Abstract
ObjectivesTo explore the safety and efficacy of the enhanced recovery after surgery (ERAS) program for elderly total knee arthroplasty (TKA) patients.MethodsA prospective controlled study was conducted for patients older than 65 years, who would undergo unilateral TKA with a minimum follow‐up of 2 years. Patients were divided into an ERAS group (n = 106) and a traditional group (n = 141) based on the patients’ willingness to participate in the ERAS program. Baseline parameters of American Society of Anesthesiologists classification and comorbidity were recorded. Complication, mortality, knee function assessment using knee society score and knee range of motion, and perioperative clinical outcomes were compared between the two groups.ResultsThere were no significant differences between the two groups in terms of baseline parameters. Although no significant differences were found in postoperative nausea and vomiting, urinary tract infection, deep venous thrombosis, pulmonary embolism, wound delayed healing, superficial infection, and deep infection, there were significantly fewer total complications in the ERAS group (26/106 vs 52/141; P = 0.039). No significant difference was found in short‐term mortality (1/106 vs 3/141; P = 0.836) between the two groups. There were no significant differences in preoperative visual analogue scale (VAS), knee society score (KSS), and range of motion (ROM) between the two groups. Lower VAS scores were found in the ERAS group at time of postoperative day (POD) 1 (P = 0.012) and POD 5 (P = 0.020); no significant differences were observed at time of postoperative month (POM) 1 and final follow‐up. Higher KSS scores were found in the ERAS group at time of POD 1 (P = 0.013), and POD 5 (P = 0.011), no significant differences were observed at time of POM 1 and final follow‐up. Increased ROM degree was found in the ERAS group at time of POD 1 (P = 0.021); no significant differences were observed at time of POD 5, POM 1 and final follow‐up. Decreased intraoperative blood loss (P < 0.001), total blood loss (P < 0.001), transfusion rate (P = 0.004), and length of stay (P < 0.001) were found in the ERAS group; no significant differences were found in operative time and hospitalization costs between the two groups.ConclusionThe ERAS program is safer and more efficacious in elderly TKA patients compared to the traditional pathway. It could effectively relieve perioperative pain and improve joint function, and reduce blood transfusion, length of stay, and total complications without increasing short‐term mortality.
Highlights
Total knee arthroplasty (TKA) has become one of the most effective treatments for relieving joint pain and improving joint function in patients with knee arthritis[1]
There were no significant differences in baseline parameters between the two groups, including gender, age, body mass index (BMI), operation side, American Society of Anesthesiologists (ASA) classification, and medical history (Table 2)
Complications and Short-term Mortality During the 2 years of follow-up, there were no significant differences in postoperative nausea and vomiting (PONV), urinary tract infection, deep venous thrombosis (DVT), pulmonary embolism, delayed wound healing, superficial infection, and deep infection between the two groups
Summary
Total knee arthroplasty (TKA) has become one of the most effective treatments for relieving joint pain and improving joint function in patients with knee arthritis[1]. It has been predicted that the total number of TKA performed in the United States will increase to 3 480 000 cases by 20302. With the developments in medicine, TKA patients have higher expectations for surgical outcomes[3,4]. The financial burden of health care necessitates that medical institutions shorten hospitalization days and reduce complications[5]. Painless surgery and fast recovery are common pursuits of surgeons and TKA patients[6,7,8]. The core idea of enhanced recovery after surgery (ERAS) is to reduce surgical stress response, alleviate pain during perioperative
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