Abstract
BackgroundTotal knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP) – and report post-surgical outcomes.Methods74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period.ResultsAll patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°), but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period.ConclusionThe comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe protocol for providing care after a TKA.
Highlights
Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US
An emphasis is placed on reducing lengths of hospital stays and minimizing peri-operative complications as means of managing the costs associated with TKAs. [9,10,11] Each of the following has a potential to minimize length of stay and/or postoperative complications in some manner: pre-operative education, [12,13,14] peri- and post-operative pain management, [15,16,17] clinical pathways, [18,19,20] early and aggressive rehabilitation including physical therapy (PT),[10,21,22,23,24] and proactive discharge planning.[13,25]
The patients were 71.4 ± 8.7 years old on average, and the majority (62%) was female. 45% were categorized as obese (BMI > 30 kg/m2), 38% were categorized as overweight (BMI 25–29.9 kg/m2) and 17% were categorized as normal weight (BMI 18–25 kg/m2)
Summary
Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. Total knee arthroplasty (TKA) is a common and successful surgical intervention for the management of disability secondary to osteoarthritis of the knee.[1] TKAs are associated with low peri-operative morbidity and improved pain and functional status.[2,3] Over 400,000 TKAs were performed in the United States in 2005.[4] This number is expected to increase dramatically over the coming decades secondary to the success of the intervention and the aging "baby boomer" population.[4,5]. The need to efficiently utilize healthcare resources while optimizing patient outcomes when caring for patients after TKAs is obvious.[4] To accomplish this, an emphasis is placed on reducing lengths of hospital stays and minimizing peri-operative complications (e.g. hypoxia, infection, pneumonia, thrombosis, etc.) as means of managing the costs associated with TKAs. An emphasis is placed on reducing lengths of hospital stays and minimizing peri-operative complications (e.g. hypoxia, infection, pneumonia, thrombosis, etc.) as means of managing the costs associated with TKAs. [9,10,11] Each of the following has a potential to minimize length of stay and/or postoperative complications in some manner: pre-operative education, [12,13,14] peri- and post-operative pain management, [15,16,17] clinical pathways, [18,19,20] early and aggressive rehabilitation including physical therapy (PT),[10,21,22,23,24] and proactive discharge planning.[13,25]
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