1
|
Pre-operative predictors of lower extremity swelling following total knee arthroplasty in patients with venous insufficiency and osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2021; 45:2561-2567. [PMID: 33409562 DOI: 10.1007/s00264-020-04888-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Post-operative swelling and oedema following total knee arthroplasty (TKA) are one of the most important causes of dissatisfaction. We aimed to assess the clinical variables associated with post-operative swelling and edema after TKA and to compare their performance in respect of predicting them pre-operatively. METHODS The study cohort comprised 116 patients who underwent TKA between January 2018 and May 2019 in our centre. The diameters and the grade of venous insufficiency (VI) in the lower extremity veins were measured with duplex ultrasonography preoperatively and at one and three months post-operatively. The study cohort was divided into the patients with leg swelling positive with a difference in leg circumference of > 2 cm (n = 56, 48.2%) and leg swelling negative with a difference of ≤ 2 cm (n = 60, 51.7%) from the pre-operative leg diameter. RESULTS Independent predictors for lower extremity swelling were pre-operative great saphenous diameter (GSV) diameter > 5.5 mm [odds ratio (OR) 2.51, 95% CI 0.24-0.91; p = 0.0012], GSV reflux > 1 s [OR 3.28, 95% CI 1.16-12.1; p = 0.003], deep only VI [OR 1.32, 95% CI 0.74-1.87; p = 0.021], CEAP C4-6 [OR 1.62, 95% CI 0.36-0.91; p = 0.018], and hypothyroidism [OR 1.55, 95% CI 1.31-11.2; p = 0.031]. CONCLUSION GSV diameter of > 5.38 mm and GSV reflux duration > 1.23 s had the best predictive value for lower extremity oedema following TKA.
Collapse
|
2
|
Abstract
Swelling is a common phenomenon after total knee arthroplasty, with potential for negative impact on the rehabilitation process and final outcome. The aim of this study was to investigate the effectiveness of a new compression protocol with a self-adjustable, nonelastic compression wrap for the knee region. This study was conducted as a prospective comparative study. Total leg volume and the circumference of the knee at three levels were compared between groups. The results of our study suggest that the application of the new compression protocol has no effect on swelling in the acute postoperative phase (0-2 days) but reduces swelling at Day 14 within the subacute phase. The observed positive effect of the compression protocol could be of clinical importance in the subacute phase as well as for a subgroup of patients suffering from aberrant quadriceps weakness concomitant with knee swelling.
Collapse
|
3
|
Application of compression bandaging post-osteotomy results in altered pain profile; results of a single-centre randomised controlled trial. Int J Orthop Trauma Nurs 2020; 42:100833. [PMID: 33531268 DOI: 10.1016/j.ijotn.2020.100833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/05/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess if application of dual-layer compression bandage to osteotomy patients post-surgery can positively influence levels of post-operative pain and swelling. PATIENTS & METHODS Prospective, single-centre, randomised controlled trial comparing standard care, non-compression bandaging, versus Coban™ 2 (3M). Seven day application of the latter to index leg of osteotomy patients. RESULTS Primary outcome data was available for 36 out of 49 study subjects (18 standard care versus 18 Coban™ 2 subjects). Median 10-cm scale pain levels showed a statistically non-significant difference at day 5 and day 12 post-surgery between standard care and Coban™ 2 respectively: 5.5 cm vs 2.5 cm (p-value 0.068) and 4.0 cm vs 2.3 cm (p-value 0.39). However, on day 12 (p-value 0.029) and week 6 (p-value 0.027), 'throbbing pain' was significantly higher for Coban™ 2 patients. Changes in limb swelling measures, comparing before and after the surgical procedure, did not differ between treatment arms. Compression led to more patients reporting bandage-related discomfort (6% standard care versus 63% Coban™ 2 patients). CONCLUSION Compression bandaging changes the post-surgery pain profile in osteotomy patients, but does not reduce leg swelling. Any subsequent leg compression trials must take into account patient comfort and titrate intervention length and compression rates.
