Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr;32(4):963-977.
doi: 10.1002/ksa.12122. Epub 2024 Mar 10.

Optimised fast-track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

Riccardo Compagnoni  1   2 , Francesco Puglia  3 , Mauro Magnani  4 , Raymond Klumpp  5 , Paolo Ferrua  1 , Filippo Calanna  1 , Carlo Francesco Minoli  6 , Daniele Genco  7 , Alessandra Menon  1   8   9 , Pietro Simone Randelli  1   8   10 ; SIAGASCOT Guidelines Working Group
Collaborators, Affiliations

Optimised fast-track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

Riccardo Compagnoni et al. Knee Surg Sports Traumatol Arthrosc. 2024 Apr.

Abstract

Purpose: This literature review aims to present evidence-based clinical recommendations for the eight most debated topics related to perioperative management in total knee arthroplasty: counselling, prehabilitation, transfusion risk, tranexamic acid, drainage, analgesia, urinary catheter and compression stockings.

Methods: A multidisciplinary team conducted a systematic review on these topics. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the literature review and result presentation. The research encompassed articles from 1 January 2009 to 28 February 2023, retrieved through the MEDLINE database via PubMed, Embase database and Cochrane Library.

Results: Forty-five articles were selected. Preoperative counselling has limited evidence for its impact on postoperative outcomes; yet, it can help alleviate surgery-related anxiety and manage postoperative symptoms. Prehabilitation can also prepare patients for surgery, reducing hospital stays and improving postsurgery functionality. Numerous studies suggest that preoperative Hb levels are independently linked to transfusion risk, with a recommended level of 13 g/dL. Combining intravenous and local tranexamic acid administration is strongly advised to reduce perioperative blood loss, while drainage after primary total knee arthroplasty offers no functional advantages. Employing a multimodal analgesia approach yields better results with reduced opioid usage. Indwelling urinary catheters provide no benefit and avoiding them can lower the risk of urinary tract infections. As for compression stockings, there is insufficient evidence in the literature to support their efficacy in preventing venous thromboembolism.

Conclusion: The best-track protocol has demonstrated its efficacy in reducing hospitalisation time and perioperative/postoperative complications. It is success relies on a collaborative, resource-adaptive approach led by a multidisciplinary team. Both patients and hospitals benefit from this approach, as it enhances care quality and lowers costs. Several studies have highlighted the significance of a patient-centred approach in achieving high-quality care. Creating a novel treatment protocol could be a prospective goal in the near future.

Level of evidence: Level III.

Keywords: complications; drainage; fast track; prehabilitation; total knee arthroplasty; tranexamic acid.

PubMed Disclaimer

References

REFERENCES

    1. Akaravinek P, Kampitak W, Tanavalee A, Ngarmukos S, Tanavalee C, Limsakul K. effect of adding perineural methylprednisolone to peripheral nerve blocks combined with intravenous dexamethasone for prolonged postdischarge analgesia after fast‐track total knee arthroplasty: a randomized controlled trial. Clin J Pain. 2023;39(4):180–187. https://doi.org/10.1097/AJP.0000000000001098
    1. Andersen KV, Nikolajsen L, Haraldsted V, Odgaard A, Søballe K. Local infiltration analgesia for total knee arthroplasty: should ketorolac be added? Br J Anaesth. 2013;111(2):242–248. https://doi.org/10.1093/bja/aet030
    1. Basora M, Tió M, Martin N, Lozano L, Salazar F, Sánchez‐Etayo G, et al. Should all patients be optimized to the same preoperative hemoglobin level to avoid transfusion in primary knee arthroplasty? Vox Sang. 2014;107(2):148–152. https://doi.org/10.1111/vox.12147
    1. Biehl M, Wild L, Waldman K, Haq F, Easteal RA, Sawhney M. The safety and efficacy of the IPACK block in primary total knee arthroplasty: a retrospective chart review. Can J Anesth. 2020;67(9):1271–1273. https://doi.org/10.1007/s12630-020-01652-1
    1. Bjerregaard LS, Homilius M, Bagi P, Hansen TB, Kehlet H. Indwelling urinary catheterisation may increase risk of complications in hip and knee arthroplasty. Dan Med J. 2019;66(4):A5538.

Publication types

MeSH terms

Grants and funding