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Subacute pain and function after fast-track hip and knee arthroplasty
L Ø Andersen1, L Gaarn-Larsen, B B Kristensen
1Department of Anaesthesiology, Hvidovre University Hospital, Denmark. lasse.oestergaard.andersen@hvh.regionh.dk
Anaesthesia
|May 6, 2009
Summary
Fast-track hip and knee surgery offers good pain control for most patients. However, total knee arthroplasty patients experience significant pain one month post-op, needing better pain management strategies.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Anesthesiology
Background:
- Fast-track surgery protocols aim to optimize recovery after major orthopedic procedures.
- Multimodal analgesia is standard for hip and knee arthroplasty, but subacute pain remains a concern.
Purpose of the Study:
- To evaluate pain, side effects, analgesic use, and function after fast-track total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- To identify challenges in pain management and functional recovery in the subacute phase post-discharge.
Main Methods:
- Prospective, observational study of patients undergoing fast-track THA and TKA.
- Multimodal analgesia: local anesthetic infiltration, celecoxib, gabapentin, and paracetamol.
- Data collection on pain (VAS), side effects, analgesic use, and function at 1-10 and 30 days postoperatively.
Main Results:
- Over 95% of THA patients had low pain and opioid use by 10 days post-discharge.
- 52% of TKA patients reported moderate pain and 16% severe pain at 1 month, with increased opioid use.
- Acceptable pain and nausea/vomiting levels were observed in the early fast-track recovery phase.
Conclusions:
- Fast-track THA demonstrates effective early pain management and functional recovery.
- Significant moderate to severe pain persists 1 month after fast-track TKA, indicating a need for improved post-discharge analgesia.
- Enhanced pain management strategies are crucial for TKA rehabilitation and long-term outcomes.