Collapse
|
4
|
Liu P, Mu X, Zhang Q, Liu Z, Wang W, Guo W. Should compression bandage be performed after total knee arthroplasty? A meta-analysis of randomized controlled trials. J Orthop Surg Res 2020; 15:52. [PMID: 32059737 PMCID: PMC7023752 DOI: 10.1186/s13018-019-1527-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Compression bandage often is used after total knee arthroplasty (TKA) to alleviate pain, ameliorate swelling, and reduce bleeding. However, there is controversy about its application due to conflicting clinical outcomes and potential compression-related complications. This meta-analysis aimed to answer the question of if compression bandage should be implemented routinely after TKA. Methods Relevant randomized controlled trials (RCTs) on compression bandage were comprehensively retrieved utilizing search engines such as PubMed, EMBASE, Web of Science, and the Cochrane Library, up to September 2019. Studies included in the meta-analysis were those that compared post-operative pain score, swelling, total blood loss, pre- and post-operative hematocrit levels differences, range of motion (ROM), and complications, using Review Manager 5.3.0. Results Included were seven RCTs, which reported on 511 knees. The pooled results showed the compression bandage group was associated with a greater post-operative pain score during ambulation at 48 h (WMD = 0.70, 95% CI 0.07 to 1.34, P = 0.03), compared with the non-compression bandage group. No statistically significant differences were found between the groups in post-operative pain scores at the other times, swelling, blood loss, ROM, or other complications (P > 0.05). Conclusions The current evidence is unable to conclude that compression bandage is necessary after primary TKA. Surgeons routinely undertaking compression bandage should deliberate whether there is enough clinical evidence.
Collapse
Affiliation(s)
- Pei Liu
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Xiaohong Mu
- Department Orthopedics 4, Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Zhaohui Liu
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, China.
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, China.
| |
Collapse
|
5
|
Pennestrì F, Maffulli N, Sirtori P, Perazzo P, Negrini F, Banfi G, Peretti GM. Blood management in fast-track orthopedic surgery: an evidence-based narrative review. J Orthop Surg Res 2019; 14:263. [PMID: 31429775 PMCID: PMC6701001 DOI: 10.1186/s13018-019-1296-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Innovations able to maintain patient safety while reducing the amount of transfusion add value to orthopedic procedures. Opportunities for improvement arise especially in elective procedures, as long as room for planning is available. Although many strategies have been proposed, there is no consensus about the most successful combination. The purpose of this investigation is to identify information to support blood management strategies in fast-track total joint arthroplasty (TJA) pathway, to (i) support clinical decision making according to current evidence and best practices, and (ii) identify critical issues which need further research. METHODS AND MATERIALS We identified conventional blood management strategies in elective orthopedic procedures. We performed an electronic search about blood management strategies in fast-track TJA. We designed tables to match every step of the former with the latter. We submitted the findings to clinicians who operate using fast-track surgery protocols in TJA at our research hospital. RESULTS Preoperative anemia detection and treatment, blood anticoagulants/aggregants consumption, transfusion trigger, anesthetic technique, local infiltration analgesia, drainage clamping and removals, and postoperative multimodal thromboprophylaxis are the factors which can add best value to a fast-track pathway, since they provide significant room for planning and prediction. CONCLUSION The difference between conventional and fast-track pathways does not lie in the contents of blood management, which are related to surgeons/surgeries, materials used and patients, but in the way these contents are integrated into each other, since elective orthopedic procedures offer significant room for planning. Further studies are needed to identify optimal regimens.
Collapse
Affiliation(s)
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy. .,San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Salerno, Italy. .,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, London, England.
