Article

OBJECTIVE: To evaluate whether a further optimization of an existing accelerated
clinical pathway protocol after total knee replacement is feasible and improves
postoperative outcome. DESIGN: Prospective, parallel group design. SETTING:
Orthopaedic University Medical Centre. PATIENTS: A total of 143 patients,
scheduled for unilateral primary total knee replacement under perioperative
regional analgesia. INTERVENTION: Sixty-seven patients received an optimized
accelerated clinical pathway including patient-controlled regional analgesia
pumps, ultra-early/doubled physiotherapy and motor-driven continuous passive
motion machine units. Seventy-six patients received a standard accelerated
clinical pathway. MAIN MEASURES: Feasibility was defined as the proportion of
patients successfully completing the assigned pathway. Early postoperative pain
on a visual analogue scale, consumption of regional anaesthetics, knee range of
motion, time out of bed, non-stop walking distance/stair climbing, circumference
measurement and Knee Society Score on the operated leg. Possible discharge
according to an own discharge checklist. RESULTS: All patients assigned to both
groups successfully completed this pathway. Patients in the optimized pathway
showed significant benefits regarding stair climbing/walking distance/time out of
bed/circumference measurements of the thigh/Knee Society function score on the
fifth postoperative day and stair climbing/ circumference measurements of the
thigh on the eighth postoperative day, and reduction of the consumption of
regional anaesthetics. No significant reduction in length of stay was observed.
CONCLUSIONS: Early postoperative functional process indicators tended to be
higher within the optimized pathway group, but the main effects flattened over
the course of the first eight postoperative days.

Langue : ANGLAIS