Abstract
The increasing numbers of patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), combined with the rapidly growing repertoire of surgical techniques and interventions available have put considerable pressure on surgeons and other healthcare professionals to produce excellent results with early functional recovery and short hospital stays. The current economic climate and the restricted healthcare budgets further necessitate brief hospitalization while minimizing costs.Clinical pathways and protocols introduced to achieve these goals include a variety of peri-operative interventions to fulfill patient expectations and achieve the desired outcomes.In this review, we present an evidence-based summary of common interventions available to achieve enhanced recovery, reduce hospital stay, and improve functional outcomes following THA and TKA. It covers pre-operative patient education and nutrition, pre-emptive analgesia, neuromuscular electrical stimulation, pulsed electromagnetic fields, peri-operative rehabilitation, modern wound dressings, standard surgical techniques, minimally invasive surgery, and fast-track arthroplasty units.
Highlights
Joint arthroplasty is a surgical procedure performed to reduce pain, improve function, and correct deformity [1]
The aim of this review is to provide an evidence-based summary of measures, interventions, and procedures that help to achieve early functional recovery, reduce hospital stay, and improve functional outcome following total hip arthroplasty (THA) and total knee arthroplasty (TKA)
Peri-operative rehabilitation programs a recent meta-analysis failed to establish the effectiveness of post-discharge physiotherapy exercises following THA in improving function, quality of life, mobility, range of motion, and muscle strength [49], a similar analysis supported the use of functional exercises to obtain short-term benefits after TKA [50]
Summary
Joint arthroplasty is a surgical procedure performed to reduce pain, improve function, and correct deformity [1]. The extension-resisted exercises alone were found to reduce the LOS and to improve the muscle strength and functional performance significantly compared with NMES alone or conventional physiotherapy alone in a three-armed RCT [43] This procedure should be tested further in the context of fast-track recovery following TKA and THA. Peri-operative rehabilitation programs a recent meta-analysis failed to establish the effectiveness of post-discharge physiotherapy exercises following THA in improving function, quality of life, mobility, range of motion, and muscle strength [49], a similar analysis supported the use of functional exercises to obtain short-term benefits after TKA [50] Both these studies were concerned with post-discharge physiotherapy alone rather than with peri-operative physiotherapy in the context of enhanced recovery. Additional research looking at improvements in these areas and their effect on outcomes is needed
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