title: Physical activity after outpatient surgery and enhanced recovery for total knee arthroplasty.
abstract: OBJECTIVE
  The purpose of this study was to 'objectively' measure improvement of physical activity with the use of an activity monitor between patients who followed an enhanced recovery- or outpatient surgery pathway after total knee arthroplasty (TKA). It was hypothesized that both pathways will have comparable physical activity after TKA at 6-week follow-up.
  
  
  METHODS
  This prospective observational comparative case study was designed to investigate activity parameters (e.g. physical activity, number of steps, sit-stand transfers) of two different pathways after 6 weeks with the use of a non-invasive triaxial accelerometer activity monitor. This study included 20 patients with a mean age of 65.5 years (SD 6.1) undergoing TKA who were allocated to follow one of the two pathways: enhanced recovery (n = 10) or outpatient surgery (n = 10). Patients were monitored for 4 days pre-, 4 days during and 4 days after 5 weeks postoperatively. Patient-reported outcome measures (PROMs) and range of knee motion were obtained pre- and 6 weeks postoperatively.
  
  
  RESULTS
  The activity parameters recovered steeply during the first 4 postoperative days and continued to improve within both pathways (n.s.). Preoperative and during the first 4 days and 5 weeks postoperative, activity parameters were comparable (n.s.) between both pathways but did not reach preoperative levels of physical activity and range of motion (n.s.). PROMs improved within each pathway, and no difference between both pathways was observed (n.s.).
  
  
  CONCLUSIONS
  This study demonstrates that the early physical activity parameters of patients after TKA, following the outpatient surgery pathway, were similar to patients who followed the standard enhanced recovery pathway. The activity monitor is an added value for a more detailed and objective analysis of the physical performance in patients after TKA.
  
  
  METHODS
  III.
authors: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands. martijnschotanus@hotmail.com.
authors: M G M
authors: http://orcid.org/0000-0002-3975-6337
authors: MGM
authors: Schotanus
authors: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
authors: Y F L
authors: YFL
authors: Bemelmans
authors: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
authors: B
authors: B
authors: Grimm
authors: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
authors: I C
authors: IC
authors: Heyligers
authors: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
authors: N P
authors: NP
authors: Kort
mesh_terms: D061725:Accelerometry; D000368:Aged; D000556:Ambulatory Surgical Procedures; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000534:rehabilitation*; D016022:Case-Control Studies; D002985:Clinical Protocols; D019091:Critical Pathways; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function
keywords: Accelerometer; Activity monitor; Day care surgery; Enhanced recovery; Fast track; Outpatient surgery; Pathway; Physical activity; Total knee arthroplasty