| | - Paolo Sirtori
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Paolo Perazzo
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Francesco Negrini
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy.,Vita-Salute San Raffaele University, Scientific Direction, Milan, Italy
| | - Giuseppe M Peretti
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy.,University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| |
Collapse
|
6
|
Abstract
BACKGROUND Compression bandages often are used after TKA to reduce swelling. However, the degree to which they are helpful has not been well characterized. QUESTIONS/PURPOSES The purpose of this study was to determine whether use of a compression bandage after TKA was associated with (1) less leg swelling (our primary endpoint); or (2) secondary study endpoints, including improved ROM of flexion and extension, lower visual analog scale (VAS) pain scores for worst pain and pain during physical therapy just before surgery, postoperative day (POD) 1, POD 2, and POD 28, or fewer wound complications within 90 days of surgery. METHODS A prospective, single-center, two-arm, parallel-group randomized controlled trial was conducted on 51 patients undergoing simultaneous, bilateral, primary TKA between February 2015 and August 2016. Patients were excluded if they had a body mass index > 40 kg/m, a history of a venous thromboembolic event, an allergy to the dressing or compression bandage, or lymphedema in one or both legs. Participants averaged a mean age of 62 years (range, 40-83 years). In all patients, we released the tourniquet after full wound closure, and we applied an Aquacel dressing to both limbs. Patients were randomized by opaque envelope, and the compression bandage was applied to the randomized limb. For each leg, study personnel not involved in patient care measured the patients' limb circumference (thigh, knee, and tibia), ROM, and VAS pain scores 24 hours after surgery, 48 hours after surgery, and on POD 28. The minimal clinically important difference for circumference was 2 cm with a SD of 2 cm in the circumference. For VAS, it was 2 points with a SD of 2. For ROM, it was 10° with a SD of 15. We conservatively picked an effect size of 0.5 SD and assumed a correlation between limbs of 0.3. This set the power level at 0.80 with an α error of 0.05; thus, a power analysis for paired t-tests indicated that 45 patients would be an appropriate sample size. There were 29 patients randomized to the right leg group and 22 patients randomized to the left leg group. There were no differences between the limb with and without the compression bandage preoperatively. RESULTS Postoperatively, there were no differences between the groups in terms of leg swelling at the thigh (POD 1: mean ± SD = 51 ± 6 with compression bandage versus mean ± SD = 51 ± 6 without compression bandage, mean Δ = - 0.14, 95% confidence interval [CI], -0.65 to 0.37], p = 0.586; POD 2: mean ± SD = 53 ± 6 with compression bandage versus mean ± SD = 53 ± 7 without compression bandage, mean Δ = -0.22, 95% CI, -0.95 to 0.51, p = 0.548; POD 28: mean ± SD = 47 ± 6 with compression bandage versus mean ± SD = 47 ± 6 without compression bandage, mean Δ = -0.01, 95% CI, -0.39 to 0.38, p = 0.975), knee (POD 1: mean ± SD = 45 ± 4 with compression bandage versus mean ± SD = 45 ± 5 without compression bandage, mean Δ = -0.44, 95% CI, -1.16 to 0.28, p = 0.223; POD 2: mean ± SD = 46 ± 4 with compression bandage versus mean ± SD = 46 ± 4 without compression bandage, mean Δ = -0.30, 95% CI, -0.69 to 0.10, p = 0.137; POD 28: mean ± SD = 42 ± 5 with compression bandage versus mean ± SD = 42 ± 5 without compression bandage, mean Δ = 0.21, 95% CI, -0.34 to 0.76, p = 0.446), and shin (POD 1: mean ± SD = 40 ± 4 with compression bandage versus mean ± SD = 40 ± 4 without compression bandage, mean Δ = -0.22, 95% CI, -1.23 to 0.79, p = 0.659; POD 2: mean ± SD = 41 ± 4 with compression bandage versus mean ± SD = 41 ± 4 without compression bandage, mean Δ = -0.31, 95% CI, -0.72 to 0.09, p = 0.126; POD 28: mean ± SD = 37 ± 4 with compression bandage versus mean ± SD = 37 ± 4 without compression bandage, mean Δ = -0.34, 95% CI, -0.92 to 0.24, p = 0.246). There were no differences between the groups in terms of flexion ROM (POD 1: mean ± SD = 56 ± 25 with compression bandage versus mean ± SD = 58 ± 22 without compression bandage, mean Δ = -2.63, p = 0.234; POD 2: mean ± SD = 64 ± 20 with compression bandage versus mean ± SD = 63 ± 23 without compression bandage, mean Δ = 1.22, p = 0.534; POD 28: mean ± SD = 101 ± 20 with compression bandage versus mean ± SD = 102 ± 20 without compression bandage, mean Δ = -1.64, p = 0.103) and extension (POD 1: mean ± SD = 12 ± 7 with compression bandage versus mean ± SD = 12 ± 7 without compression