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After-hour elective total knee arthroplasty does not affect clinical outcomes but negatively affects alignment
Yuesheng Tu1, Yanhong Ning1, Kangxian Li1
1Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
Archives of Orthopaedic and Trauma Surgery
|May 25, 2022
Summary
After-hour total knee arthroplasty (TKA) does not impact clinical outcomes but may affect lower limb alignment and increase postoperative vomiting. These findings suggest careful consideration for scheduling elective TKAs outside standard hours.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Surgical Outcomes Research
Background:
- Elective total knee arthroplasty (TKA) may be performed after typical work hours due to resource limitations.
- Potential impacts of after-hour surgeries include surgeon fatigue and logistical challenges, possibly affecting patient outcomes.
Purpose of the Study:
- To investigate whether after-hour total knee arthroplasty (TKA) procedures lead to impaired clinical or radiological outcomes.
- To compare outcomes between day-time and after-hour elective TKA surgeries.
Main Methods:
- Retrospective analysis of 321 elective unilateral TKAs performed between January 2016 and November 2018.
- Patients were divided into day-time (8:00 AM - 5:29 PM) and after-hour (5:30 PM - 11:59 PM) surgery groups.
- Outcomes assessed included operative time, Knee Society Score (KSS), range of motion (ROM), blood loss, length of stay (LOS), complications, and radiological alignment.
Main Results:
- No significant differences were found in operative time, LOS, or total blood loss between groups.
- Overall and specific postoperative complication rates were comparable, except for a higher incidence of postoperative vomiting (POV) in the after-hour group.
- Knee function (KSS, ROM) and femoral notch evaluation showed no significant differences, but day-time surgeries had better coronal alignment and fewer outliers.
Conclusions:
- After-hour TKA procedures do not negatively impact clinical outcomes such as knee function or major complications.
- Scheduling TKA after hours is associated with poorer lower limb coronal alignment and an increased risk of postoperative vomiting.
- Patient comfort may be reduced, and surgical precision in alignment potentially compromised by after-hour TKA.
