7% vs. 0.6%) rates were significantly reduced (p<0.001). Within the ERP group median pain scores (0 = no pain, 10 = maximal pain) on mobilisation were three throughout hospital stay with 95% of patients ambulating within 24h. No statistical difference was found in post-operative thrombolytic events (p=0.35 and 0.5), infection (p=0.86), mortality rates (p=0.8) and Oxford Knee Scores (p=0.99) at follow up. This multidisciplinary approach provided satisfactory post-operative analgesia allowing early safe ambulation and expedited discharge to home with no detriment to continuing rehabilitation, infection or complication rates at one year.
authors: Department of Orthopaedic Surgery, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, United Kingdom. david.mcdonald@nhs.net
authors: D A
authors: DA
authors: McDonald
authors: R
authors: R
authors: Siegmeth
authors: A H
authors: AH
authors: Deakin
authors: A W G
authors: AW
authors: Kinninmonth
authors: N B
authors: NB
authors: Scott
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D004434:Early Ambulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000502:physiology*; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain / Q000534:rehabilitation*; D010351:Patient Discharge; D011184:Postoperative Period; D015397:Program Evaluation; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom