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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Research

Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions

Authors: Aksel Paulsen, Ane Djuv, Jarle Ludvigsen, Ingvild Dalen

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

Fast-track hip and knee arthroplasty (HA and KA) has been increasingly common over the last decade. In the same time period, there was a strong trend toward less restrictive mobilization. However, few reports have been published on combining these novel programs while measuring the postoperative results by patient-reported outcome measures (PROMs). Descriptions of fast-track surgery programs and their results are warranted.

Methods

The aim of this retrospective cohort study was to examine if it is possible to achieve excellent PROM results for hip and knee arthroplasty patients in a fast-track pathway without postoperative restrictions. During 2014–2017, the stepwise introduction of a PROM program was implemented at Stavanger University Hospital for all scheduled HA and KA patients, with preoperative assessments and postoperative follow-ups at the outpatient clinic. Standardized information with a focus on early mobilization and no postoperative restrictions was also initiated for the same patients. The generic EuroQol questionnaire (EQ-5D) and either the Hip or Knee disability/injury and Osteoarthritis Outcome Score (HOOS or KOOS) were used.

Results

PROM response rates varied from 80 to 99%. The median (interquartile range) change from preoperative to one-year postoperative results were as follows for HA and KA patients, respectively: pain, 55 (43–68) and 47 (31–61); other symptoms, 50 (40–65) and 36 (19–50); function in daily living, 54 (41–65) and 44 (31–55); function in sports and recreation, 56 (38–75) and 40 (15–64); joint-related quality of life, 69 (50–81) and 56 (38–75). The length of stay (LOS) was reduced by 1.9 days (mean), corresponding to a 40% reduction for HA patients and a 37% reduction for KA patients.

Conclusions

We found excellent PROM results after fast-track HA and KA with no postoperative restrictions. We believe that a fast-track program focusing on mobilization without any postoperative restrictions is superior for most patients, but further comparative studies are warranted.

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Hansen TB, et al. [Fast-track hip arthroplasty]. Ugeskr Laeger. 2017;179(51):V03170252.PubMed

Kehlet HJDO. History and future challenges in fast-track hip and knee arthroplasty. Orthopade. 2020;49(4):290–2.PubMedCrossRef

Fransen BL, et al. Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up. Arch Orthop Trauma Surg. 2018;138(9):1305–16.PubMedPubMedCentralCrossRef

Tan NLT, Hunt JL, Gwini SM. Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: a quality improvement study. BMC Anesthesiol. 2018;18:64.PubMedPubMedCentralCrossRef

Vehmeijer SBW, Husted H, Kehlet H. Outpatient total hip and knee arthroplasty: Facts and challenges. Acta Orthop. 2018;89(2):141–4.PubMedCrossRef

Pamilo KJ, et al. Reduced length of uninterrupted institutional stay after implementing a fast-track protocol for primary total hip replacement: Register-based analysis of 4 hospitals and 3,193 replacements. Acta Orthop. 2018;89(1):10–6.PubMedCrossRef

Castorina S, et al. Clinical evidence of traditional vs fast track recovery methodologies after total arthroplasty for osteoarthritic knee treatment. A retrospective observational study. Muscles Ligaments Tendons J. 2017;7(3):504–13.PubMedCrossRef

Klapwijk LCM, et al. The first 6 weeks of recovery after primary total hip arthroplasty with fast track: A diary study of 94 patients. Acta Orthop. 2017;88(2):140–4.PubMedPubMedCentralCrossRef

Nöth U, et al. Fast-Track-Strategien in der Hüftendoprothetik. Der Orthopäde. 2019;48(4):330–6.PubMedCrossRef

10.

Smith TO, et al. Rehabilitation implications during the development of the Norwich Enhanced Recovery Programme (NERP) for patients following total knee and total hip arthroplasty. Orthop Traumatol Surg Res. 2012;98(5):499–505.PubMedCrossRef

11.

Gromov K, et al. Fast-track total knee arthroplasty. Ugeskr Laeger. 2017;179(38):V04170300.PubMed

12.

