Surgeons from the Cleveland Clinic in Ohio divided a group of total hip patients into two groups. One group 73 patients had the traditional post-operative treatment after hip replacement. The second group 30 patients tried a new rapid recovery program. The rapid recovery program combines several factors to enhance recovery. The abductor muscles are along the inside of the thigh and help bring the legs together.
Second, nurses supervise the use of pain medications. Pain management begins in the operating room where patients receive a special injection of numbing agents around the joint just operated on. And third, the patients are seen right away by physical therapists on the multidisciplinary team.
Uncontrolled postoperative pain has a more deleterious effect on the recovery of function than the length of the incision. The marketing claims made by proponents of minimally invasive surgery for THA have given misguided perceptions to the public regarding the current standard of care. It appears that pain control plays a much larger role in functional recovery than incision length.
Many advocates of minimally invasive surgery assert faster recovery and rehabilitation of their patients. Yet, the definition of minimally invasive surgery has not been accurately illustrated. In many cases, in our attempts at performing minimally invasive surgery, we end up with a minimal incision surgery instead, without minimizing trauma to the soft tissues, or in some cases with increased traumatic injury to the tissues.
The definition of minimally invasive surgery should entail a smaller incision with direct visualization and a modified technique. But we should not deviate from the classic surgical principles, which should include:. Adhering to these principles would enable us to ensure a faster rehabilitation program for our patients. Patient expectations and education preoperatively are important predictors of improved functional outcomes and satisfaction after THA.
In a study looking at preoperative rehabilitation advice reinforced by a patient information booklet, 35 patients were recruited and randomly allocated before admission to receive either the standard pathway of care or the rehabilitation program and booklet. In addition, patients attending the class reported higher levels of satisfaction at 3 months postoperatively and had more realistic expectations of surgery. In a similar study, the impact of a social work preadmission program on length of stay of orthopedic patients undergoing elective THA or total knee arthroplasty TKA was evaluated.
The social work interventions included preadmission psychosocial evaluation and preliminary discharge planning. Mean length of stay was reduced significantly in the intervention patient groups, as compared with the pre-intervention patient groups in the same hospital. They concluded that preadmission screening and case management by a social worker can contribute to the efforts to decrease length of stay of orthopedic patients by early multidisciplinary evaluations, discharge planning, and coordination of services.
Daltroy and coworkers, in another study, further illustrated that educational intervention reduced length of stay. Also found was a reduction in the use of pain medication for patients who exhibited most denial and reduced postoperative anxiety. The preoperative nutritional state of the patient has an immense impact on wound healing postoperatively. In addition, it has a predictive role in morbidity and length of hospital stay. Accordingly, special attention should be made to this aspect of patient care.
Del Savio and associates sought to identify preoperative nutritional factors that could be used to define a subgroup of patients undergoing elective THA who are at high risk for poor postoperative outcome. They found an inverse relationship between serum albumin value and length of hospital stay.
Patients with an albumin level less than 3. They concluded that preoperative malnutrition appears to be associated with the in-hospital postoperative recovery but unrelated to long-term recovery. Conversely, Gherini and colleagues found that preoperative serum transferrin levels showed significant value in predicting which patients would have delayed wound healing.
However, there is a paucity of data available for modern general anesthesia GA regimens used at high-volume joint replacement centers. Methods: We retrospectively reviewed a series of consecutive primary TJAs total hip arthroplasties and total knee arthroplasties performed over a 3-year span at a single institution that uses a contemporary GA protocol and report on the length of stay, early recovery rates, perioperative complications, and readmissions.
All rights reserved. Abstract Fast-track surgery, or enhanced recovery, has appeared in the last 20 years or so as a combination of the optimisation of clinical protocols and organisational processes, pursuing the reduction in surgical stress with the aim of reducing peri-operative comorbidities, convalescence time, and functional recovery, resulting in a reduction in admission time.
Publication types Review.
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