Pathway-controlled fast-track rehabilitation after total knee arthroplasty: a randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay

Adrianus Den Hertog,Kerstin Gliesche,Bernd Mühlbauer,Jürgen Timm,Sylvia Zebrowski

doi:10.1007/s00402-012-1528-1

Abstract

PurposeTo investigate fast-track rehabilitation concept in terms of a measurable effect on the early recovery after total knee arthroplasty (TKA).MethodsThis was an open, randomized, prospective clinical study, comparing the fast-track rehabilitation—a pathway-controlled early recovery program (Joint Care®)—with standard postoperative rehabilitation care, after TKA. Overall, 147 patients had TKA (N = 74 fast-track rehabilitation, N = 73 standard rehabilitation). The fast-track rehabilitation patients received a group therapy, early mobilization (same day as surgery) and 1:1 physiotherapy (2 h/day). Patient monitoring occurred over 3 months (1 pre- and 4 post-operative visits). The standard rehabilitation group received individual postoperative care according to the existing protocol, with 1:1 physiotherapy (1 h/day). The cumulative American Knee Society Score (AKSS) was the primary evaluation variable, used to detect changes in joint function and perception of pain. The secondary evaluation variables were WOMAC index score, analgesic drug consumption, length of stay (LOS), and safety.ResultsAfter TKA, patients in the fast-track rehabilitation group showed enhanced recovery compared with the standard rehabilitation group, as based on the differences between the groups for the cumulative AKSS (p = 0.0003), WOMAC index score (<0.0001), reduced intake of concomitant analgesic drugs, reduced LOS (6.75 vs. 13.20 days, p < 0001), and lower number of adverse events.ConclusionFor TKA, implementation of pathway-controlled fast-track rehabilitation is achievable and beneficial as based on the AKSS and WOMAC score, reduced intake of analgesic drugs, and reduced LOS.

Highlights

Total knee arthroplasty (TKA) is a standard procedure in orthopedic surgery [1, 2]
After total knee arthroplasty (TKA), patients in the fast-track rehabilitation group showed enhanced recovery compared with the standard rehabilitation group, as based on the differences between the groups for the cumulative American Knee Society Score (AKSS) (p = 0.0003), WOMAC index score (\0.0001), reduced intake of concomitant analgesic drugs, reduced length of stay (LOS) (6.75 vs. 13.20 days, p \ 0001), and lower number of adverse events
Two patients were treated for Ahlback’s disease; one patient was treated for posttraumatic disease

Summary

Introduction

Total knee arthroplasty (TKA) is a standard procedure in orthopedic surgery [1, 2]. The incidence of TKA in the western countries is 150–200/100,000 inhabitants [3, 4]. Arch Orthop Trauma Surg (2012) 132:1153–1163 rehabilitation environment varies from a mean of 35 days (Japan) [6], 13.9–14.3 days (Germany) [7, 8], 7.6 days (Scotland) [9], 3–4 days in specialized hospital units (Denmark) [10, 11], and even same-day discharge [12] It appears that the LOS is dependent on the clinical outcome, but is influenced by logistical factors at the treatment center, the patient’s clinical features, as well as traditions and cultural factors (urban or rural living environment) and personal factors (co-morbidities, social and marital status) [6, 13, 14]. For a TKA in Germany, the defined minimum LOS in 2005 was 6 days, in 2007 was 5 days, and in 2010, 4 days [7, 15]

Methods

Results

Conclusion