Vogel LA, et al. Physical activity after total joint arthroplasty. Sports Health. 2011;3(5):441–50.PubMedPubMedCentralCrossRef

13.

Husted H, et al. Traditions and myths in hip and knee arthroplasty. Acta Orthop. 2014;85(6):548–55.PubMedPubMedCentralCrossRef

14.

Jorgensen CC, et al. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors. Arch Orthop Trauma Surg. 2014;134(11):1615–22.PubMedCrossRef

15.

van der Weegen W, Kornuijt A, Das D. Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil. 2016;30(4):329–39.PubMedCrossRef

16.

Peters A, et al. Less Postoperative Restrictions Following Total Hip Arthroplasty With Use of a Posterolateral Approach: A Prospective, Randomized. Noninferiority Trial The Journal of Arthroplasty. 2019;34(10):2415–9.PubMedCrossRef

17.

Tetreault MW, et al. Are Postoperative Hip Precautions Necessary After Primary Total Hip Arthroplasty Using a Posterior Approach? Preliminary Results of a Prospective Randomized Trial. J Arthroplasty. 2020;35(6S):S246–51.PubMedCrossRef

18.

Lightfoot CJ, et al. Hip precautions after total hip replacement and their discontinuation from practice: patient perceptions and experiences. Disabil Rehabil. 2021;43(20):2890–6. https://doi.org/10.1080/09638288.2020.1722262.

19.

Smith TO, et al. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev. 2016;7(7):Cd010815.PubMed

20.

Barnsley L, Barnsley L, Page R. Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review. Geriatr Orthop Surg Rehabil. 2015;6(3):230–5.PubMedPubMedCentralCrossRef

21.

Lightfoot CJ, et al. Evaluation of hip precautions following total hip replacement: a before and after study. Disabil Rehabil. 2021;43(20):2882–9. https://doi.org/10.1080/09638288.2020.1721575.

22.

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. The Lancet. 2007;370(9597):1508–19.CrossRef

23.

Beswick AD, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435.PubMedPubMedCentralCrossRef

24.

Gagnier JJ. Patient reported outcomes in orthopaedics. J Orthop Res. 2017;35(10):2098–108.PubMedCrossRef

25.

Calvert M, et al. Maximising the impact of patient reported outcome assessment for patients and society. BMJ. 2019;364:k5267.PubMedCrossRef

26.

Wilson I, et al. Orthopaedic registries with patient-reported outcome measures. EFORT open reviews. 2019;4(6):357–67.PubMedPubMedCentralCrossRef

27.

Paulsen A. Patient reported outcomes in hip arthroplasty registries. Dan Med J. 2014;61(5):B4845.PubMed

28.

Herdman M, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.PubMedPubMedCentralCrossRef

29.

Jin X, et al. Responsiveness of the EQ-5D-3L and EQ-5D-5L in patients following total hip or knee replacement. Qual Life Res. 2019;28(9):2409–17.PubMedCrossRef

30.

Nilsdotter AK, et al. Hip disability and osteoarthritis outcome score (HOOS)–validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10.PubMedPubMedCentralCrossRef

31.

Roos E, et al. Knee Injury and Osteoarthritis Outcome Score (KOOS)—Development of a Self-Administered Outcome Measure. J Orthop Sports Phys Ther. 1998;28(2):88–96.PubMedCrossRef

32.

Paulsen A, et al. Feasibility of 4 patient-reported outcome measures in a registry setting. Acta Orthop. 2012;83(4):321–7.PubMedPubMedCentralCrossRef

33.

Quintana JM, et al. Outcomes after total hip replacement based on patients’ baseline status: What results can be expected? Arthritis Care Res. 2012;64(4):563–72.CrossRef

34.

Tubach F, Giraudeau B, Ravaud P. The variability in minimal clinically important difference and patient acceptable symptomatic state values did not have an impact on treatment effect estimates. J Clin Epidemiol. 2009;62(7):725–8.PubMedCrossRef

35.

Paulsen A, et al. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively. Acta Orthop. 2014;85(1):39–48.PubMedPubMedCentralCrossRef

36.

