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. 2018 Jan 10;7(3):504-513.
doi: 10.11138/mltj/2017.7.3.504. eCollection 2017 Jul-Sep.

Clinical evidence of traditional vs fast track recovery methodologies after total arthroplasty for osteoarthritic knee treatment. A retrospective observational study

Sergio Castorina  1   2 , Claudia Guglielmino  1   2 , Paola Castrogiovanni  2 , Marta Anna Szychlinska  2 , Francesco Ioppolo  1 , Paolo Massimino  1 , Pietro Leonardi  1 , Christian Maci  1 , Maurizio Iannuzzi  1 , Angelo Di Giunta  1 , Giuseppe Musumeci  2
Affiliations

Clinical evidence of traditional vs fast track recovery methodologies after total arthroplasty for osteoarthritic knee treatment. A retrospective observational study

Sergio Castorina et al. Muscles Ligaments Tendons J. .

Abstract

Background: During the last years, programs to enhance postoperative recovery and decrease morbidity after total knee arthroplasty, have been developed across a variety of surgical procedures and referred to as "Fast-Track Surgery". In this study we aimed to find some answers in the management of osteoarthritic patients subjected to total knee arthroplasty, by using the Fast-Track methodology. To this purpose we evaluated parameters such as early mobilization of patients, better pain management, bleeding, possible complications, reduced hospitalization time, an overall improved recovery and patient satisfaction.

Methods: 132 patients were selected, of which, 95 treated with "Fast Track" method and 37 treated with traditional method (control group). All the patients were hospitalized and underwent the same rehabilitation program for the first three days after surgery.

Results: In both groups, the parameters of pain and deformity demonstrated the most rapid improvement, while those of function and movement were normalized as gradual and progressive improvement over the next 2 months. The different functional test used (Barthel, MRC, VAS) showed that the mean values were significantly greater in Fast Track group when compared to the control.

Conclusion: The results of the study confirm that the application of the Fast Track protocol in orthopaedics after total knee replacement results in rapid post-surgery recovery.

Level of evidence: IV. Case series, low-quality cohort or case-control studies.

Keywords: Barthel Test; VAS score; fast track methodology; knee joint; osteoarthritis; total knee arthroplasty.

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Conflict of interest statement

Conflict of interest The Authors declare that they do not have any conflict of interest.

Figures

Figure 1 A, B
Figure 1 A, B
A) Total knee arthroplasty; B) Tranexamic acid and chirocaina injection through the capsula.
Figure 2 A–C
Figure 2 A–C
A) Advanced colloid patch; B) Knee bent at 90 degrees on a triangular pillow, frontal view; C) Knee bent at 90 degrees on a triangular pillow, lateral view.
Figure 3 A–D
Figure 3 A–D
A) 6 hours post operative (post op), extended knee; B) 6 hours post op, active flexion of the knee at 40°; C) Day 3 post op: go up of the stairs; D) Day 3 post op: go down of the stairs.
Figure 4 A, B
Figure 4 A, B
Chart of P-ROM and A-ROM: A) Statistical analysis showed that the Fast Track P-ROM was very significantly greater than the No Fast Track P-ROM (p<0.01); B) Statistical analysis showed the Fast Track A-ROM was very significantly greater than the No Fast Track A-ROM (p<0.01). The Fast Track group showed a better ROM performance of ROMs.
Figure 5
Figure 5
Chart of the Barthel Index: the difference between initial and final Barthel Index between the two groups (Fast Track and No Fast Track) is significant (p<0.01). However, the difference between final Barthel Index for the Fast Track and the No Fast Track is not significant (p>0.05).
Figure 6
Figure 6
Chart of the MRC test: The difference between the mean values of the Fast Track and the No Fast Track groups is significant (p<0.01). Both groups achieve a mean value greater than grade 3 (active movement against gravity), while the Fast Track group shows a better result.
Figure 7
Figure 7
Chart of the VAS pain test: The difference between the means values of the Fast Track and No Fast Track groups is significant (p<0.01). Both groups do not achieve a high level of VAS but the Fast Track group shows a lower pain level compared with the No Fast Track group.
See this image and copyright information in PMC

References

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