bandage, mean Δ = 0.51, p = 0.328; POD 2: mean ± SD = 9 ± 5 with compression bandage versus mean ± SD = 10 ± 6 without compression bandage, mean Δ = -1.28, p = 0.061; POD 28: mean ± SD = 6 ± 14 with compression bandage versus mean ± SD = 4 ± 4 without compression bandage, mean Δ = 2.19, p = 0.252). With the numbers available, we observed greater maximal postoperative pain for the limb with the compression bandage than the control limb on POD 1 and POD 2, but not on POD 28 (POD 1: mean ± SD = 8 ± 3 with compression bandage versus mean ± SD = 7 ± 3 without compression bandage, mean Δ = 0.66, p = 0.030; POD 2: mean ± SD = 7 ± 2 with compression bandage versus mean ± SD = 7 ± 3 without compression bandage, mean Δ = 0.80, p = 0.008; POD 28: mean ± SD = 4 ± 3 with compression bandage versus mean ± SD = 3 ± 3 without compression bandage, mean Δ = 0.14, p = 0.526). Likewise, there was greater pain during physical therapy for the limb with the compression bandage than the limb without on POD 2, but not on POD 1 and POD 28 (POD 1: mean ± SD = 7 ± 3 with compression bandage versus mean ± SD = 6 ± 3 without compression bandage, mean Δ = 0.29, p = 0.460; POD 2: mean ± SD = 8 ± 2 with compression bandage versus mean ± SD = 7 ± 3 without compression bandage, mean Δ = 0.67, p = 0.018; POD 28: mean ± SD = 5 ± 2 with compression bandage versus mean ± SD = 5 ± 3 without compression bandage, mean Δ = 0.14, p = 0.600). With the numbers available, we observed no difference in 90-day wound healing complications between the limb with and the limb without the compression dressing; however, the sample size was too small to analyze this in a meaningful statistical way. Overall, there were 6% total wound complications in the compression bandage group and 12% total wound complications in the group without the compression bandage (odds ratio [OR], 0.47; p = 0.487). Drainage was not observed in the group with the compression bandage, whereas the group without the compression bandage had 6% drainage (OR, 0.00; p = 0.243). There were no deep infections or reoperations within 90 days postoperatively. CONCLUSIONS Applying a compression bandage after TKA did not result in any clinical improvement in limb circumference, ROM, or pain. Based on this study, we believe that applying a compression bandage after TKA neither benefits nor harms the patient. Thus, we no longer use compression dressings for routine primary TKA. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
|
7
|
Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial. Eur J Trauma Emerg Surg 2018; 44:947-956. [DOI: 10.1007/s00068-017-0892-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
|
8
|
Outpatient surgery for unicompartmental knee arthroplasty is effective and safe. Knee Surg Sports Traumatol Arthrosc 2017; 25:2659-2667. [PMID: 26130425 DOI: 10.1007/s00167-015-3680-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 06/08/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE There has been increasing interest in accelerated programs for knee arthroplasty. We examined the efficacy and safety of an outpatient surgery (OS) pathway in patients undergoing unicompartmental knee arthroplasty (UKA). METHODS This case-controlled study evaluates patients operated for UKA in an OS pathway (n = 20) compared to rapid recovery (RR), the current standard (n = 20). We investigated whether patients could be discharged on the day of surgery, resulting in comparable or better outcome by means of adverse events (AEs) in terms of pain (numerical rating scale, NRS), incidences of postoperative nausea and vomiting (PONV) and opiate use (<48 h postoperatively), complication and readmission rates (<3 months postoperatively). Patient-reported outcome measures (PROMS) were obtained preoperatively and 3 months postoperatively. RESULTS Postoperative pain (NRS > 5) was the most common reason for prolonged hospital stay in the OS pathway. Eighty-five per cent of the patients were discharged on the day of surgery, whereas 95 % of the patients were discharged on postoperative day 3 in the RR pathway. Overall, median pain scores in both pathways did not exceed a NRS score of 5, without significant differences (RR vs. OS) in the number of patients with PONV (4 vs. 2) and opiate use (11 vs. 9) <48 h postoperatively. At 3 months postoperatively, no significant differences were found for AEs and PROMS between both pathways. CONCLUSION The results of this study illustrates that an OS pathway for UKA is effective and safe with acceptable clinical outcome. Well-established and adequate standardized protocols, inclusion and exclusion criteria and a change in mindset for both the patient and the multidisciplinary team are the key factors for the implementation of an OS pathway. LEVEL OF EVIDENCE Case-control study, Level III.
