Summary
Accelerated rehabilitation program should be the default post-operative course after TKA.
Abstract
Introduction
The optimal course of post-operative rehabilitation after total knee arthroplasty (TKA) is debated. Accelerated processes have been developed in order to facilitate the rehabilitation, to shorten the duration of hospital stay and to improve the final functional result. However, the exact indication and limits are not clearly defined. The goal of this study was to assess the indication, limits and possible difficulties of accelerated rehabilitation programs in a multicentric analysis at a nationwide level.
Methods
A prospective, observational study was conducted at a national level. All participating centers were selected on a voluntary basis. All centers had previously implemented an accelerated rehabilitation program, and no attempt was made to change this program for the purpose of the study. The selection criteria for participating to an accelerated rehabilitation program were early deambulation (<24h) and home discharge.
All patients undergoing TKA in the participating centers between October 2016 and October 2017 were eligible for this study. Patients operated for unilateral primary TKA with an accelerated rehabilitation program were selected. Usual demographic and peri-operative items have been recorded. All patients were contacted after 1 year for repeat clinical and radiological examination (KSS, Oxford knee questionnaire and knee plain X-rays). Patients who did not return were interviewed by phone call. For patients lost of follow-up, family or general practitioner was contacted to obtain relevant information. Attention was paid to collect all clinically relevant difficulties and all complication, especially those related to the accelerated rehabilitation program.
Results
839 patients were included: 314 men and 525 women, with an average age of 70 ± 10 years, and an average body mass index of 30 ± 6 kg/m². Patients not entering the accelerated rehabilitation program after surgery were mainly people who were living alone at home. Mean length of stay was 4.4 days for all cases, and 566 patients (67%) were discharge home after a mean length of stay of 3.9 days. No complications related to the short length of stay was observed. 22 patients (3%) needed a phone call following discharge. 33 patients (4%) had an early repeat hospitalization. 29 patients (3%) were reoperated. A significant improvement was observed for both KSS and Oxford knee questionnaire between baseline and the 3 months follow-up. Mean KSS increased from 107 to 178 points. Mean Oxford knee questionnaire score increased from 36 to 51 points.
No difference was observed between the rehabilitation of the different centers. No difference was observed between teaching hospitals and general hospitals. No difference was observed between centers according to the number of procedures. No difference was observed between centers located in big urban regions and more rural centers.
Discussion
Accelerated rehabilitation program was easily implemented and used in all centers and widely accepted by patients. No specific complication was observed. Accelerated rehabilitation program should be the default post-operative course after TKA.