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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2017

01-09-2017 | Knee

Outpatient surgery for unicompartmental knee arthroplasty is effective and safe

Authors: Nanne P. Kort, Yoeri F. L. Bemelmans, Martijn G. M. Schotanus

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2017

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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.
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Metadata
Title
Outpatient surgery for unicompartmental knee arthroplasty is effective and safe
Authors
Nanne P. Kort
Yoeri F. L. Bemelmans
Martijn G. M. Schotanus
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3680-y

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