Collapse
|
9
|
Meyr AJ, Mirmiran R, Naldo J, Sachs BD, Shibuya N. American College of Foot and Ankle Surgeons ® Clinical Consensus Statement: Perioperative Management. J Foot Ankle Surg 2017; 56:336-356. [PMID: 28231966 DOI: 10.1053/j.jfas.2016.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Indexed: 02/07/2023]
Abstract
A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.
Collapse
Affiliation(s)
- Andrew J Meyr
- Committee Chairperson and Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | | | - Jason Naldo
- Assistant Professor, Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Brett D Sachs
- Private Practice, Rocky Mountain Foot & Ankle Center, Wheat Ridge, CO; Faculty, Podiatric Medicine and Surgery Program, Highlands-Presbyterian St. Luke's Medical Center, Denver, CO
| | - Naohiro Shibuya
- Professor, Department of Surgery, Texas A&M, College of Medicine, Temple, TX
| |
Collapse
|
10
|
Brock TM, Sprowson AP, Muller S, Reed MR. STICKS study - Short-sTretch Inelastic Compression bandage in Knee Swelling following total knee arthroplasty - a feasibility study. Trials 2017; 18:6. [PMID: 28069060 PMCID: PMC5223465 DOI: 10.1186/s13063-016-1767-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative knee swelling is common and impairs early postoperative function following total knee arthroplasty. It was hypothesised that the use of a short-stretch, inelastic compression bandage would reduce knee swelling and improve pain and early function. The aim of this study was to provide preliminary data and test feasibility with a view to informing a larger, future trial. METHODS Fifty consecutive patients selected for primary total knee arthroplasty underwent distance randomisation to receive a short-stretch, inelastic compression bandage or a standard wool and crepe bandage for the first 24 h postoperatively. Study feasibility including recruitment rates, retention rates and complications were analysed. The Oxford Knee Score, the EQ-5D-3L index score, knee swelling, knee range of motion, visual analogue pain score and length of stay were compared between groups. Analysis of covariance (ANCOVA) was performed adjusting for the preoperative measurement. RESULTS Sixty-eight percent of eligible patients were recruited into the trial. The retention rate was 88%. There were no complications regarding compression bandage use. There was a greater mean but non-significant improvement in Oxford Knee Score (p = 0.580; point estimate = 2.1; 95% CI -3.288 to 7.449) and EQ-5D-3L index score (p = 0.057; point estimate = 0.147; 95% CI -0.328 to 0.005) in the compression bandage group at 6 months. There was no significant difference between groups regarding knee swelling, knee range of motion, visual analogue pain score, complications and length of stay. CONCLUSION Preliminary data suggests that the use of an inelastic, short-stretch compression bandage following total knee arthroplasty is a safe technique that is acceptable to patients. A larger, multicentre trial is required to determine its effect postoperatively. TRIAL REGISTRATION The study was registered with Current Controlled Trials, identifier: ISRCTN86903140 . Registered on 30 May 2013.
Collapse
Affiliation(s)
- T M Brock
- Trauma and Orthopaedic Surgery, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.
| | - A P Sprowson
- Trauma and Orthopaedics, Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - S Muller
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - M R Reed
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, NE63 9JJ, UK
| |
Collapse
|
11
|
Hoorntje A, Koenraadt KLM, Boevé MG, van Geenen RCI. Outpatient unicompartmental knee arthroplasty: who is afraid of outpatient surgery? Knee Surg Sports Traumatol Arthrosc 2017; 25:759-766. [PMID: 28229182 PMCID: PMC5332488 DOI: 10.1007/s00167-017-4440-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/20/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE In recent years, duration of hospitalisation after knee arthroplasty has decreased and fast track and outpatient surgery protocols have been developed. Studies have shown that outpatient surgery is feasible, safe, and cost effective. However, the psychological well-being of patients undergoing outpatient surgery has never been described before. The purpose of this study was to investigate how patients experience outpatient surgery for unicompartmental knee arthroplasty (UKA), examining levels of anxiety and depression, satisfaction, and pain. It was hypothesized that the same-day discharge following UKA would not result in higher levels of anxiety and depression, compared to the standard fast-track surgery. METHODS This case-controlled study included 20 patients undergoing UKA in an outpatient surgery setting and 20 patients undergoing the standard fast-track procedure. The Hospital Anxiety and Depression Scale (HADS, 0-42, lower is better) and numeric rating scales (NRS, 0-10) for pain and satisfaction were collected preoperatively, on the day of surgery, on the first, second, and seventh postoperative days and after 6 and 12 weeks. The Oxford Knee Score (OKS), the KOOS, EuroQoL-5D, and Net Promoter Score (NPS) were collected preoperatively and 3 months postoperatively. RESULTS 90% of patients in the outpatient surgery group were discharged on the day of surgery. At the first postoperative day, the median HADS score was significantly lower in the outpatient surgery group compared to the fast-track group (3 vs. 8, p = 0.02), the median NRS satisfaction score was significantly higher in the outpatient surgery group (8 vs. 5, p = 0.03), and no differences existed between both groups for the NRS pain scores. At 3 month follow-up, no significant differences in improvement scores existed between both groups for the HADS, the NRS scores, and for the OKS, KOOS, EuroQoL-5D, and NPS. CONCLUSION The results of this study emphasize the feasibility of an outpatient surgery pathway in carefully selected UKA patients. The outpatient surgery pathway is safe, and clinical outcome, including levels of anxiety and depression, satisfaction, and pain, was similar in outpatient surgery patients compared to the standard fast-track patients. LEVEL OF EVIDENCE Case-control study, Level III.
