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Evidence-based review for patients undergoing elective hip and knee replacement
Jenson C S Mak1, Marlene Fransen, Matthew Jennings
1Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales, Australia; Department of Medicine, Ryde Hospital, Eastwood, New South Wales, Australia.
ANZ Journal of Surgery
|March 19, 2013
Summary
Evidence for optimizing care during total hip (THR) and knee (TKR) replacement surgery is limited. Further research is needed to improve patient outcomes and clinical practice in joint replacement procedures.
Area of Science:
- Orthopaedics
- Rehabilitation Medicine
- Evidence-Based Practice
Background:
- Elective total hip replacement (THR) and total knee replacement (TKR) surgery involve complex care pathways.
- Evaluating evidence for interventions across preoperative, perioperative, and postoperative phases is crucial for optimizing patient outcomes.
Purpose of the Study:
- To systematically evaluate the evidence base for various interventions in the care continuum for elective THR and TKR.
- To provide recommendations for clinical practice based on the available evidence.
Main Methods:
- A multidisciplinary working group systematically searched major databases (Medline, Embase, CENTRAL, Cochrane) for randomized controlled trials and systematic reviews published May 2007-April 2011.
- Study eligibility, data extraction, and evidence assessment were performed by multiple reviewers following NHMRC guidelines.
Main Results:
- Recommendations were made for 16 out of 25 identified aspects of care, including preoperative preparation, smoking cessation, pain management, and venous thromboembolism prophylaxis.
- Significant heterogeneity in postoperative care studies limited the ability to make specific recommendations for that period.
- Key areas with recommendations included multidisciplinary preparation, preoperative exercise, and antibiotic prophylaxis.
Conclusions:
- A notable deficiency exists in the quality of evidence supporting critical aspects of care for primary THR/TKR surgery.
- Limited recommendations highlight the need for improved research quality and focus.
- Prioritizing and funding research in areas impacting clinical practice and patient outcomes after joint replacement is essential.