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Comparison of two accelerated clinical pathways--after total knee replacement how fast can we really go?
T Renkawitz1, T Rieder, M Handel
1Department of Orthopedic Surgery, Regensburg University Medical Center, Department of Anaesthesiology, Asklepios Klinikum Bad Abbach. tobias.renkawitz@web.de
Objective:
To evaluate whether a further optimization of an existing accelerated clinical pathway protocol after total knee replacement is feasible and improves postoperative outcome.
Design:
Prospective, parallel group design.
Setting:
Orthopaedic University Medical Centre.
Patients:
A total of 143 patients, scheduled for unilateral primary total knee replacement under perioperative regional analgesia.
Intervention:
Sixty-seven patients received an optimized accelerated clinical pathway including patient-controlled regional analgesia pumps, ultra-early/doubled physiotherapy and motor-driven continuous passive motion machine units. Seventy-six patients received a standard accelerated clinical pathway.
Main Measures:
Feasibility was defined as the proportion of patients successfully completing the assigned pathway. Early postoperative pain on a visual analogue scale, consumption of regional anaesthetics, knee range of motion, time out of bed, non-stop walking distance/stair climbing, circumference measurement and Knee Society Score on the operated leg. Possible discharge according to an own discharge checklist.
Results:
All patients assigned to both groups successfully completed this pathway. Patients in the optimized pathway showed significant benefits regarding stair climbing/walking distance/time out of bed/circumference measurements of the thigh/Knee Society function score on the fifth postoperative day and stair climbing/ circumference measurements of the thigh on the eighth postoperative day, and reduction of the consumption of regional anaesthetics. No significant reduction in length of stay was observed.
Conclusions:
Early postoperative functional process indicators tended to be higher within the optimized pathway group, but the main effects flattened over the course of the first eight postoperative days.
