title: [Multidisciplinary Rehabilitation and Fast-track Rehabilitation after Knee Replacement: Faster, Better, Cheaper? A Survey and Systematic Review of Literature].
abstract: BACKGROUND
  The aim of multidisciplinary rehabilitation after total knee replacement (TKA) is to reduce postoperative complications and costs and enable faster convalescence. The goals of fast-track rehabilitation, as a multidisciplinary concept, are to reduce the length of hospital stay and achieve early functional improvements by optimizing the perioperative setting.
  
  
  METHODS
  A literature review was carried out for the years 1960-2013. The search terms were: "rehabilitation", "training", "physiotherapy", "physical therapy", "recovery", "exercise program", "knee surgery", "TKA", "total knee replacement", "arthroplasty", "intensive", "multidisciplinary", "accelerated", "rapid" or "fast track". Only randomized controlled trials and metaanalyses were included. A survey was also performed to assess care as actually offered in orthopaedic rehabilitation clinics in North Rhine-Westphalia.
  
  
  RESULTS
  A total of 729 articles were identified of which 11 studies were included. Fast-track rehabilitation can significantly reduce both the duration of hospital stay and costs after TKA. Current studies showed that a better short-/middle-term clinical outcome might be achieved with multidisciplinary rehabilitation. However, a difference in the long-term outcome could not be observed. Our survey shows that most patients are admitted to a rehabilitation clinic in a state of poor general condition as well as decreased mobility and knee range of motion.
  
  
  CONCLUSIONS
  Fast-track rehabilitation facilitates a shortened hospital stay as well as cost saving. It probably can be used to optimize the condition of the patient before admission to a rehabilitation facility.
authors: Klinik für Orthopädie, RWTH Aachen, Universitätsklinikum Aachen.
authors: V
authors: V
authors: Quack
authors: Klinik für Orthopädie, RWTH Aachen, Universitätsklinikum Aachen.
authors: A V
authors: AV
authors: Ippendorf
authors: Klinik für Orthopädie, RWTH Aachen, Universitätsklinikum Aachen.
authors: M
authors: M
authors: Betsch
authors: Klinik für Orthopädie, RWTH Aachen, Universitätsklinikum Aachen.
authors: H
authors: H
authors: Schenker
authors: Klinik für Orthopädie, RWTH Aachen, Universitätsklinikum Aachen.
authors: S
authors: S
authors: Nebelung
authors: Klinik für Orthopädie, RWTH Aachen, Universitätsklinikum Aachen.
authors: B
authors: B
authors: Rath
authors: Klinik für Orthopädie, RWTH Aachen, Universitätsklinikum Aachen.
authors: M
authors: M
authors: Tingart
authors: Klinik für Orthopädie, Klinikum Dortmund.
authors: C
authors: C
authors: Lüring
mesh_terms: D000359:Aftercare / Q000191:economics* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000534:rehabilitation* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D010348:Patient Care Team / Q000191:economics*; D020127:Recovery of Function; D012046:Rehabilitation / Q000191:economics*