Collapse
Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Postbus 90158, 4800 RK Breda, The Netherlands
| | - Koen L. M. Koenraadt
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Postbus 90158, 4800 RK Breda, The Netherlands
| | - Margreet G. Boevé
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Postbus 90158, 4800 RK Breda, The Netherlands
| | - Rutger C. I. van Geenen
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Postbus 90158, 4800 RK Breda, The Netherlands
| |
Collapse
|
12
|
Song M, Sun X, Tian X, Zhang X, Shi T, Sun R, Dai W. Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis. SPRINGERPLUS 2016; 5:1074. [PMID: 27462522 PMCID: PMC4943919 DOI: 10.1186/s40064-016-2690-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/23/2016] [Indexed: 01/26/2023]
Abstract
Aim This study aims to conduct a meta-analysis to identify and compare the effectiveness of compressive cryotherapy and cryotherapy alone for patients undergoing knee surgery. Background Postoperative management is an important guarantee for the success of surgery. Cryotherapy and compression are two common nursing techniques after knee surgery, and are considered to be effective for postoperative clinical symptoms such as local pain and swelling. However, no previous meta-analyses have compared the effectiveness of compressive cryotherapy and cryotherapy alone in patients undergoing knee surgery. Design A meta-analysis of randomized controlled trials (RCTs). Methods We conducted a search in MEDLINE (via Pubmed, 1990–2014), EMBASE (via Elsevier, 1990–2014), Cochrane Central Register of Controlled Trials (The Cochrane Library, 1990–2014), CINAHL (1990–2014) and China National Knowledge Infrastructure (1990–2014) databases for RCTs published in English and Chinese. The primary outcome measure of interest was visual analog scale and girth measure. Finally, a meta-analysis was carried out using RevMan 5.3. Results Among the 593 RCTs, 10 RCTs were selected and included into this study. These studies included 522 patients who underwent knee surgery. Patients who underwent compressive cryotherapy tended to have less pain than patients who underwent cryotherapy alone at POD2 and POD3, while compressive cryotherapy had a strong tendency towards less swelling over cryotherapy alone at POD1 and POD2. However, there was no significant difference between compressive cryotherapy and cryotherapy alone at the intermediate stage of rehabilitation after knee surgery. All adverse reactions were recorded in all included RCTs. Conclusion Current evidence suggests that compressive cryotherapy is beneficial to patients undergoing knee surgery at the early rehabilitation stage. At the last stage, the effectiveness of compressive cryotherapy and cryotherapy alone were found to be similar.
Collapse
Affiliation(s)
- Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China.,Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, 378 Shi Ji West Road, Jinpu New Area, 116200 Liaoning People's Republic of China
| | - Xiaohong Sun
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China.,Department of Nursing, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China
| | - Xiliang Tian
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China
| | - Xianbin Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China
| | - Tieying Shi
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China
| | - Ran Sun
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China.,Operation Room, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China
| | - Wei Dai
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China.,Operation Room, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, Dalian, 116011 Liaoning People's Republic of China
| |
Collapse
|