Enhanced recovery after total knee replacement surgery – A case-control study

Abstract

Objectives: Recently, our institution has been working with Enhanced Recovery After Surgery (ERAS) protocol in total knee replacement. So far, only seven patients were enrolled in this programme. Our objective was to evaluate its impact on functional capacity and postoperative rehabilitation, in order to apply ERAS in total knee replacement in our daily routine. Methods: A case-control study, 1:1 pair-matched. A total of 7 pairs of cases, matched by sex, age and ASA functional status classification were purposed to total knee replacement. The case group consisted of patients that enrolled ERAS programme. Descriptive statistics are presented as percentage for categorical variables and average ± standard deviation for continuous variables. Results: In both groups six (85.7%) patients were female and the average age was 72±5.03 years. All operations were performed under subarachnoid block. The average tourniquet time was 91.71±16.42 and 102±16.03 minutes in the case and control group, respectively. Post-surgical pain was managed in the ERAS group with ropivacaine 0.2% through a knee joint catheter while in the control group was used ropivacaíne 0.2% and morphine by use of an epidural catheter. Numeric pain rating scale was ≤3 in 71.43% in the case group versus 28.57% in the control group. None of the 14 patients were transfused or had thrombotic complications. The average length of hospital stay (LOS) was 5.1±1.9 and 6.0±0.6 days in the case and control group, respectively. At discharge 13 patients were walking independently with crutches assistance and one patient from the control group was dependent on wheelchair. Conclusion: The ERAS programme seems to be associated with better outcomes in pain management, LOS and postoperative rehabilitation, without more complications. This was the starting point for the implementation, fitting and standardisation of the ERAS programme in orthopaedic surgery at our institution, however further studies are needed to validate our results. Disclosure of interest: None declared.