Effectiveness evaluation between enhanced recovery after surgery and traditional treatment in unilateral total knee arthroplasty

Abstract

Objective: To investigate the clinical effect of enhanced recovery after surgery (ERAS) in unilateral total knee arthroplasty (TKA). Methods: Retrospective analysis of 98 patients received unilateral TKA from September 2015 to September 2016 in the Orthopaedic Departmentof Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces.Of the patients, 52 cases were treated by traditional operation (routine group) and the other 46 cases were treated with ERAS concept (ERAS group). The following data were gathered and statistically analyzed between the groups: gender, age, body mass index, preoperative hemoglobin, preoperative visual analogue scale (VAS) score, postoperative visible blood loss, postoperative hemoglobin at 24 hour after operation, blood transfusion rate, postoperative VAS score, length of hospital stay, the satisfaction rate, preoperative and 1 and 6 months postoperative evaluation with hospital for special surgery knee score (HSS), postoperative range of motion (ROM) of knees after 2 weeks, 1 month and 6 months of surgery, incidence rate of complications after surgery.Data between groups were analyzed with one-factor analysis of variance or chi-square test. Results: There was no significant difference in preoperative data between two groups.Postoperative visible blood loss of ERAS group was significantly lower than that in routine group[(224±59) vs (361±70) ml, t=4.723, P<0.01]; postoperative hemoglobin after 24 hours in ERAS group was significantly higher than that in routine group[(109±8) vs (96±10) g/L, t=-3.297, P=0.004]; blood transfusion rate of ERAS group was significantly lower than that in routine group[6.5 %(3/46) vs 46.2%(24/52), χ(2)=19.207, P<0.01]; the 12-hour and 48-hour postoperative VAS scores in ERAS groups were both significantly lower than those in routine group (t=3.708, 3.894, both P<0.05); length of hospital stay in ERAS group was significantly shorter than that in routine group[(6.8±1.2) vs (13.1±2.6) d, t=6.924, P<0.01]; HSS scores of ERAS groups at 1 month and 6 months after surgery were both significantly higher than those in routine group (t=-3.677, -3.594, both P<0.05); knees ROM in ERAS group at 2 weeks and 1 month after surgery were both significantly higher than those in routine group (t=-4.628, -4.442, both P<0.05); the rate of postoperative nausea vomiting in ERAS group was significantly lower than that in routine group[13.0%(6/46) vs 48.1%(25/52), χ(2)=13.852, P=0.002]. VAS score at 1 month after surgery, knees ROM at 6 months after surgery and the satisfaction rate were all comparable between the two groups (t=0.412, -1.026, χ(2)=3.695, all P>0.05). Conclusions: Condition of patients treated by unilateral TKA under ERAS model improves effectively during perioperative period when compared with routine treatment, patients have earlier rehabilitation and better experience in hospital and operation.