title: Challenges in postdischarge function and recovery: the case of fast-track hip and knee arthroplasty.
abstract: This narrative review updates the recent advances in our understanding of the multifactorial pathogenesis for reduced postdischarge physical and cognitive function after fast-track surgery, using total hip and knee arthroplasty as surgical models. Relevant factors discussed include the surgical stress responses and potential methods for controlling postsurgical inflammation, pain, and cognitive dysfunction. The continuation of moderate to severe pain in up to 30% of patients for 2-4 weeks calls for better understanding of the underlying mechanisms and development of effective multimodal opioid-sparing analgesic regimens. The need for the development of effective physiotherapy programmes on a patient-specific basis is discussed, along with the need for optimal assessment of postoperative function to guide rehabilitation. Other relevant factors discussed include the role of orthostatic intolerance, sleep disturbances, and blood management, and specific patient populations at risk for adverse outcomes, including psychiatric disorders, to identify and guide future interventions for optimizing functional postdischarge outcomes after fast-track surgery.
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø 2100, Denmark The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark eske.kvanner.aasvang.01@regionh.dk.
authors.forename: E K
authors.initials: EK
authors.lastname: Aasvang
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø 2100, Denmark The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
authors.forename: I E
authors.initials: IE
authors.lastname: Luna
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø 2100, Denmark The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000517:prevention & control; D006801:Humans; D007902:Length of Stay; D010149:Postoperative Pain / Q000517:prevention & control; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods; D020127:Recovery of Function; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control
keywords: complications; recovery; surgery