Lyman S, et al. What Are the Minimal and Substantial Improvements in the HOOS and KOOS and JR Versions After Total Joint Replacement? Clin Orthop Relat Res. 2018;476(12):2432–41.PubMedPubMedCentralCrossRef

37.

Berg U, et al. Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011–2015: an observational study including 51,169 THR and 8,393 TKR operations. Acta Orthop. 2020;91(3):306–12.PubMedPubMedCentralCrossRef

38.

Gromov K, et al. Varying but reduced use of postoperative mobilization restrictions after primary total hip arthroplasty in Nordic countries: a questionnaire-based study. Acta Orthop. 2019;90(2):143–7.PubMedPubMedCentralCrossRef

39.

Berry DJ, Bozic KJ. Current practice patterns in primary hip and knee arthroplasty among members of the American Association of Hip and Knee Surgeons. J Arthroplasty. 2010;25(6 Suppl):2–4.PubMedCrossRef

40.

Carli AV, et al. Variation in Use of Postoperative Precautions and Equipment Following Total Hip Arthroplasty: A Survey of the AAHKS and CAS Membership. J Arthroplasty. 2018;33(10):3201–5.PubMedCrossRef

41.

Drummond A, et al. Hip Precautions following Primary Total Hip Replacement: A National Survey of Current Occupational Therapy Practice. Br J Occup Ther. 2012;75(4):164–70.CrossRef

42.

Smith TO, Sackley CM. UK survey of occupational therapist’s and physiotherapist’s experiences and attitudes towards hip replacement precautions and equipment. BMC Musculoskelet Disord. 2016;17:228.PubMedPubMedCentralCrossRef

43.

Gromov K, et al. Removal of restrictions following primary THA with posterolateral approach does not increase the risk of early dislocation–reply. Acta Orthop. 2015;86(4):518–9.PubMedCrossRef

44.

van der Weegen W, et al. It is safe to use minimal restrictions following posterior approach total hip arthroplasty: results from a large cohort study. Hip Int. 2019;29(6):572–7.PubMedCrossRef

45.

Crompton, J., L. Osagie-Clouard, and A. Patel, Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthop. 2020;91(6):687–92. https://doi.org/10.1080/17453674.2020.1795598.

46.

The Norwegian National Advisory Unit on Arthroplasty and Hip Fractures publishes national annual reports. 2019. https://helse-bergen.no/nasjonal-kompetansetjeneste-for-leddproteser-og-hoftebrudd/norwegian-national-advisory-unit-on-arthroplasty-and-hip-fractures#:~:text=%E2%80%8BThe%20Norwegian%20Hip%20Fracture,treatment%20methods%20and%20patient%20care.

47.

The Norwegian National Advisory Unit on Arthroplasty and Hip Fractures publishes national annual reports. 2021. https://helse-bergen.no/nasjonal-kompetansetjeneste-for-leddproteser-og-hoftebrudd/norwegian-national-advisory-unit-on-arthroplasty-and-hip-fractures#:~:text=%E2%80%8BThe%20Norwegian%20Hip%20Fracture,treatment%20methods%20and%20patient%20care.

48.

The Swedish Knee Arthroplasty Register, Annual Report 2018. Malmö: Holmgrens; 2018. https://www.myknee.se/pdf/SVK_2018_Eng_1.0.pdf.

49.

Pronk Y, et al. What is the minimum response rate on patient-reported outcome measures needed to adequately evaluate total hip arthroplasties? Health Qual Life Outcomes. 2020;18(1):379.PubMedPubMedCentralCrossRef

50.

Streiner DL, Norman GR. Norman, Health Measurement Scales. 3rd ed. New York: Oxford University Press; 2003.

51.

Paulsen A, Harboe K, Dalen I. Data entry quality of double data entry vs automated form processing technologies: A cohort study validation of optical mark recognition and intelligent character recognition in a clinical setting. Health Sci Rep. 2020;3(4):e210.PubMedPubMedCentralCrossRef

Title: Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions
Authors: Aksel Paulsen
Ane Djuv
Jarle Ludvigsen
Ingvild Dalen
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05276-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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